Module 3 Part 2 Musculoskeletal Trauma

Soft Tissue Injury Types

Contusion, strain, sprain, dislocation, subluxation

RICE Method for Strains/Sprains

Rest, Ice, Compression, Elevation; immobilization as needed

Closed vs Open Fracture

Closed: bone does not break through skin; Open: bone protrudes through skin (high infection risk)

Simple vs Compound Fracture

Simple: no multiple fragments; Compound: complex fracture with fragments

Intra-Articular Fracture

Fracture crosses the joint space

Fracture Clinical Manifestations

Loss of function, deformity, limb shortening/rotation, crepitus, edema, bruising/ecchymosis

Fracture Assessment Priorities

Health history/comorbidities, comprehensive pain assessment, vital signs/LOC/shock signs, neurovascular assessment, bowel/bladder function (hip fractures), skin condition, coping/anxiety support

Fracture Immediate Management

Immobilize immediately, cover open wound (prevent contamination), NEVER attempt to reduce/realign as nurse

Closed Reduction

Manual traction to realign fracture without surgery

Open Reduction

Surgical realignment of fracture

ORIF Definition

Open Reduction Internal Fixation; surgical approach with realignment and fixation (plates/screws)

Fracture Immobilization Methods

External fixators or internal fixation (plates and screws)

Neurovascular Assessment (5 P's)

Pain, Pulse, Pallor, Paresthesia, Paralysis

CSM Assessment Alternative

Color, Sensation, Motion (alternative to 5 P's)

Fracture Nursing Interventions

Elevate extremity, monitor neurovascular compromise (5 P's), monitor elimination (hip fractures), isometric/muscle-setting exercises, ADL participation, pain management (often opioids), wound care (open fractures)

Poor Fracture Healing Risk Factors

Age >40, bone loss, tobacco use, medical comorbidities, corticosteroid/NSAID use, extensive local trauma, inadequate immobilization, infection, local malignancy, malalignment, premature weight-bearing, AVN

Fracture Acute Complications

Shock, fat embolism, compartment syndrome (CRITICAL), DVT, PE, DIC, infection, bladder control loss, hemorrhage (especially hip fractures)

Fracture Chronic Complications

Delayed union, malunion, nonunion, avascular necrosis, complex regional pain syndrome, heterotopic ossification (benign bone growth in atypical location)

Compartment Syndrome Pathophysiology

↑ pressure within muscle compartment → impairs blood flow → compromises tissue viability; commonly extremities (forearm, lower leg, thigh)

Compartment Syndrome Assessment

Intense pain disproportionate to injury (despite recent analgesia), ↓ capillary refill, diminished/absent distal pulses, numbness/tingling, muscle weakness/loss of function, taut area with shiny skin and possible blistering

Compartment Syndrome Priority Action

Notify provider IMMEDIATELY; administer analgesics; severe cases require fasciotomy (surgical decompression)

Fasciotomy

Surgical decompression to relieve compartment pressure; incision down affected area (can be done at bedside in emergencies)

Cast/Splint Assessment Focus

Neurovascular status (5 P's), assess/treat lacerations/wounds associated with fracture

Post-Cast Removal Concern

Muscle atrophy from immobilization; patient education on prevention and recovery

Amputation Causes

Congenital, traumatic, progressive peripheral vascular disease, infection, malignancy, pain control, disease process improvement

Amputation Site Options

Above/below elbow, above/below knee, knee disarticulation (across knee joint), SIEM (ankle joint), phalangeal/metatarsal (fingers/toes)

Amputation Assessment Priorities

Neurovascular/functional status, signs of infection at residual limb incision, nutritional status, concurrent health problems (diabetes, PVD), psychological status/grief/coping (especially if unexpected)

Amputation Nursing Interventions

Pain relief, wound care, resolve grief, enhance body image, promote independent self-care, assist physical mobility (wheelchair, walker, cane use)

Prosthetic Device Timing

Introduced after healing period and resolution of edema at surgical site (avoid stress on incision)

Figure-Eight Wrapping Purpose

Method for wrapping residual limb on lower extremity amputation

Amputation Acute Complications

Postoperative hemorrhage, infection, poor wound healing/skin breakdown (especially diabetes patients)

Amputation Delayed/Long-Term Complications

Joint contracture (promote optimal alignment), phantom limb pain

Phantom Limb Pain Characteristics

Very distressing; patient experiences pain in amputated limb; difficult to medicate adequately; patient may acknowledge limb is gone but still feels pain; requires emotional support

Hip Fracture Specific Complications

Hemorrhage (common), bladder elimination issues requiring bowel sounds/I&O monitoring