Topic 10: Fractures & Soft Tissue Injuries

Question 1

sprain

Answer 1

an injury to the ligaments surrounding a joint

Question 2

first-degree sprain

Answer 2

(mild) involves tears in only a few fibers, with mild tenderness and minimal swelling

Question 3

second-degree sprain

Answer 3

(moderate) sprain results in partial disruption of the involved tissue with more swelling and tenderness

Question 4

third-degree sprain

Answer 4

(severe) sprain is a complete tear of the ligament with moderate to severe swelling.

Question 5

strain

Answer 5

an excessive stretching of a muscle and its fascial sheath, often involving the tendon

Question 6

classification of strains

Answer 6

first-degree (mild or slightly pulled muscle)
second-degree (moderate or moderately torn muscle)
third-degree (severely torn or ruptured muscle)

Question 7

s/s of strains/sprains

Answer 7

Pain, edema, decreased function, and bruising
Continued use of the joint, tendon, or ligament makes pain worse
Edema develops in the injured area because of the local inflammatory response

Question 8

avulsion fracture

Answer 8

can be caused by a severe sprain; in which the ligament pulls loose fragment of bone – leading to subluxation or dislocation

Question 9

hemarthrosis

Answer 9

bleeding into a joint space or cavity

Question 10

impingement syndrome

Answer 10

Entrapment of soft tissues and nerves under coracoacromial arch of shoulder

Question 11

acute care

Answer 11

(1) stopping the activity and limiting movement to the injured part, (2) applying ice packs to the injured area, (3) compressing the involved area, (4) elevating the extremity, and (5) providing analgesia as needed

Question 12

RICE

Answer 12

(Rest, Ice, Compression, Elevation) may decrease local inflammation and pain for most musculoskeletal injuries.

Question 13

dislocation

Answer 13

complete displacement or separation of the articular surfaces of the joint.

Question 14

Subluxation

Answer 14

partial or incomplete displacement of the joint surface

Question 15

the longer the joint is dislocated, the greater the risk for…

Answer 15

avascular necrosis

Question 16

closed reduction

Answer 16

no incision (for dislocation realignment)

Question 17

open reduction

Answer 17

surgical realignment of joint

Question 18

Repetitive strain injury (RSI)

Answer 18

(cumulative trauma disorder) terms used to describe injuries resulting from prolonged force or repetitive movements and awkward postures

Question 19

fracture

Answer 19

break in the continuity of bone

Question 20

open vs closed fracture

Answer 20

open = skin break, bone exposed
closed = skin intact

Question 21

complete vs incomplete fracture

Answer 21

complete = if break goes completely through bone
incomplete = not all the way; often result of bending or crushing

Question 22

displaced vs nondisplaced fracture

Answer 22

displaced = 2 ends of broken bone are separated and apart from normal pos. (often comminuted/oblique)
nondisplaced = bone fragments in alignment (transverse, spiral, greenstick)

Question 23

greenstick

Answer 23

incomplete fracture with 1-side splintered

Question 24

comminuted

Answer 24

fracture with more than 2 fragments. The smaller fragments appear to be floating

Question 25

6 stages of fracture healing

Answer 25

(A) Bleeding at fractured ends of the bone with hematoma formation.
(B) Organization of hematoma into fibrous network.
(C) Invasion of osteoblasts, lengthening of collagen strands, and deposition of calcium.
(D) Callus formation: new bone is built up as osteoclasts destroy dead bone.
(E) Remodeling is accomplished as excess callus is resorbed and trabecular bone is laid down.

Question 26

traction

Answer 26

the application of a pulling force to an injured or diseased body part or extremity
used to:
(1) prevent or reduce pain and muscle spasm (e.g., whiplash, unrepaired hip fracture),
(2) immobilize a joint or part of the body,
(3) reduce a fracture or dislocation
(4) treat a pathologic joint condition (e.g., tumor, infection)

Question 27

skin traction

Answer 27

used for short-term treatment (48 to 72 hours) until skeletal traction or surgery is possible.

Question 28

Buck’s traction

Answer 28

type of skin traction sometimes used for the patient with a hip, knee, or femur fracture

Question 29

skeletal traction

Answer 29

to align injured bones and joints or to treat joint contractures and congenital hip dysplasia

Question 30

balanced suspension traction

Answer 30

A common type of skeletal traction

Question 31

superior mesenteric artery syndrome (cast syndrome)

Answer 31

occurs if the brace is too tight, compressing the superior mesenteric artery against the duodenum
s/s: abdominal pain, abdominal pressure, nausea, and vomiting

Question 32

degrees of weight-bearing

Answer 32

(1) non–weight-bearing (no weight on the involved extremity)
(2) touch-down/toe-touch weight-bearing (contact with floor for balance but no weight borne)
(3) partial–weight-bearing ambulation (25% to 50% of weight borne)
(4) weight-bearing as tolerated (based on pain and tolerance)
(5) full–weight-bearing ambulation (no limitations).

Question 33

compartment syndrome

Answer 33

swelling causes increased pressure within a limited space (similar to osteomyelitis) that compromises the function of blood vessels and nerves

Question 34

Ischemia can occur within…

Answer 34

4 to 8 hours after the onset of compartment syndrome.

Question 35

6 P’s of compartment syndrome

Answer 35

pain
pressure
paresthesia
pallor
paralysis
pulselessness

Question 36

early vs late signs of compartment syndrome

Answer 36

. Pain unrelieved by drugs and out of proportion to the level of injury is one of the FIRST signs
Paresthesia is also early

Pulselessness & Paralysis are LATE
prolonged ischemia = possible amputation

Question 37

fasciotomy

Answer 37

(surgical decompression) surgical site is left open for several days to allow adequate soft tissue decompression

Question 38

with suspected compartment syndrome, DO NOT…

Answer 38

elevate above heart
ice/cold compress

Question 39

VTE

Answer 39

(Venous Thromboembolism)
Veins of the lower extremities and pelvis are at great risk for clot (thrombus) formation after a fracture

Question 40

prophylactic anticoagulants are given…

Answer 40

for at least 10-14 days
- warfarin
- LMWH (low molecular weight heparin) = enoxaparin
- aspirin
- factor Xa inhibitor = apixaban

Question 41

FES

Answer 41

(Fat Embolism Syndrome)
-fat globules entering the circulatory system from fractures
-fractures most often associated with FES are those of the long bones, ribs, tibia, and pelvis

Question 42

FES patho

Answer 42

fat emboli originate from fat released from the marrow of injured bone. The fat enters systemic circulation, where it travels to other organs. As fat droplets become stuck in small blood vessels, local ischemia and inflammation occur

Question 43

s/s FES

Answer 43

most patients have s/s within 24-48hrs post-injury
ARDS = chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and hypoxemia (Changes in LOC)

Question 44

diagnostics for FES

Answer 44

No specific labs for diagnosis
objective data: acute and rapid
skin color from pallor to cyanosis
comatose
fat cells in blood, urine, sputum
dec. O2 <60
dec. platelet ct. & hematocrit
high ESR
chest x-ray = bilateral pulmonary infiltrates

Question 45

Tx FES

Answer 45

• airway and O2 priority
• cardio managed w/ IV fluids, pulmonary vasodilators, peripheral vasoconstrictors, and inotropic drugs
• Preventing FES is important. Careful immobilization and handling of a long bone fracture are the most important factors in preventing FES

Question 46

Rhabdomyolysis

Answer 46

caused by the breakdown of damaged skeletal muscle cells

Question 47

s/s of rhabdo.

Answer 47

dark reddish urine & symptoms of AKI (acute kidney injury)

Question 48

Colles fracture

Answer 48

distal radius = most common types of fractures in adults
occurs when the patient falls on an outstretched arm
- occurs in patients over 50 years old whose bones are osteoporotic; if a younger person presents with Colles Fracture refer for osteoporotic eval.