Musculoskeletal Injuries and Traction Techniques

Musculoskeletal Trauma Management

• Musculoskeletal trauma encompasses soft tissue injuries, strains, sprains, and dislocations.
• Soft tissue injury: Blunt force causes pain, swelling, and discoloration (ecchymosis).
• Strain: Pulled muscle injury; pain, edema, muscle spasm, ecchymosis, and loss of function are graded first, second, and third degree.
• Sprain: Ligament and supporting muscle fiber injury around a joint; pain (worsens with movement), edema, tenderness increase with ligament damage and joint stability.
• Dislocation: Articular surfaces of the joint lose contact, causing pain, change in contour, altered limb axis and length, and loss of mobility. Subluxation is a partial dislocation, showing less deformity.
• Contusion (Bruise): Blunt force injury to soft tissue; small blood vessels rupture, bleeding into tissues (ecchymosis/bruising).

Fracture Management

• Types of Fractures:
  • Closed (simple): No break in the skin.
  • Open (compound/complex): Wound extends to the bone. Grades (I-III) based on wound size and contamination. Grade III involves extensive soft tissue injury; potential for amputation. Intra-articular fractures extend into the joint surface of a bone.
  • Pathologic fractures occur in diseased bone (e.g., osteoporosis, cysts, Paget's, metastasis, tumors). Can occur without trauma or fall.
  • Other Types: Spiral, Comminuted, Greenstick, Transverse. (Illustrations describe these.)
• Manifestations of a Fracture:
  • Acute pain.
  • Loss of function.
  • Deformity.
  • Shortening of the extremity.
  • Crepitus.
  • Local swelling and discoloration.
  • Diagnosis by symptoms and radiography.
  • Patient typically reports an injury to the area.
• Emergency Management:
  • Immobilize the affected body part.
  • Splint proximal and distal joints to the fracture site.
  • Assess neurovascular status before and after splinting.
  • For open fractures, cover the wound with sterile dressings to prevent contamination. Do not reduce the fracture.
• Medical Management:
  • Fracture reduction: Restoration of fracture fragments to anatomic alignment.
    • Closed reduction: uses manipulation and manual traction.
    • Open reduction: Internal fixation devices (metal pins, wires, screws, plates) hold bone fragments in place.
    • Immobilization: external (casts, splints) or internal (fixations).
• Factors Affecting Fracture Healing:
  • Inadequate fracture immobilization.
  • Inadequate blood supply in the fracture site or surrounding tissue.
  • Multiple trauma.
  • Extensive bone loss.
  • Infection.
  • Poor adherence to prescribed restrictions.
  • Certain medications (e.g., corticosteroids).
  • Age >40 years.
  • Comorbidities (e.g., diabetes, rheumatoid arthritis).

Early Complications of Fractures

• VTE (Venous Thromboembolism): Associated with lower extremity and pelvic fractures, especially prolonged bed rest. (Deep vein thrombosis (DVT) and pulmonary embolism (PE)).
• Shock: Hypovolemia from hemorrhage, especially in pelvic and femoral fractures.
• Fat Embolism: Fat globules from the marrow enter the bloodstream and cause problems typically 24–72 hours after injury.
• Acute Compartment Syndrome: Increased pressure in a confined space (e.g., muscles) compromises blood flow; causes ischemia and potential irreversible damage if not addressed promptly. Clinical assessment using "5 Ps" (pain, pallor, pulselessness, paresthesia, paralysis) and immediate intervention (e.g., surgical decompression).

Delayed Complications of Fractures

• Delayed union, malunion, and nonunion
  • Delayed union: healing takes longer than expected
  • Malunion: healing occurs but bone is in improper position.
  • Nonunion: Healing fails; fracture sites do not unite.
• Avascular necrosis: Bone death due to loss of blood supply, leading to bony collapse and progressive joint pain, worsening upon movement and at rest.
• Heterotopic ossification: Abnormal bone formation in unusual locations, often after trauma, surgery, or prolonged immobility. High risk in young athletes.

Patient Assessment for Brace, Splint, or Cast

• Before Application: General health assessment, emotional assessment, current signs/symptoms and area condition. Neurovascular assessment. Treat lacerations and abrasions before immobilization. Explain the purpose of treatment and procedure.
• During Application #1: Monitoring: Regularly monitor neurovascular status (5 Ps) and for potential complications.
• During Application #2: Monitor and treat pain; describe site, character, and intensity; use elevation, ice packs, and analgesics as needed..

Potential Complications of Brace, Splint or Cast

• Acute Compartment Syndrome: Increased pressure in a confined area, compromises blood flow; leads to ischemia and irreversible damage. Clinical assessment of 5 Ps. Immediate treatment (e.g., surgical fasciotomy).
• Pressure Injuries: Inappropriate cast application; painful "hotspots," tightness. Inspection for breakdown.
• Disuse Syndrome: Muscle atrophy and loss of strength. Isometric exercises, muscle setting exercises.

External Fixation Devices

• Used for open fractures with soft tissue damage.
• Provide support to complicated/comminuted fractures.
• Patient requires assurance due to the external device appearance.
• Early mobility possible.
• Elevate to reduce edema.
• Monitor for infection. Pin care. Patient education is essential.

Traction

• Pulling or drawing force; used to manipulate and reduce fractures; still used today.
• Less common as surgical methods have improved.
• Can temporarily provide pain relief, reduce blood loss/shock, and prepare for definitive treatment, especially in children.
• Purposes: reduce muscle spasms, reduce/align/immobilize fractures, reduce deformities, and increase space between opposing forces. Can be skeletal or skin traction.
• Principles: Counterforce must be present. Traction should be continuous for reduction/immobilization.

Nursing Interventions for Traction

• Monitoring application and maintenance.
• Skin inspection.
• Palpation of traction tapes for tenderness.
• Assessment of sensation, movement, pulses, color, capillary refill, and temperature of fingers and toes.
• Observe for signs of DVT and infection.
• Active and passive foot/leg exercises.
• Special mattresses and pressure reduction devices.

Nursing Interventions for Patients with Amputations

• Assisting patient achieve mobility.
• Correct positioning of the limb. Avoid abduction and external rotations/flexion.
• Prone positioning for comfort.
• Proper assistive devices.
• ROM exercises.
• Muscle strengthening exercises.

Amputation

• May be congenital or caused by trauma or conditions such as vascular disease, infections, tumors, or trauma.
• Performed to control pain, disease process, improve function, and quality of life.
• Assessment: neurovascular status of affected and unaffected extremities, signs/symptoms of infection, nutritional status, concurrent health problems, psychological status, grief/coping, phantom limb pain.

Education

• Signs and symptoms to report: persistent pain or swelling, changes in sensation/movement/skin color/temperature, and signs of infection (redness, swelling, warmth, drainage) or pressure areas.
• Required follow-up care.
• Cast/device removal/aftercare instructions.

This quiz covers key concepts related to musculoskeletal injuries, including strains, sprains, and traction principles. Test your knowledge on symptoms, healing processes, and emergency indications in injuries such as dislocations and fractures. Perfect for students in healthcare and physical therapy fields.