Injuries, Fractures, Skeletal System Review

Injuries and Altered Coordination

• Fractures are typically caused by trauma, falls, car accidents, or sports injuries

Review of the Skeletal System

• The skeletal system involves bones, joints, cartilage, and ligaments
• It provides structural support, enables movement through muscle interaction, and protects vital organs
• It also produces blood cells in bone marrow and stores minerals like calcium
• Bones are the skeleton's main structural units, consisting of compact, cancellous bone, and the periosteum

Bone Fractures Explained

• Bone fractures and broken bones are the same injury that describes a broken bone
• Bone fractures and bruises are painful injuires caused by strong forces; the difference is the severity of the bone damage
• Common sports injuries include bone fractures and sprains
• A sprain occurs when ligaments are stretched or torn

Classifications of Fractures

• Fractures can be classified by pattern, cause, and body part

Oblique Fractures

• Occur when a bone breaks at an angle and are referred to as complete fractures
• The break line goes all the way through the bone
• Oblique fractures commonly affect long bones like the femur, tibia, fibula, humerus, radius, ulna, and clavicle

Transverse Fractures

• These fractures run horizontally, perpendicular to the bone's direction
• They are also referred to as complete fractures because the break line goes through the bone
• Commonly affect long bones such as the femur, tibia, fibula, humerus, radius, ulna, and clavicle

Greenstick Fractures

• This type of fracture occurs when a bone bends enough to crack but doesn't break entirely into multiple pieces
• Greenstick fractures usually affect longer bones, including the humerus, radius, ulna, phalanges, femur, and fibula

Comminuted Fractures

• This type are fractures where the bone is broken into at least two places
• These fractures can affect any large or long bone in the body
• Some common bones that can be affected are the femur, tibia, fibula, humerus, radius, ulna, clavicle, and skull

Segmental Fractures

• They occur when a bone breaks in at least two places, creating a segment fully separated by the breaks
• Segmental fractures tend to affect long bones like the femur, tibia, fibula, humerus, radius, and ulna

Spiral Fractures

• These fractures happen when a bone breaks due to a twisting motion, creating a corkscrew-like fracture line
• They are also referred to as complete fractures as the break runs completely through the bone
• Spiral fractures usually occur in long bones in the body like the femur, tibia, fibula, talus, humerus, radius, ulna, phalanges and metacarpals

Stress Fractures

• Stress fractures involve small cracks in a bone
• Stress fractures are fractures that happen when something puts too much stress on your bone
• They are most likely to happen in the lower leg (tibia and fibula), foot and heel

Avulsion Fractures

• They’re fractures where a small piece of bone attached to a tendon or ligament gets pulled away from the main part of the bone
• Avulsion fractures may occur in the elbow, ankle, foot, knee, fingers, wrist, pelvis, spine and hip

Buckle/Impacted Fractures

• These fractures usually affect children
• They're incomplete fractures where the break doesn't go completely through the bone
• Buckle fractures are possible in the femur, tibia, fibula, or humerus

Clavicular Fracture

• The clavicle can crack in one or several regions
• If broken in multiple locations, it is called a comminuted fracture
• Displacement of fractured collarbone pieces determine if it its called a displaced fracture

Shoulder Fracture

• Occurs in a broken bone of the shoulder joint

Oblique Fracture Symptoms

• Symptoms may include pain, swelling, tenderness, loss of function, bruising, discoloration, and deformity

Treatment for Fractures

• Immobilization with traction and casting
• Closed reduction
• Surgical intervention such as internal and external fixation
• Arthroplasty
• Bone grafting

Traction

• In medical terms, traction is the application of a pulling force to a body part to treat injuries or disorders
• It is used to treat bone and muscle injuries like fractures, dislocations, and muscle spasms
• It is utilized on the arms, legs, pelvis, or spine for short-term or long-term treatment
• Pulling force is balanced by an opposing force

Purpose of Traction

• It is to realign broken or dislocated joints
• To keep a joint stable, prevents or controls muscle spasms
• Treats long-term issues such as spinal stenosis, degenerative disk disease, and scoliosis

Types of Traction

• Skin traction (buck traction) involves strapping the affected limb and attaching weights
• Skeletal traction involves inserting a K-wire through a bone

Nursing Responsibilities for Patients in Traction

• Inspecting/cleaning skin and pin sites, applying dressings, and preventing soft-tissue breakdown
• Ensuring a patient is positioned correctly
• Assisting with range of motion exercises for unaffected body parts
• Monitoring nutritional status, encouraging a balanced diet, and ensuring hydration
• Providing client education and promoting deep-breathing exercises
• Monitoring vital signs for the patient
• Ensuring the traction weight bag is hanging freely, replacing frayed ropes, and keeping the rope in the pulley tracks
• Keeping blankets and sheets away from traction ropes, keeping bed side rails up and locked, and preventing patient movement in bed

Casts

• Casts are used to immobilize a broken bone or injured area to help it heal
• Padding and stockinette should apply light pressure
• Consider adding extra padding to swollen forearms to alleviate pressure spots
• If numbness, tingling, or tightness develops after discharge, seek immediate medical attention

Application of Casts

• To immobilize a body part in a specific position
• To put uniform compression on soft tissue
• Provides early mobilization of unaffected body parts
• To keep the bone in place and stabilizes unstable joints

Cast Materials

• Plaster casts mold very smoothly but take 24-72 hours to dry, giving off heat
• Fiberglass casts are dry in 10–15 minutes and can bear weight in 30 minutes
• Polyester-cotton knit casts take 7–10 minutes to dry and can withstand bearing weight

Cast Types

• Short arm casts are for wrist and forearm fractures
• Long arm casts are for upper arm, elbow, or forearm fractures
• Shoulder spica casts are for shoulder dislocations or after shoulder surgery
• Short leg casts are for lower leg fractures, ankle fractures, or severe ankle sprains
• Leg cylinder casts are for knee or lower leg fractures, knee dislocations, or after leg or knee surgery
• Cast braces are made of hard plastic with soft pads
• Splints are made of plaster or fiberglass slabs that hold the injury still

Assessment for Patients with Casts

• Evaluate the client's pain with a focus on severity, nature, location, source and the exacerbating factors
• Assess neurovascular status
• Inspect and document any skin lesions, discoloration, or removable foreign material
• Evaluate the client ability to learn essential procedures

Possible Nursing Diagnosis for Patients with Casts

• Deficient knowledge related to the treatment regimen may be necessary
• Acute pain related to the musculoskeletal disorder related to the injury
• Physical immobility may lead to bathing,hygiene, and dressing deficit
• Related skin issues may occur due to lacerations
• Risk of neurovascular dysfunction

Nursing Management of Casts

• Clean the skin of the affected part thoroughly, explain the procedure and obtain informed consent if surgery is required
• Support an exposed cast to prevent indentations
• Ensure that the stockinet is free and clear of the area
• Elevate the casted extremity above the heart and expose the affected portion
• Refrain from wetting cast, and dry patient's synthetic cast with a hair dryer on cool setting

Management Steps for Cast Care after Application

• Encourage position changes
• Elevate the affected area & administer prescribed pain medications
• Promote non-pharmacological pain relief measures, such as guided I magery, relaxation and distraction
• Observe for signs and symptoms of cast syndrome

Observations for Cast Syndrome

• Note any reports of abdominal pain and distension
• Note any reports elevated blood pressure, tachycardia, and tachypnea among other issues due to cast syndrome
• Note any client who is claustrophobic as they may be at risk for psychological cast syndrome.
• Provide care for compartment syndrome and notify health care workers regarding neurovascular complications

Important Steps to Teach Clients with Casts

• Isometric exercises to strengthen muscles covered by the cast
• The importance of promptly reporting cast breaks, warning patients about sharp objects, and teaching appropriate cast care

Acute Compartment Syndrome

• It results from increased pressure in a muscle compartment
• It can lead to muscle and nerve damage and problems with blood flow
• Thick layers of tissue, called fascia, separate groups of muscles in the arms and legs, and muscles, blood vessels, and nerves are located here
• Fascia does not expand, which leads to increased pressure

Symptoms of Acute Compartment Syndrome

• Pain: Out of proportion to an injury and worsened with passive stretch
• Paresthesia: Tingling or a pins and needles feeling
• Pallor: Pale skin as a result of reduced blood flow
• Pulselessness: Occurs in only late stages when pulses may still be present
• Paralysis: Sign of late stages

Treatment for Acute Compartment Syndrome

• Prevent permanent damage and immediate surgery
• The surgery that will be performed is called a fasciotomy
• Important nursing considerations are if a cast or bandage is too tight, stopping repetitive exercises, and raising the affected area above the heart

Closed Reduction

• A non-surgical procedure that realigns a broken or dislocated bone without surgery
• It is performed by an orthopedic surgeon within emergency room or primary care provider
• Healthcare professional will apply force in traction to the affected area
• The broken bone is manipulated and placed in its normal position

After Care for Closed Reduction

• A cast or splint is placed to promote healing and can take 8–12 weeks
• May experience some mild bone pain and may have nerve damage

Possible Complications and Concerns for Closed Reduction

• Nerve damage and vascular injury
• Movement of fat particles and development of blood clots

When to Contact a Doctor After A Closed Reduction

• Report any Persistent pain, swelling, redness and changes to skin

Internal Fixation

• A surgical procedure that uses metal implants to stabilize broken bones
• It is often part of an open reduction (ORIF) procedure
• Techniques include rods placed through the bone that holds everything together, along with pins and wires

Aspects of Nursing Care for Internal Fixation Patients

• Assessment and monitoring of surgical sites, vital signs, and the neurovascular status
• Manage pain with pain killers and non-pharmacological treatments/techniques
• Maintain clean and dry dressings on the site and patient education is crucial

Mobility and Psychosocial Aspects In Nursing Care Post Internal Fixation

• Assist with ambulation and physical therapy
• Explain postoperative plans and educate the patient
• Address anxiety and provide reassurance

External Fixation

• A surgical procedure that uses a rigid frame to stabilize broken or dislocated joints
• The frame is attached with pins or wires through the skin
• Important to educate and ensure families care and clean the affected external area

Care for Patients with an External Fixator

• Change dressings as needed and Elevate the limb to reduce swelling
• Remove crusting and adhere to treatment plans given
• Consider the impact of this device on the patient, their mental health
• Provide patients with proper direction, support, and specialist

Arthroplasty

• Surgical procedure that replaces a damaged joint with an artificial joint

Common Types of Arthroplasty

• Hip and knee replacement
• Total joint replacement of the ankle including elbow
• Also finger replacements and should arthroplasty available

Important Nursing Actions in Arthroplasty Care

• Prepare for the surgery & rigorously check all bed linens
• Check Balkan frame to ensure it is suitable

Possible Complications That May Result From Osteoplasty

• Infections may occur if post-operative care is not followed
• Issues with dislocation and fractures may occur due to movement

Sports Injuries

• Sports injuries can be caused by trauma or from overuse of muscles, including sprains/strains, and fractures
• Bruises are caused by blunt force and sprains
• These are stretches or tears of the ligaments that affect the ankles, knees, or wrists
• Strains will cause the twisting or tearing the muscles, fractures that cracked the bone, dislocations, mild brain injury will lead to concussions

Anterior Cruciate Ligament Tear (ACL)

• ACL is a tearing of a ligament that connects the ligaments to the femur to the tibia
• Commonly occurs in sports because of sudden changes in direction and movement can cause a large shock to your musculoskeletal frame

Risk Factors for Causing ACL:

• Gender - the most prominent risk factor caused by difference in structure or hormone levels
• Poor conditioning & footwear are other important points that may result in ACL
• You can prevent ACL injury by working on exercises and leg strength