Topic 10: Fractures & Soft Tissue Injuries Flashcards
sprain
an injury to the ligaments surrounding a joint
first-degree sprain
(mild) involves tears in only a few fibers, with mild tenderness and minimal swelling
second-degree sprain
(moderate) sprain results in partial disruption of the involved tissue with more swelling and tenderness
third-degree sprain
(severe) sprain is a complete tear of the ligament with moderate to severe swelling.
strain
an excessive stretching of a muscle and its fascial sheath, often involving the tendon
classification of strains
first-degree (mild or slightly pulled muscle)
second-degree (moderate or moderately torn muscle)
third-degree (severely torn or ruptured muscle)
s/s of strains/sprains
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
avulsion fracture
can be caused by a severe sprain; in which the ligament pulls loose fragment of bone – leading to subluxation or dislocation
hemarthrosis
bleeding into a joint space or cavity
impingement syndrome
Entrapment of soft tissues and nerves under coracoacromial arch of shoulder
acute care
(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
RICE
(Rest, Ice, Compression, Elevation) may decrease local inflammation and pain for most musculoskeletal injuries.
dislocation
complete displacement or separation of the articular surfaces of the joint.
Subluxation
partial or incomplete displacement of the joint surface
the longer the joint is dislocated, the greater the risk for…
avascular necrosis
closed reduction
no incision (for dislocation realignment)
open reduction
surgical realignment of joint
Repetitive strain injury (RSI)
(cumulative trauma disorder) terms used to describe injuries resulting from prolonged force or repetitive movements and awkward postures
fracture
break in the continuity of bone
open vs closed fracture
open = skin break, bone exposed
closed = skin intact
complete vs incomplete fracture
complete = if break goes completely through bone
incomplete = not all the way; often result of bending or crushing
displaced vs nondisplaced fracture
displaced = 2 ends of broken bone are separated and apart from normal pos. (often comminuted/oblique)
nondisplaced = bone fragments in alignment (transverse, spiral, greenstick)
greenstick
incomplete fracture with 1-side splintered
comminuted
fracture with more than 2 fragments. The smaller fragments appear to be floating
6 stages of fracture healing
(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.
traction
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)
skin traction
used for short-term treatment (48 to 72 hours) until skeletal traction or surgery is possible.
Buck’s traction
type of skin traction sometimes used for the patient with a hip, knee, or femur fracture
skeletal traction
to align injured bones and joints or to treat joint contractures and congenital hip dysplasia
balanced suspension traction
A common type of skeletal traction
superior mesenteric artery syndrome (cast syndrome)
occurs if the brace is too tight, compressing the superior mesenteric artery against the duodenum
s/s: abdominal pain, abdominal pressure, nausea, and vomiting
degrees of weight-bearing
(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).
compartment syndrome
swelling causes increased pressure within a limited space (similar to osteomyelitis) that compromises the function of blood vessels and nerves
Ischemia can occur within…
4 to 8 hours after the onset of compartment syndrome.
6 P’s of compartment syndrome
pain
pressure
paresthesia
pallor
paralysis
pulselessness
early vs late signs of compartment syndrome
. 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
fasciotomy
(surgical decompression) surgical site is left open for several days to allow adequate soft tissue decompression
with suspected compartment syndrome, DO NOT…
elevate above heart
ice/cold compress
VTE
(Venous Thromboembolism)
Veins of the lower extremities and pelvis are at great risk for clot (thrombus) formation after a fracture
prophylactic anticoagulants are given…
for at least 10-14 days
- warfarin
- LMWH (low molecular weight heparin) = enoxaparin
- aspirin
- factor Xa inhibitor = apixaban
FES
(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
FES patho
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
s/s FES
most patients have s/s within 24-48hrs post-injury
ARDS = chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, and hypoxemia (Changes in LOC)
diagnostics for FES
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
Tx FES
- 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
Rhabdomyolysis
caused by the breakdown of damaged skeletal muscle cells
s/s of rhabdo.
dark reddish urine & symptoms of AKI (acute kidney injury)
Colles fracture
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.
