Musculoskeletal Trauma - PowerPoint PPT Presentation

1 / 37
About This Presentation
Title:

Musculoskeletal Trauma

Description:

Contusions - due to a sudden, external pressure that tears the SC ... Cervical skeletal (halo brace, Crutchfield Tongs - fx cervical spine, muscle spasms ... – PowerPoint PPT presentation

Number of Views:774
Avg rating:3.0/5.0
Slides: 38
Provided by: debora77
Category:

less

Transcript and Presenter's Notes

Title: Musculoskeletal Trauma


1
Musculoskeletal Trauma
  • BY
  • Deborah Cary, MSN
  • Associate Professor
  • Broward Community College

2
ORTHOPEDIC TRAUMASOFT TISSUE INJURIES
  • Contusions - bruise without a break in skin
  • affects skin/subcutaneous tissue
  • Strain - pull in a muscle, ligament or tendon
    caused by excessive stretch
  • Sprain - a tear in a muscle, ligament, tendon

3
Causes of injuries
  • Contusions - due to a sudden, external pressure
    that tears the SC circulatory veins
  • and capillaries resulting in bleeding in sc
  • tissue
  • bluish discoloration of the injured tissues
    with resulting edema.

4
  • Strain - cause is undue force to muscles,
  • ligaments or tendons. Stretches fibers
  • causing a temporary weakness,
  • numbness. Weakness lasts 24-72 hrs
  • ex a charley horse

5
  • Sprains - can affect portions of the bone in
  • and around a joint.
  • Affects ankles, wrists,
    fingers/toes
  • 1st - 3rd degrees (marked edema, pain,
  • hemorrhage and loss of function -
  • full tearing (avulsion)

6
FRACTURES
  • Discontinuity or break in a bone
  • Cause major trauma to musculoskeletal tissues
  • Type of fx related to source or force of blow
  • 6.2 million fx/yr 150,000 die from trauma

7
FRACTURES
  • Wrist (Colles)- most common due to falls
  • Humerus - rx with casts
  • use of swath/sling
  • Clavicle - use of figure of eight bandage
  • With upper extremity Fx - Elevate distal joints
    above proximal joints (Elbow above shoulder and
    wrist above elbow)

8
Lower extremity Fractures
  • Femur
  • Tibia/ fibula
  • Pelvic, pubic, coccygeal
  • Ankle

9
Medical Management Fractures
  • Reduction via
  • closed reduction with or without external
    fixation
  • open reduction with internal fixation (ORIF)
    use of pins/wires
  • casting
  • traction - can be used along with open

10
  • Assess for breaks in skin (compound fx)
  • If open wound, DSD -pressure if bleeding
  • Keep person warm to prevent shock
  • RICE rest, ice, compression, elevation
  • Keep area immobilized
  • If major trauma, suspect neck injury

11
Nursing Management
  • Initiate bedrest til injuries assessed
  • Assess vitals - R/O life-threatening injury
  • Assess for swelling, discoloration, abrasions,
    contusions or obvious deformity
  • Assess neurovascular status hourly
  • document color, temp, pulses, edema,
    presence of pain, sensory function, capillary
    refill - always compare to unaffected limb
  • If casted - assess q 1-2hr initially, then q 4

12
Management 2
  • Special foam or alternating pressure mattress
  • High protein, high carb diet if allowed
  • Fluids to 3,000cc daily
  • Turning sheet to relieve pressure on skin/bony
    prominences - prevent shearing force
  • Bed making top to bottom

13
Teaching
  • Purposes for bedrest
  • Purpose of position change q 2 hr
  • Teach quadriceps, buttocks and triceps
  • setting exercises to maintain strength (q4h)
    unaffected extremity

14
Fracture Femur
  • Young males in MVA - falls due to ETOH
  • Sx - enlarged, deformed, painful thigh
  • severe pain upon movement hip or knee
  • dislocations common
  • shock common due to blood loss
  • Increasing diameter thigh indicates
    continuous bleeding (measure) - compare

15
Types of Traction
  • Skin- Velcro boot used (Bucks)
  • Skeletal- Steinman pins, wires,tongs,screws
  • (allows for longer tx time and heavier
    weights)
  • Plaster -combines skeletal with a cast
  • Brace - correction of alignment deformities
  • Circumferential - use of a belt around body

16
Types of Traction 2
  • Upper Extremity
  • Fx humerus with or without involvement of the
    shoulder/clavicle
  • Skeletal tx (forearm flexed and extended
  • 90 degrees from upper part of body)
  • Plaster traction (pins inserted through the
    bone are fixed in the cast) Fx wrist

17
Lower Extremity Traction
  • Bucks extension - fx hip or femur pre-op
  • prevention hip flexion contractures
  • hip dislocation/spasms most common
  • Russells traction - similar to above, but a
  • sling under knee suspends leg
  • fx hip or end of femur
  • Balanced skin or skeletal traction - limb
    elevated in a Thomas splint with Pearsons
  • attachment - fx femur or pelvis

18
Traction 3
  • Cervical halter - strap under chin
  • Uses - cervical muscle spasms, strain/sprain
    and arthritis
  • Cervical skeletal (halo brace, Crutchfield Tongs
    - fx cervical spine, muscle spasms
  • Pelvic Belt-strap around hips at iliac crests is
  • attached to weights at foot of bed - spasms
  • Pelvic sling - wide strap around hips attached to
    overhead bar to keep pelvis off bed-pelvic fx

19
Cast Care
  • Explanation to patient
  • Use palms of hands until dry
  • Can use a hair dryer on low to hasten drying
  • Petal the cast edges when dry
  • Neurovascular checks!!

20
Bucks Extension
  • Used in any age - usually adults
  • One or both legs
  • Pre-op for hip fx
  • Pulls contracted muscles/ relieves spasms
    in legs or back
  • 5-7 weights ordered by MD
  • Pt in recumbent position - HOB to 30degrees

21
Nursing Management
  • Weights hanging free
  • Ropes on pulleys
  • Body in straight alignment
  • Foot plate or board to prevent footdrop

22
Nursing Management 2
  • fx, turn to UNAFFECTED side only
  • Either side if no fx present
  • Pillows to back and between legs when turn
  • Assess CMS and burning under tape of boot
  • Check heels for spongy feel - keep off bed

23
Fractured Hip
  • INCIDENCE
  • Frail, elderly women - Caucasian,Asian
  • Causes cerebral ischemia (ex TIA,
  • syncope
  • falls (occasionally inner ear problems
  • balance (vestibular) disturbances
  • Comorbidity cardiovascular,
  • pulmonary complications due to bedrest

24
Complications of all Fractures
  • Acute Compartment Syndrome
  • (Volkmanns Contracture)
  • Fat Embolism
  • Deep Vein Thrombosis (DVT)
  • Infection
  • Avascular Necrosis
  • Delayed Union

25
  • Acute Compartment Syndrome
  • Serious complication in which increased pressure
    within 1 or more compartments causes massive
    compromise of circulation to the area
  • ISCHEMIA-EDEMA CYCLE
  • Observe for edema, decreased sensation
  • Assess lab tests Total Protein, Albumin
  • ESR, WBC

26
  • Most common sites ACS are in lower leg
  • and dorsal and volar compartments of
  • forearm (Volkmans)
  • Causes External (casts/ tight bulky
    dressings) Internal (blood or fluid accumulation)

27
Fat Embolism
  • Fat globules released from bone marrow into blood
  • Long bone fx and multiple fx
  • Older clients - fx hips risk and common in fx
    pelvis
  • Earliest sx - AMS
  • respiratory distress, tachycardia,
  • tachypnea, fever Petechiae

28
DEEP VEIN THROMBOSIS
  • MOST COMMON COMPLICATION
  • of lower extremity surgery or trauma
  • Increased risk in smokers, obese, heart disease,
    hx of thromboembolic complications
  • Increased incidence in older adults in lst 2-3
    days post-op
  • Fx lower extremities/pelvis
  • Prevention!!!!

29
  • Local venous stasis secondary to trauma or
  • surgery (use of tourniquets in lower extremity
    injuries) increases risk of DVT
  • Prevention- ROM, anticoagulants (heparin,
    lovenox), Sequential compression device,
  • Antiembolism stockings, force fluids,
    insertion of Greenfield filter (IVC) pre-op

30
Infection
  • Cause - trauma to tissue
  • implanted hardware
  • (pins, screws, rods)
  • organism of clostridium gangrene
    or tetanus
  • Most common Staph
  • Osteomyelitis bone with open fx and
  • after repair

31
Avascular Necrosis (AVN)
  • Aseptic or ischemic necrosis (osteonecrosis)
  • Blood supply disrupted leading to death of
  • bone tissue
  • Can occur after hip fx or any fx with bone
  • displacement
  • Hardware can interfere with circulation

32
AMPUTATIONS
  • CAUSES
  • Peripheral Vascular Disease
  • Gangrene
  • Trauma
  • Frostbite
  • Electrical Burns
  • Malignancy
  • Chronic Osteomyelitis

33
Nursing Considerations
  • Traumatic - usually upper extremity
  • Drastic reconstructive surgery
  • Major body changes
  • Altered physical mobility/ADL
  • Psychological support pre/post-op
  • Surgical site chosen is the most distal
    part that will heal successfully
  • prosthetic fit best with BKA major advances in
    prostheses

34
Nursing continued
  • Gentle handling residual limb (stump)
  • Control of edema via closed rigid dressing
  • with cast or soft compression dressing
  • Observe for hemorrhage - keep large
  • tourniquet at bedside
  • Pillows below stump for 48 hrs. only
  • Phantom limb pain - with AKA
  • SEE Table 61-15 in text pg. 1684

35
Prostheses
  • Fit when swelling subsides

36
(No Transcript)
37
Crutch Walking
  • Principle determine lifestyle and upper
  • body strength
  • Gait patterns two-point
  • three- point
  • four-point
  • swing-to- gait
  • swing-through
  • Use transfer belt when ambulating
  • Measurement
Write a Comment
User Comments (0)
About PowerShow.com