MS Injuries and Trauma - NCM of Clients with Orthopedic Conditions

strain

It is an injury to a muscle/tendon when it is stretched, overused, or pulled beyond its capacity. Small blood vessels may rupture and muscle fibers sustain tiny tears.

sprain

An injury to the ligament surrounding a joint. The force twists the joint in a direction it was not designed for or displaces it beyond its normal ROM.

muscle spasms, defect in muscle belly, and reduced ROM of joint

What are the common symptoms of a strain?

feeling of instability of the joint and may present with increased ROM

What are the common symptoms of a sprain?

protection, rest, ice, compression, elevation

To manage the injury, the patient must be advised to use PRICE measures. What does PRICE stand for?

heat, alcohol, running, massage

To avoid worsening the injury, the patient must be advised to avoid HARM in the first 72 hours. What does HARM stand for?

avulsion

A ligament is torn or ruptured completely, with possible detachment of a fragment of a bone with hematoma, severe pain, edema, and abnormal joint movement. 3rd degree sprain.

dislocation

The articular surfaces of a joint are no longer in contact. Most common areas are the shoulders, hips, and knee.

subluxation

A partial dislocation. The client often reports a popping sound. The joint just gave way; the structural shape is altered.

rotator cuff tear

It is a traumatic injury from chronic overuse or irritation of the shoulder joint.

rotator cuff

It is made up of 4 muscles and their tendons that connect the proximal humerus, clavicle, and scapula, which connect with the sternum and ribs.

ligament/meniscal injuries

It occurs in the knee as a result of trauma. Knees click as the client ambulates.

menisci

It is the cartilage of the knee

3-12 months

What is the recovery period of a client who had a ligament/meniscal injury?

ruptured achilles tendon

It is secondary to trauma: the client engages in an activity, the calf muscle suddenly contracts while the foot is grounded firmly in space. A loud pop and severe pain; inability to plantar flex the affected foot.

warm-up before sports, stretching, toning, cool-down

What are the preventive measures for orthopedic injuries?

fracture

A break in the continuity of the bone due to sudden direct force, blow, or fall.

pain, loss of function, crepitus, edema, spasm

What are assessment findings indicative of a fracture?

hypovolemic shock, fat embolism, pulmonary embolism

What are the possible complications of fractures occurring in the first 24-72 hours?

administer blood and fluid volume replacements

What is the management for a hypovolemic shock?

fat embolism

Occurs within 48-72 hours with patients experiencing respiratory distress.

emboli

In a fracture, fat globules are released from long bones and combine with platelets to form?

pulmonary embolism

It may occur after fracture or surgery; it can be fatal.

administer low dose heparin or any anti-coagulants

What is the management for a pulmonary embolism?

infection, avascular necrosis, delayed wound healing

What are the possible complications of fractures occurring after 72 hours?

maintain asepsis in dressing; wound care

What is the management for an infection?

avascular necrosis

It results from interruption of the blood supply to the fracture fragments and bone tissues die. Clients with this condition can be candidates for bone graft, amputation, or joint replacement.

delayed wound healing

This condition occurs when the bone fails to heal at the expected rate. It results from non-union or malunion of the ends of a bone, thus causing a deformed position.

hematoma

The first stage of bone healing, in which the bleeding has stopped.

internal callus, fibrous tissue and cartilage, spongy bone trabecula, new blood vessels, external callus

During the second stage of bone healing, which is fibrocartilage callus formation, what structures develop during this stage?

osteoblasts, osteocytes, osteoclasts

What are the cells involved during the third stage of bone healing, which is bony callus formation?

osteoblasts

Also known as bone cells.

osteocytes

Bone cells that are needed for ossification and calcification.

osteoclasts

Bone cells needed for bone resorption and bone remodeling.

bone remodeling

The fourth stage of bone healing in which the fracture is healed.

8 weeks to 2 years

How long does a bone heal?

reduction

It is the process of bringing the ends of the broken bone into proper alignment.

closed reduction

Also known as manipulation, it is a non-surgical realignment of the bones to their previous anatomic position. General or local anesthesia is given.

open reduction

A surgical incision made at general anesthesia. It is usually done for open, compound/communited to clean the area of fragments and debris.

fixation

An attempt to attach the fragments of the broken bone together, when due to type and extent of the break.

internal fixation

It includes the use of rods, pins, nails, screws, wires, or metal plates to align bone fragments for healing. Example is ORIF.

external fixation

Pins are directly inserted into the bone, above or below the fracture. Pins are attached to an external frame and adjusted to realign the bone.

casts and splints

These are used to secure the position of the body parts being treated. They hold the bone in alignment while allowing enough movement of other body parts to carry out ADL.

plaster of paris, fiberglass, thermoplastic resin. thermolabile plastic with polyurethane

What is the variety of materials used in preparation for a cast application?

pain, pallor, paresthesia, pulse, pressure, paralysis

What are the signs to observe for neurovascular checks?

traction

It exerts a pulling force on a fractured bone to provide alignment of broken bone fragments.

skin traction

It is applied directly to the skin. It should not be more than 5-10 lbs in order to prevent the skin. One example is Buck's traction.

skeletal traction

It provides a steady, continuous pull and can be used for prolonged periods of time. Heavier weights can be used, usually 5-10 lbs. One example is Crutchfield or Vinke tongs.

recommended weight, pulley, metal frame, overhead trapeze

What are the requirements of a traction bed?

TRACTION

What mnemonic is followed for the care of patients in traction?

rehabilitation

It refers to interventions, treatments, evaluations that help patients regain normal function.

physical therapy, assistive devices, electrical stimulation, and pulsed EM fields

What measures are used for the rehabilitation of an orthopedic conditions?

electrical stimulation and pulsed EM fields

It is a non-invasive therapy that includes a control box and a pad that induces electrical charges around and within the cell.

Immobilization, elevating affected area, analgesics, repositioning, massage, diversion

What is the goal of care for pain-alteration in comfort?

frequent neurovascular checks

What is the goal of care for inadequate peripheral circulation?

strict asepsis for dressing changes, wound irrigations, care of pins and drains

What is the goal of care for potential for infection?

ROM, resistance exercises, participation in ADL, recreational activities, nutrition and hydration

What is the goal of care for potential for activity intolerance?

extent, type of injury, and tolerance of the patient

The degree of pain experienced depends on the?

inadequate peripheral circulation

It occurs due to soft tissue injury resulting from trauma, fracture, hemorrhage, edema, compartment syndrome, and positioning.

potential for activity intolerance

It is due to prolonged immobility that people become weaker, and their ability to participate in activities diminishes.