Unit 2 -MSK Flashcards
Fracture
disruption or break of the structure of a bone. When force is greater then bone strength.
Classification of a fracture depend on
What bone, where, how many fragments, what direction.
Open or closed, complete or incomplete, direct, displaced or not
Open fracture
open breaks through the skin (highest risk for infection)
Closed fracture
The bone breaks but it does not go through the skin
Displaced fracture
The bone breaks and both ends are no longer straight (no longer togther, separated)
Non-displaced fracture
The fracture is in one spot and the bone is still straight
complete break
all the way through the bone
incomplete break
only through part of the bone
Directions a bone can be broken
linear, oblique, transverse, longitudinal, spiral, greenstick, comminuted, pathological, stress
What is a stress fracture
often runners will get this, this happens in small bones that are having to much stress put on them
when do people typically get spiral fractures
from a fall, sport, twist, trauma, accident
transverse fracture
across the shaft
spiral fracture
direction down the shaft
greenstick fracture
incomplete one side is splintered, the other is just bent
Comminuted fracture
more then the 2 bone peices anywhere from 3 fragaments usually displaces
Oblique fracture
angled down the bone
Pathological fracture
spontaneous, due to bone disease
conditions that can cause a fracture
OA, RA, Osteoporosis, osteomyleitis
Symptoms
immediate pain, immobility, unable to weight bare
what if the bone is not stable during the healing process
likely to shorten, angulate or roate before healing and lead to poor function in long term
SEADS stands for
S: swelling E: erythema A: Atrophy D: deformities S: skin change
Assess for
edema, pain, muscle spasm, deformity, level of fluid loss, crepitation, warmth
PIPS stands for
postion, inspect, palpate specail test
CSM checks
Circulation, sensation, motion/movement
How to assess for circulation
colour, temp, cap refill (BILAT)
how to assess for sensation
Ask the casualty if there is any numbness, tingling, pins and needles, or pain at the end of the injured limb. Pain or lack of sensation could indicate a damaged nerve
how to assess movement
range of movement at injury site, loss can indicate damaged nerve
Diagnostic studies for fractures
radiology, Bone Mineral Density, Endoscopy, Mineral metabolism, serological studies, Electromyogram
Lab tests for fractures
ALP (liver and bone, usually elevated), Calcium, ionized calcium, phaspahet, magesium (osteoblast degeneration), ESR (specific inflammation), CRP (Non specific degeneration), RF (arthritis)
Closed reduction
Nonsurgical realignment of the bones to restore and keep length. The bone is immobilized until it can heal.
What is closed reduction followed by
Traction, cast, splint, external fixation, brace
Cast
plaster or fibreglass, keep the broken ends in proper position while they heal
Brace
Allow limited or controlled movement of nearby joints
Traction
used to align a bone or bones by a gentle, steady weighted pulling action
External fixation
metal pins or screws are placed into the broken bone above and below the fracture site. The pins or screws are connected to a metal bar outside the skin, a stabilzing frame that holds the bones in the proper position while they heal
Open reduction orif
Surgical, internal fixation to stabilize
-wire, screw, pins, plates, rods, nails
Electrical bone growth stimulation
enhance healing of fractures
teaching for fractures
cast care, pin care, pain control, nutrition, S/S infection. post op care, fluid/mobility/physio
Complication for fracture
Compartment syndrome, DVT, PE, Fat embolism syndrome, infection, decreased union
Fascia
layers of connective tissue with intermeshed fibres limites ability to stretch. The fibrous tissue that surounds muscle, nerves and blood vessels. Seperates the muscles. Inside is a confined space (a compartment)
Patho of Compartment syndrome
Swelling, vascular insufficiency, nerve/muscle compression, irreversible damage within 4-6 hours
Compartment syndrome assessment
unrelieved and unexplained pain in limb, distal tissue becomes pale, dusk, or edematous. Pulselessness and loss of sensation.
Intervention for compartment syndrome
Medical emergency!!!!
Cause of compartment syndrome
Crush injury, burns, tight bandages, prolonged compression of a limb during a period of unconsciousness, surgery to blood vessels of an arm or leg, Casta, extremely vigourous movement (extension under pressure)
6 P’s
Pain, Paresthsia, poikilothermic, pallor, paralysis, pulses
Pain
disproportionatae pain at site/distal, aggravted by a passive movement, unrelieved by medication
Paresthesia
numbness and tingling
Poikilothermia
Decreased temp of affected extremities
pallor
abnormal color
Paralysis
late, loss of function
Pulses
loss of pulse, rare, an intact pulse indicates an adequate blood supplu to the extremity, but compartment syndrome may be present
What to do for compartment syndrome
remove any ice, lower the leg if elevated, release any constricting cast/tensor, call the physician!!!
What to do if someone has compartment syndrome
fasciotomy
Virchows Triad
Stasis, vessel wall injury, hyper coagulation
DVT pathogen
RBC, WBC, platelets, and fibrin adhere to venous wall forming a clot causing venous distention congestion
assessment for DVT
warmth, edema, redness, and or tenderness, difference bilaterally
Intervention for DVT
anticoagnulantion, bedrest
prevention of DVT
Prophylactic, anticoagulant, pneaumatic stocking
Fat embolism pathogen
small and multiple fat globules from the bone marrow are released into circulation. Multiple trauma
Assessment for fat embolism
Symptoms specific to target organ affected. Restlessness or mental staus changes, dyspnea, tachypnea, hypoxemia, tachycardia, and hypotension
Intervention for fat embolism
medical emergency, ABC, Supportive
Prevention of a fat embolism
early atbalization of fracture
Patho of infection (osteomyelitis)
Intro of organism into bones
Assessment of osteomyelitis
febrile, tachycardia, erythema, leukocytes
intervention for osteomyelitis
Long term IV antibiotics, internal hardware may have tp be removed, untreated may result in amputation
Delayed union
fracture has not healed within expected time frame
Malunion
healing of the bone in unacceptable position
Nonunion
fracture with no possible chance of healing with current treatment
depressed skull fracture
Bone framents forced below their normal level
Impacted fracture
boen driven into bone with pressure
Avulsion fracture
fragements of bone connected to a ligament breaks off from the rest of the bone
Compression fracture
common in spine from too much force of pressure
Colle’s fracture
Hyperextension injury, usually due to a fall, common in wrist
Diagnositc for soft tissue injury
special test, xray, CT, MRI, Physical assessment
The soft tissue mantra
- remove any clothing
- RICE (Rest ice compress elevate)
- NSAIDs
Sprain
Injury to joint and its ligament
Strain
Injury to muscle and its tendon (torn muscle)
Presentation of a sprain
pain, swelling
Grade 1 sprain
few fibres tear
Grade 2 sprain
Partial tearing of a ligament
Grade 3 sprain
complete tear of a ligament usually have a cast or a boot
Presentation of a strain
Pain and spasm in foot/leg/back no deformity, no neuro deficit, decreased ROM
Treatment for a strain
Mantra, NSAID/muscle relaxant, massage, therapy, CT/MRI to see if surgery is needed
Subluxation
partial or complete diplacement of a joint
Dislocation
injury to a ligament/joint that causes complete displacement of a bone
shoulder dislocation
anterior displacement of the humeral head
Complications of shoulder dislocation
avascular necrosis (damage to the arteries), reccurent dislocation
Assess, do, teach shoulder dislocation
Assess: SEADS, mech of injury, ROM, Pain
Do: Anticipate, specail test, X ray, advocate, assist with shoulder immobilization
Teach: Immobilizer, activity restriction, pain management,
Carpal tunnel syndrome
Peripheral compressive neuropathy, compression of the median nerve. Continuum from mild to moderate numbness, tingling, or burning sensation in the thumbs and fingers PALM SIDE OF THE HAND
(wrist falls down preventing blood flow) NERVE COMPRESSION
treatment for carpal tunnel
SPlinting, steroids, activity modification, PT, SX
Assessment for carpal tunnel
expose hands and forearms, shoulders related, elbows 90 degrees, compare bilateral, skin bursing, hair, pallor, rash, laceration, nails: clubbing, inf, leukonychia, swelling, deformities
Carpal tunnel teaching
Do not lift heavy, do not drive on pain meds, keep hand elevated as much as you can, excises
what puts someone at risk for carpal tunnel
repetitive motions
Presentation of a roatator cuff injury
Dull ache in upper arms and shoulders, Pain is intense at night, decreased ROM above shoulder activity
Knee injury side to side movement
MCL, LCL
Knew injury forward and backward movement
ACL, PCL
Meniscus
2 shock absorbing pieces on the top surfaces of the tibia
Placement of MCL vs ACL
MCL inner, ACL outer
ACL injury presentation
A loud pop, severe pain, swelling within hours, instant give awat with weight bearing
MCL injury presentation
Popping sound, Pain and tenderness along the inner part of the knee, swelling og the knee joint, a feeling that your knee is going to give out, locking or catching on the knee joint
Meniscus injury
A C shaped peice of tough ribbery cartilage that acts as a shock absorber betweent eh shinbone and thighbone. Can be torn when you suddely twist your knee
Specail knee tests
McMurray test (bend , move in and out, pain?)
Patellofemoral Grin-osteoarthritis (Compression, pushdown and grind)
Apleys grind Meniscus patho (sit with legs in 90 and compress down)
Aprehension test-disclosing patella
Risk factors for Hip fractures
white or asian female, increased age, post metposal, smoker, alcohol use, poor calcium intake, osteoporosis, increased intake of caffeine
Osteoporisis vs osteoarthritis
Osteoporosis: bones lose minerals, become birttle
Osteoarthritis: Progressive degeneration, inflammatory response
Intracasular hip fracture
Within the joint capsule
Extracapsular Hip fracture
Outside the joint capsule
You know its a hip fracture when….
the leg is shorted, adducted, external rotated, pain and muscle spasm
ORIF
Open reduction internal fixation
Hemiarthroplasty
femoral head is replaces
Total hip replacement
Both femoral heads and acetabulum are replaced
Post op assessments
CSM, pain, caprefill, dressing, edema
Teach: Hip precautions
Keep knees apart, put pilloe between legs when sleeping, never cross legs, avoid bending when seated in a chair, avoid bening to pick up an object on the floor, use a high seated chair and raised toilet seat
Teach -Fall precautions
Keep passage way clearm remove throw rug, wear low heeled shoes, keep food within easy reach
