Ch 30 - Musculoskeletal Trauma

functions of musculoskeletal system

• giving the body shape

• protecting internal organs

• providing for movement

• storing salts and other materials

• producing RBC

tendons

connect muscles to bone

ligaments

connect bones to bones

cartilage

• extension of bone end, composed of connective tissue

• allow the bones to ride over each other during movement with relatively little friction

6 types of motion

• flexion

• extension

• adduction

• abduction

• rotation

• circumduction

axial skeleton

head, thorax, vertebral column

appendicular skeleton

• made up of the bones in extremities

• includes the shoulder, girdle, and the pelvis

fracture

• break in the continuity of the bone

• can be open or closed

• can cause damage to surround tissues

osteoporosis

• degenerative bone disorder

• signs and symptoms

  • pain tenderness

  • deformity, discoloration

  • paresthesia, anesthesia

  • paresis/paralysis/ inability to move an extremity

  • decrease in pulse or perfusion

types of fracture

• comminuted

• impacted

• greenstick

• oblique

• spiral

• transverse

complications of fractures

• hemorrhage

• tissue damage, including nerves and blood vessels

• infection

• interruption of blood supply

strain

• injury to muscle/muscle and tendon

• possibly caused by overextension or overstretching

• immediate pain, tenderness, with delayed swelling and discoloration

dislocation

• displacement of bones in a joint

• may be damage blood vessels and nerves

• ligament or joint capsule damage likely

three types of MOI

• direct force

• indirect force

• twisting force

direct force

injury occurs at the point of impact

indirect force

injury impacts one end of a limb, causing injury some distance away

twisting force

part of the extremity remains stationary while the rest twists

What are critical bones to fracture and why?

• pelvis and femur

• pt can have significant bleeding, which can be life-threatening

how much blood can a pt lose in a femur fracture?

about 1500 mL

what to assess in secondary assess

• six Ps

  • pain

  • pallor

  • paralysis

  • paresthesia

  • pressure

  • pulses

splints

• used to prevent movement of dislocated joints or bone fragments/ends to reduce further injury

• reduces pain and chances of complication

general rules of splinting

• assess PMS

• immobilize joints both above and below

• cover all wounds

• align the injured limb

• pad each splint

• hold the traction till splint is applied

types of splints

• rigid

• pressure (air/pneumatic)

• traction

• formable

• vacuum

• sling and swathe

• spine board/full-body vacuum mattresses

• vest-type immobilization devices

hazards of improper splinting

• compression of nerves, tissues, blood vessels

• delayed transport

• reduced distal circulation

• aggravation of the injury

• excessive movement

• skin damage frm improper padding

traction splinting

• using traction to align femur to reduce complications

• treat for the fracture if the thigh is painful, swollen, or deformed

• can be uni/bipolar

when not to use a traction splint

• injury is within 1-2 inches of the knee or ankle

• the knee is injured

• the hip is injured

• pelvis is injured

• partial amputation or avulsion

What to use to splint a pelvic fracture

• pelvic binder

• improvised splints

• PASG

compartment syndrome

• pressure develops within an injured area

• the pressure exceeds the capillary pressure needed to perfuse the tissues

• the tissues become hypoxic, which results in further damage and swelling

signs and symptoms of compartment syndrome

• severe pain or burning sensation

• decrease strength in extremity

• paralysis of extremity

• pain with movement

• extremity feels hard to palpation

• distal pulses and motor and sensory functions may be normal

pathologic fracture

• involves a diseased bone; less force is required to fracture the bone

• in pts with history of cancer, osteoporosis, other benign bone conditions (i.e. congenial cysts)