Musculoskeletal Trauma/Test 4 Flashcards
Musculoskeletal Trauma Definition:
a complete or partial interruption of osseous tissue
Musculoskeletal Trauma usually occurs….
as a result of a blow to the body, a fall or accident.
Musculoskeletal incidence is highest among
15-30 year olds and women over 65 (osteoporosis)
Humerus fractures are
common among young and middle aged adults
- elderly d/t neuromuscular instability
- People in high risk occupations
- Disease processes; cancer renal failure, chronic degenerative disease
Stable trauma:
aligned
Unstable trauma:
displaced
Diagnostic tests:
Xray
MRI
CT Scan
Pt history indicates…
a mechanism of injury associated with:
- Immediate localized pain
- decreased function
- Inability to bear weight or used affected part
- guarding
- may or may not be accompanied by obvious bone deformity.
- excessive motion
- crepitus (do not attempt to elicit this sign)
- soft tissue edema
- inflammatory changes
- ecchymosis
- sensory changes
Process of Bone Healing:
Immobilization and proper re-allignment of bone fragments must occur
Factors that impede bone healing:
- Age-hormones
- Medications- steroids, anticoagulants
- Metabolic disorders or diseases-diabetes, cancer, malnutrition, immunodeficiency, osteoporosis
- inadequate blood supply
- site and extent or soft tissue injury
- Infection
- Excess motion of the fracture fragments
- Excessive edema at the tx site
- Bone necrosis
Peripheral Neurovascular Assessment Neuro:
- Sensation
- Movement
- pain
- paresthesia
- paresis/palsy
Peripheral Neurovascular Assessment Vascular:
- Color
- Temperature
- Edema
- Capillary refill
- Peripheral pulse
Physiological splintage
*Guarding, muscle spasm, and avoidance of use
External orthopedic splinting
*Casts, plaster splints, and braces
Internal fixation:
*Screws, plates or rods to hold opposing ends together
Fracture reduction: Closed reduction-
- Manual manipulation (non-surgical)
* Casting, external fixation, splint, braces to immobilize for healing
Fracture reduction: Open reduction-
- May use plates, screws, pins
* ORIF- Open reduction with internal fixation for joints
Fracture reduction can be a combination of:
Closed and open reduction
Objectives for treatment:
- reduce the fracture by realigning the fracture fragments
- Maintain the fragments in correct alignment by immobilization
- Restore function and prevent excessive loss of joint mobility
Traction:
Temporary immobilization to reduce bone fracture. -prevent/reduce muscle spasm-immobilize a joint or part of the body-reduce a fracture or dislocation-treat a joint pathologic condition.(Hip, femur, knee, back), correct alignment and prevent further soft tissue damage. Can provide some relief from pain and muscle spasms.
Complications of traction: Skin
- Pressure over bony sites cause breakdown.
* Persistent skin pressure can cause peripheral neuro vascular injury
Buck’s tx:
Simple form provides pull on the affected limb
Russell traction:
Allows some movement. Permits flexion of the knee joint. Used for fx of the femur when surgery is contraindicated
Skin traction is _____ pounds
7-10 Buck's Russell's Bryant's (children) Pelvic belt Head halter
Skeletal Tractions:
- Overhead arm (90-90)
- Lateral arm
- balanced suspension
The purpose of trochanter rolls:
is to maintain alignment while in bed
Reduction
realignment of bone fractures
Fixation-
immobilization of fragment sites
Casts are:
fiberglass or plaster
Types of casts:
- sugar-tong splint
- posterior splint
- short arm cast
- long arm cast
- body jacket cast(cast syndrome-abd pain, pressure, n/v)
- hip spica
- long leg cast
- short leg cast
- cylinder cast
Jones dressing:
bulky padding material, splint, ace wrap or bia cut stockinette
Internal Fixation: ORIF
- preferred method to manage a femoral fracture
- pins, plates and screws
- surgically inserted at the time of realignment
- stainless steel, titanium
External fixation:
- metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize fracture.
- Can be used alone or in conjunction with plaster
- Provides extremely rigid fixation.
- Alignment evaluated by x-ray
Common Drug Therapy: Tetanus
*If fracture is open
Drug therapy: Antibiotics
- Bone penetrating
- cefazolin (Ancef, Kefzol)
- Preventive measure
Drug therapy: Analgesics
Treatment for pain
Drug therapy: Skeletal Muscle Relaxant
- Soma (Carisoprodol)
- Flexeril (cyclobenzaprine)
- Robaxin (methocarbamol)
Drug Therapy:
- Antibiotics
- Analgesics
- Skeletal muscle relaxant
Hip Fracture d/t advanced age:
- Elderly prone to falls
- d/t neuromuscular instability
- Inability to correct postural imbalance
- Inadequacy of local tissue shock absorbers
- Underlying skeletal strength
- Bone remodeling is altered
- Muscle mass and strength decrease
- Loss of motors neurons
- Tendons and ligaments less flexible
Hip Fracture misc risk factors:
- osteoporosis
- female
- caucasian
- decreased estrogen
- prior hip fractions
- alzheimer disease
- residing in institution
- sedentary lifestyle
- inadequate calcium and vit D
- excessive intake of protein
- caffeine intake
- smoking
- use of ETOH
- psychotropic drugs
Classification of hip fractures:
- Intracapsular (femoral neck)
- Extracapsular fracture (intertrochanteric)
- Subtronchanteric fracture
Intracapsular (femoral neck) hip fracture:
- Occurs within the hip joint and capsule
- Can disrupt blood supply
- R/F nonunion and avascular necrosis
Extracapsular hip fracture (intertochanteric):
- Occurs outside the hip joint below to an area (2 inches) of the lesser trochanter
- Complications: malunion and shortening of the affected extremity.
Subtronchanteric hip fracture:
*below the lesser trochanter
S/S of a hip fracture:
- Severe pain at the fracture sight
- Inability to move leg voluntarily
- Shortening and external rotation of leg
- Other s/s consistent with those of any fracture
Hip Fracture surgical management:
- Reduction and stabilization of fracture
- Insertion of an internal fixation device (ORIF)
- pin, screw, nail, plates
- Occasionally may replace hip joint (hip arthroplasty)
