Musculoskeletal Trauma & Orthopedic Surgery: Repetitive Strain Injury, ACL Injury, Buritis, Fractures, and Osteomyelitis

What is repetitive strain injury?

it is when someone strains a body part several times over a period of time

What is an example of repetitive strain injury?

carpal tunnel syndrome

What are some signs and symptoms of repetitive strain injury?

• pain in affected area

• weakening in affected area

• numbness of extremity

What are the types of ACL injuries?

• partial tear

• complete tear

• avulsion

What are some signs and symptoms of ACL injuries?

• pt. states they heard a loud pop

• knee pain

What is the diagnostic test for ACL injury?

MRI

What is a surgical intervention for ACL injury?

ACL reconstruction

What are some nursing actions and interventions for ACL injury?

• keep pt.’s leg elevated

• administer NSAIDs when ordered

What are some teachings for patients with ACL injury?

• tell pt. they do not need to have surgery right away

• tell pt. to elevate their affected knee

• tell pt. to ambulate on leg as tolerable 

• tell pt. they can take NSAIDs for pain

What is buritis?

 it is inflammation of the bursae from repeated or excessive trauma, friction, gout, RA, or infection

What are buritis most commonly found?

• hands

• elbows

• shoulders

• knees

• hips

What are some signs and symptoms of buritis?

• warmth on affected area

• pain on affected area

• limited range of motion of the affected area

What is the surgical intervention for buritis?

bursectomy

What are some nursing actions and interventions for buritis?

• elevate the extremity

• keep the affected extremity immobilized and at rest

• administer NSAIDs when ordered

What are some teachings for patients with buritis?

• tell pt. to rest extremity with immobilization

• tell pt. to ice affected area

• tell pt. to take NAIDs when prescribed

What are fractures?

they are a break in the continuity of the bone caused by trauma, twisting as result of muscle spasm or indirect loss of leverage or bone decalcification and disease that results in osteopenia

What are some signs and symptoms of fractures?

• pain/tenderness over involved area

• decreased or loss of muscular strength or function

• obvious deformity of affected area

• crepitation and erythema

• edema and bruising around affected area

• muscle spasm and neurovascular impairment

What are the complications for fractures?

• compartment syndrome

• fat embolism

What are some signs and symptoms of compartment syndrome due to a fracture?

• unrelieved or increased pain in limb

• distal area of cast becomes pale, dusty, or edematous

What are some signs and symptoms of fat embolism due to a fracture?

• restless

• increased anxiety

• dyspnea

• chest pain

• develop a cough

• decreased stats

• lung crackles

• confusion

What are some surgical interventions for fractures?

• fasciotomy- for compartment syndrome 

• amputation- for avascular necrosis

What are some nursing actions and interventions for fractures?

• if suspected Compartment Syndrome: notify HPC immediately and loosen tight dressings or viable restrictive cast 

• if suspected fat embolism: give supplemental oxygen, make sure pt. has IV for medication, monitor vitals, monitor respiratory stats

What are some patient teachings for patients with fracture?

• tell pt. to keep cast dry 

• tell pt. to report pain, swelling, or discoloration to distal extremity to cast 

• teach pt. R.I.C.E.

• tell pt. to report sores or foul odor under cast

• tell pt. they can dry cast with hair dryer on low, cool setting if cast gets wet

What is osteomyelitis?

it is severe infection of the bone, bone marrow and surrounding soft tissue

What are some labs and diagnostic tests for osteomyelitis?

• blood & wound cultures

• WBC

• MRI

• x-ray

• CT

What is a surgical intervention for osteomyelitis?

debridement of infected bone

What are some teachings for patients with osteomyelitis?

• tell pt. they may go home with a PICC Line and IV antibiotics for 4-6 weeks

• tell pt. they may have to have a hyperbaric oxygen chamber at home

• tell pt. they may have long term myelitis

What does a strain involve?

muscles and tendons

What does a sprain involve?

ligaments

Which picture depicts subluxation of the hip?

What picture depicts dislocation of the hip?

What is some patient teaching postop for Arthroscopic surgery for a torn rotator cuff?

• tell pt. their arm will be immobilized for 6 weeks

• tell pt. to take anti-inflammatory medications

• tell pt. they can have steroid injections in shoulder

What is a complication of Arthroscopic surgery for a torn rotator cuff?

“frozen shoulder” is a complications

What picture depicts bursitis?

What is buck’s traction?

it is a traction that is used to treat fractures, realign broken bones, correct contractures or deformities, and for knee immobilization

What are some nursing assessments for a patient with buck’s traction?

• assess for muscle spams

• assess skin

• monitor affected extremities for sensation

• assess for proper body alignment

When is ischemia irreversible with compartment syndrome?

it is irreversible in 4-6 hours after onset