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What is the most commonly reported injuries?

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Contusions, Strains, and Sprains.

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Contusion

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Blunt force-bleeding into soft tissue, but skin remains intact. (Swelling, discoloration of skin) Least serious

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Strain

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Stretching injury to a muscle or a muscle-tendon unit. Caused by mechanical overloading. (Pain, limited motion, muscle spasms/weakness, swelling.) Most common: lower abck and Hamstring muscle

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Sprain

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Stretch/tear of ligaments surrounding joint. (Loss of the ability to move or use the joint, feeling a "pop" or tear, discoloration, pain, rapid swelling.) Most common: ankles and knees

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RICE

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Rest Ice Compression Elevation 24-48hrs do RICE.

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Joint dislocation

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Trauma or illness forces ends of the bones from normal position. (Pain, deformity, limited motion, shorter limb) Care: Reduction by manual traction or surgery immobilization, hip dislocation requires immediate reduction to prevent complications to prevent necrosis.

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Subluxation

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partial dislocation is which the bones of the joint remain in partial contact

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Necrosis

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Death of bone tissue

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Electrical Bone Stimulation

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Used to treat fractures that aren't healing appropriately, increases migration of osteoblasts and osteoclasts to fracture site.Application of an electrical current

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What to do for fracture of the skull?

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Assess patient for neurologic changes, document LOC, depressed skull fracture can cause neurologic damage.

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Fracture Care

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Emergency Care: Immobilize the fracture, maintain tissue perfusion, prevent infection. Medications: Analgesics, NSAIDs, antibiotics,anticoagulants, stool softeners, antacids. Surgery: External fixation device, ORIF

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Fracture of the Face

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Manifestations: Hematoma, pain, edema, bony deformity. Focus on airway, assess neurologic, body image disturbance, assess pain

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Fracture of the Spine

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Cervical, lumbar, thoracic, or sacral...damage to spinal cord. MOST SEVERE, can result in ischemia and cause permanent paralysis.

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Fracture of the Clavicle

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Usually midclavicular, can damage subclavian vessels or lung. Seen most common with falls

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Fracture of Humerus

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Complications: nerve and ligament damage, frozen or stiff joints, and malunion--fractured fragments are not in good position... Fractures of the proximal humerus are more common in older adults.

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Fracture of the Elbow

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Usually distal humerus, common complications: nerve or artery damage, hemiartrosis, Volkmann's contracture (claw deformity of hand and fingers). Fall or direct blow is main report.

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Fracture of the radius and/or ulna

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Complication: compartment syndrome, delayed healing, decreased wrist and finger movement, infection. Care: alleviate pain, immobilization, education. ***Tell MD if changes in sensation

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Wrist Fractures

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Colle's Fracture: the distal radius fractures after a fall onto an outstretched hand. Patient presents with bony deformity, pain, numbness, weakness, decreased ROM of fingers.

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Hand Fractures

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Usually metacarpals and phalanges (Pain, edema, decreased ROM) Complications: compartment syndrome, nerve damage, ligament damage, delayed union.

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Fracture of the Ribs

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Blunt chest trauma, Can damage the spleen, liver, subclavian artery, or vein. Flail chest; Complications: pulmonary contusion, pnuemothorax and or hemothorax, pneumonia, intra-abdominal bleeding

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Flail Chest

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results from the fracture of two or more adjacent ribs in two or more places and the formation of a free-floating segment that moves in the opposite direction of the rib cage.Care: coughing, deep breathing, and splinting.

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Fracture of the Pelvis

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Caused by trauma, patient presents with back or hip pain. Complications: hemorrhage, damage to pelvic and extra-pelvic organs. Care: Tx discomfort, maintaining immobilization, and identify potential complications.

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Fracture of the Shaft of the femur

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Edema, deformity, pain in the thigh, inability to move hip or knee. Complications: hypovolemia, fat embolism, hip and/or knee dislocation, muscle atrophy, ligament damage. Provide pain meds, provide reassurance and decreasing anxiety, assist with exercises of the lower legs, feet, and toes. Circulation and sensation in affected extremity;skeletal traction, internal or external fixation

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Intracapsular Fractures

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involve the head or neck of the femur...MOST SERIOUS

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Extracapsular Fractures

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Involves the trochanteric region

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Fracture of the Hip

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Intracapsular or extracapsular. Risks: Lower body weakness, problems walking/balance, taking 4 or more meds or psychoacitve meds. Nursing: maintain skin integrity, prevent infection, alleviate pain, manifest circulation, increase mobility

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Causes of repetitive use Injuries

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Twisting and turning wrist Pronating and supinating forearm Kneeling Raising arms over head

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Dislocation

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injury in which the ends of the bones are displaced out of their normal position and joint articulation is lost

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Carpal Tunnel

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a cannal through which flexor tendons and the median nerve pass from the wrist to the hand. Sybdrome: compression of the median nerve as a result of inflammation and swelling of the synovial lining. Alleviated by shaking or massaging the fingers.

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Bursitis

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an enclosed sac found between muscles, tendons, and bony prominences, inflammation of these. Caused by friction between bursa and surrounding tissue. Common Places: Shoulder, hip, knee, elbow.

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Epicondylitis

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inflammation of the tendon at its point of origin into the humerus. Increase mobility and alleviate pain

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Hematoma Formation

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First Phase of Fracture healing. Localized necrosis, heightened inflammatory response. Inflammation, bleeding and hemotoma. Fibroblasts, lymphocytes (inflammation), macrophages migrate to fracture site.

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Fibrocartilaginous Callus Formation

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Second Phase of Fracture Healing. Occurs within 48 hours of injury, granulation tissue replaces hematoma. base is laid for bone growth, and they cannot yet bear weight.

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Bony Callus Formation

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Third Phase of Fracture healing. Occurs 3-4 weeks after injury, formation and gradual mineralization of collagen fibers and bone matrix

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Remodeling

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Last stage of Fracture healing (4th). Removal of excess callus, remodeling by osteoblasts and osteoclasts. Compact bone replaces spongey bone.

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Compartment syndrome

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Occurs when pressure within a confined space constricts and entraps the structures within. Can lead to limb loss, sepsis, ARF. Early signs: pain, normal or decreased peripheral pulse. Later signs: cyanosis, parethesias, paresis, severe pain. Tx: alleviate pressure, removal of cast, fasciotomy. Do NOT elevate or use ice

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Fat embolism Syndrome

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Characterized by neurologic dysfunction, pulmonary insufficiency, and a petechial rash on the chest, axilla, and upper arms. Bone fracture results in a rise of pressure in the bone marrow, fet globules enter the bloodstream and combine with platelets. They occlude small blood vessels, and cause tissue ischemia. Signs: confusion, changes in LOC, petechiae, soft palate, conjunctiva. TX: Intubation, fluid balance, corticosteriods.

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Deep Venous Thrombosis (DVT)

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Blood clot forms along the intimal lining of a large vein, accompanied by inflammation of the vein wall. Can lead to venous insufficiency, pulmonary embolism. Signs: Swelling, pain, tenderness, or cramping of the affected extremity.Can be asymptomatic TX: prevention is best.

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Delayed Union

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Prolonged healing of the bones beyond the usual time period. Diagnosed with serial x-ray studies. May lead to nonunion. Usually affects long bones

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Delayed Nonunion

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can cause persistant pain and movement at the fracture site. may require surgical intervention, such as internal fixation and bone grafting. Electronic or ultrasonic stimulation of the fracture site may be effective to promote healing. Usually affects long bones

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Complex Regional Pain Syndrome

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may occur after musculoskeletal or nerve trauma. Causes extremity pain that is severe, diffues, and burning. Initially appearing inflamed, edematous but later becomes cool and pale. Muscle wasting, skin and nail changes and bone abnormalities can occur. TX: Sympathetic nervous system blocking agent.

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Traction

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applies a straightening or pulling force to return or maintain the fractured bones in normal anatomic position.

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Casts

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Rigid device applied to immobilize the injured bones and promote healing. Immobilizes the joint above the joint below the fractured bone so that the bone will not move during healing. Nursing: Monitor for "hot spots", pain, and drainage. Neurovascular assess, and teaching care of this device.

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External Fixator

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consists of a frame connected to pins that are inserted perpindicular to the long axis of the bone. The number of pins depends on the type and site of fracture.Monitor Neurovascular assess and infection

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Closed "Simple" fracture

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skin is intact

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Open "Compound" fracture

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The skin intergrity is interrupted. Allows bacteria to move into open area and can cause complications.

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Complete fractures

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Involve the entire width of the bone

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Incomplete fractures (Greenstick)

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involve only part of the width of the bone.

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Oblique fracture line

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ar an angle to the bone

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Avulsed fracture

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when the fracture pulls bone and other tissue awayfrom the point of attachment

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Spiral fracture line

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curves around the bone

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Comminuted Bone

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bone breaks into many pieces

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Compressed Bone

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Bone is crushed

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Impacted Bone

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Broken bone ends are forced into each other

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Depressed Bone

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the broken bone is forced inward

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Stable (nondisplaced) Fracture

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fracture where bones maintain their anatomic alighment

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Unstable (Displaced) Fracture

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Fracture occurs when the bones move out of the correct amatomical alignment

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Faciotomy

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Surgical insicion of a muscle or Fascia to relieve pressure within the compartment.. Afterwards the incision is left open, leading to possible infection

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Volkmann's Contracture

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uncommon complication of elbow or forearm fractures, can result from unresolved compartment syndrome. Signs: Ischemia, degeneration, and contraction of forearm muscles

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Manual Traction

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applied by physically pulling on the extremity. often is used to reduce a fracture or dislocation.

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Skin traction (straight traction)

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used to control muscle spasms and to immbolize a part of the body during transport or before surgery. Non-invasive and relatively comfortable for the patient. Most common: Bucks traction: used to immobilize the leg before surgery tp repair a hip or proximal femur fx.

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Balanced Suspension Traction

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more than once force of pull to raise and support the injured extremity off the bed and maintain its alignment. Increases mobility while maintaining bone position.

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Skeletal Traction

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Pulling force is applied directly through pins inserted into the bone, allows more weight to be used to maintain the proper alignment. Risk of infection is greater and may cause more discomfort.

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Internal Fixation

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fracture is reduced (placed back into alignment) and nails, screws, plates, or pins are inserted to hold the bone in place. All done inside. Can be done by (ORIF) Neurovascular assess and monitor infection

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Stump Care

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Massage, air exposure, keeping area and socks/wraps clean.

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Amputation

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Partial or total removal of an extremity. Acute process or chronic condition. PVD is the main cause of lower extremity loss. Risk factors: HTN, Diabetes, smoking, hyperlipidemia.

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Traumatic Amputation

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Highest among young men, result from: vehicle crashes, machinery accidents, combat-related, frostbite, burns, electrocutions. Interruption in blood flow causes loss, may be acute or chronic.

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Acute trauma Amputation

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the limb is partially or completely severed, and tissue death ensues. Replantation may be possible (fingers, small body parts, and somtimes limbs)

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Chronic Disease

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Impaired circulation, venous pooling begins, proteins leak into the interstitium, and edema develops. Stasis ulcers develop and become infected b/c impaired healing. Infection leads to gangrene and ultimately requires amputation.

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Levels of Amputation

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determined by local and systemic factors. Ultimately the joints are preserved when possible to allow greater function. Local factors: ischemia, gangrene Systemic Factors: cardiovascular, renal, and severity of diabetes

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Types of Amputation

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Open (guillotine): performed when infection is present, not closed but remaining open to drain, when infection is gone surgery will take place to close wound. Closed (flap): closed with a flap of skin that is sutured in place over the stump.

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Post-amputation care

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rigid or compression dressing is applied to prevent infection and minimize edema. dressing is made by placing a cast on the stump and molding the stump to fit a prosthesis.

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Complications of Amputation

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Infection: drainage odor, redness, increased discomfort, chills, + wound and blood cultures. Delayed healing:`electolytes imbalance or infections prolong process, smoking, circulatory or cardiac problems. Chronic Stump pain: Neuroma formation- severe burning pain;TENS, surgical procedure, meds Phantom Pain, and Contracures

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Contracture

answer

abnormal flexion and fixation of a joint caused by muscle atrophy and shortening. Most common site is above the joint of the amputation. Exercising is VERY important. AKA: should lie prone for periods of the day. BKA: can prop the leg up with a pillow.

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