Traumatic Conditions

7/29/2019 Traumatic Conditions

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Traumatic Conditions

of theMusculoskeletal System


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Soft Tissue Trauma

Is the damageof muscles, ligaments and tendons throughout

the body.

A contusion is a soft tissue injury produced

by blunt force, such as a blow, kick, or fall A strainis a muscle pull caused by

overuse, overstretching, or excessive stress.

A sprain is an injury to the ligaments

surrounding a joint that is caused by awrenching or twisting motion.


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Management

Treatment of contusions, strains, andsprains consists of resting and elevating

the affected part, applying cold, and

using a compression bandage.

REST ICE

COMPRESSION

ELEVATION


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Dislocation

A dislocation of a joint is a condition in

which the articular surfaces of the bones

forming the joint are no longer in

anatomic contact. The bones are literally

out of joint. A subluxation is a partial dislocation of

the articulating surfaces

Traumatic dislocations are orthopedic

emergencies


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Management

The affected joint needs to be immobilized

while the patient is transported to the hospital.The dislocation is promptly reduced (ie,

displaced parts are brought into normal

position) to preserve joint function

Analgesia, muscle relaxants, and possiblyanesthesia are used to facilitate closed

reduction

active and passive movement is begun to

preserve range of motion (ROM) and restorestrength


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Fractures

Fractures occur when the bone is subjected tostress greater than it can absorb.

Fractures are caused by direct blows, crushing

forces, sudden twisting motions, and even

extreme muscle contractions

soft tissue edema

hemorrhage into the muscles and joints

joint dislocations

ruptured tendons severed nerves

damaged blood vessels


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Types of Fracture

A complete fracture involves a break across theentire cross-section of the bone and is frequently

displaced (removed from normal position). In an

Incomplete fracture (eg, greenstick fracture), the

break occurs through only part of the cross-section of the bone.

A comminuted fracture is one that produces

several bone fragments.

A closed fracture (simple fracture) is one thatdoes not cause a break in the skin.


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An open fracture is one in which the skin or

mucous membrane wound extends to thefractured bone. Open fractures are graded

according to the following criteria:

Grade I is a clean wound less than 1 cm

long Grade II is a larger wound without extensive

soft tissue damage

Grade III is highly contaminated, has

extensive soft tissue damage, and is themost severe


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Specific Types of Fracture

Avulsion: a fracture in which a fragment ofbone has been pulled away by a ligament or

tendon and its attachment

Comminuted: a fracture in which bone has

splintered into several fragments

Compound: a fracture in which damage also

involves the skin or mucous membranes; also

called an open fracture

Compression: a fracture in which bone has

been compressed

Depressed: a fracture in which fragments are

driven inward (seen frequently in fractures of

skull and facial bones)


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Epiphyseal: a fracture through the epiphysis

Greenstick: a fracture in which one side of a

bone is broken and the other side is bent

Impacted: a fracture in which a bone fragment is

driven into another bone fragment

Oblique: a fracture occurring at an angle across

the bone (less stable than a transverse fracture)

Pathologic: a fracture that occurs through an

area of diseased bone (eg, osteoporosis, bone

cyst, Pagets disease, bony metastasis, tumor);

can occur without trauma or a fall


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Simple: a fracture that remains contained; does

not break the skin Spiral: a fracture that twists around the shaft of

the bone

Stress: a fracture that results from repeated

loading without bone and muscle recovery Transverse: a fracture that is straight across

the bone


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Clinical Manifestation

Pain

Loss of Function

Deformity Shortening

Crepitus

Swelling and discoloration


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Surgical

Management


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Reduction

Reduction of a fracture (setting the bone) refers

to restoration of the fracture fragments to

anatomic alignment and rotation.

Usually, the physician reduces a fracture as soon

as possible to prevent loss of elasticity from the

tissues through infiltration by edema orhemorrhage.

Before fracture reduction and immobilization, the

patient is prepared for the procedure; permission

for the procedure is obtained, and an analgesic isadministered as prescribed. Anesthesia may be

administered. The injured extremity must be

handled gently to avoid additional damage.


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Closed Reduction. In most instances, closed

reduction is accomplished by bringing the

bone fragments into apposition (ie, placing theends in contact) through manipulation and

manual traction. The extremity is held in the

desired position while the physician applies a

cast, splint, or other device

An open reduction and internal fixation (ORIF)

is a type of surgery used to fix broken bones.

This is a two-part surgery. First, the broken

bone is reducedor put back into place. Next,

an internal fixation device is placed on thebone; this can be screws, plates, rods, or pins

used to hold the broken bone together.


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Traction

Traction is a force applied in a specific direction

to: Reduce and immobilize fracture

To regain normal length and alignment of an

injured extremity

To lessen or eliminate muscle spasm

To prevent deformity

To give the patient freedom for in bed

activities

To reduce pain


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Running Traction is a form of traction in

which the pull is exerted in one plane

Skin traction is used in treatment of thehip fracture (Bucks extension) and

femoral shaft fracture (Russells traction)

Skeletal traction is applied by the

orthopedic surgeon under asepticconditions using wires, pins or tongs

place through the bone. Usually done in

treating fractures of the femur, humerus,

tibia fibula, and cervical spine


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Balance Suspension Traction

Uses additional weight to counterbalance

the traction force and floats the extremityin the traction apparatus


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External Fixation

Is a technique of fracture immobilization in

which a series of transfixing pins is inserted

through the bone and attached to a rigid

external metal frame.

Permits rigid support of severely

comminuted open fractures, and infectionsin the bones

Facilitates wound care

Allows early function of muscles and joints

Allows early patient comfort


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Nursing Management

Immobilize of the fracture site

Prevent Infection

Wound irrigation and debridement Wound care

Strict guidance of intake of

Antibacterial Medicines

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Traumatic Conditions