Sport Injuries: Acute and Overuse

• Fracture involves damage to the body's tissues due to sports or exercise.

Acute Sport Injury

• Occurs suddenly to previously normal tissue
• Injuries happen when force exceeds tissue strength (muscle, tendon, ligament, bone)
• Can be either direct or indirect injuries

Common Acute Injuries

• Includes shoulder dislocation
• Includes clavicular fracture
• Includes quadriceps strain
• Includes ankle Sprain

Direct/Contact Injury

• Caused by an external blow or force (extrinsic causes)
• Example: collisions with another person during sports (rugby, football)

Indirect/Non-Contact Injury

• Intrinsic causes involve what distance from impact site can impact injury
• The injury doesn't arise from physical contact but from internal forces due to over-stretching, poor technique, fatigue, or lack of fitness

Overuse Sport Injury

• Occur gradually due to excessive, repetitive tissue loading
• Early stages have little pain
• Repetitive microtrauma exceeds tissue's repair capacity

Common Overuse Injuries

• Includes bone strain, stress reaction, stress fracture (e.g., metatarsal stress fracture)
• Includes tibial stress syndrome (running, dancing)
• Includes lumbar stress fracture (gymnastics, cricket)

Fracture

• A break in bone's structural continuity
• Occurs from strong force impact
• Physical force is stronger than the bone

Pathologic Fracture

• Result of medical conditions weakening bone (osteoporosis, bone cancer, Osteogenesis imperfecta)

Closed Fracture/ Simple Fracture

• Bone breaks, but skin remains intact

Open Fracture/Compound Fracture

• Broken bone ends pierce the skin
• There is an increased risk of infection

Non-Displaced Fracture

• Bone cracks but maintains alignment

Displaced Fracture

• Bone snaps into separate parts that is not aligned straight

Fracture Pattern

• Includes linear fracture (thin line without distortion)
• Includes transverse fracture (straight line across bone)
• Includes oblique fracture (diagonal break)
• Includes spiral fracture ("twisting" force, spiral-shaped line)

Avulsion Fracture

• Bone fragment tears away from bone mass, ex: knee cap

Impacted Fracture

• Bone fragments driven into each other

Fragments

• Incomplete fracture: bone cracks but is not fully separated
• Complete fracture: bone breaks into two or more pieces
• Comminuted fracture: bone breaks into three or more pieces with fragments

Greenstick Fracture

• Is an incomplete fracture
• The bone portion is broken, the side bends

Fibrocartilaginous Callus Formation

• Osteoblasts and fibroblasts migrate to fracture to reconstruct bone
• Fibroblasts secrete collagen to connect bone ends
• Osteoblasts form spongy bone
• Fibrocartilaginous callus forms
• Granulation tissue (soft callus) forms a few days after fracture
• Capillaries grow, phagocytic cells clean debris

Bony Callus Formation

• New bone trabeculae appear in fibrocartilaginous callus
• Fibrocartilaginous callus converts into hard callus
• Bone callus begins 3-4 weeks after injury, continues until firm union for 2-3 months

Bone Remodeling

• Bone remodeling involves resorption by osteoclasts and replacement by osteoblasts
• Remodeling regulates calcium homeostasis, repairs micro-damage, shapes skeleton during growth
• Meds: Alendronate (Alendronic Acid), 70mg/tab

How to determine if bone has fully remodeled

• X-ray + absence of pain

Local Factors in Bone Healing

• Includes fracture characteristics
• Includes infection like with pain, swelling, pus
• Blood supply and color of fingernail

Systemic Factors in Bone Healing

• Includes advanced age, obesity, anemia, endocrine conditions, Steroids, malnutrition and smoking
• Wolff's Law: Bones remodel according to forces acting upon it

Principles of Nursing Management for Altered Coordination

• Requires planning
• The pain is managed
• ROM is maintained
• Improves physical mobility to prevent infection and injury

Implementation

• Use neurovascular 5P assessment, as:
• Pain
• Pulse
• Pallor
• Paresthesia
• Paralysis

Provide Pain Relief by

• Proper positioning and administrating prescribed medications

Promote Mobility and Prevent Infection through

• Prevention of infections and by ensuring the patient is well catered to and safe

Promotion of Self Care and Minimized Anxiety via

• Within limitations of injury and treatment regimen

Conditions That Cause Altered Coordination

• Hemiplegia: brain or spinal cord leads to paralysis on one side
• Quadriplegia: paralysis affecting all limbs
• Guillain-Barre Syndrome
• Multiple Sclerosis
• Myasthenia Gravis

Stages of Pressure Ulcers include;

• Stage 1: Non-blanching Erythema
• Stage 2: Partial Thickness Ulcer
• Stage 3: Full Thickness Ulcer
• Stage 4: Deep Tissue Destruction

Surgical Procedures For Orthopedic Cases

• Internal and External Fixation Surgery
• Open and Closed Reduction Surgery
• Amputation
• Bone Resection and Bone Grafting
• Tenorraphy
• Spinal Fusion

Internal Fixation

• Reconnects bones physically
• Surgeon attaches screws, plates, rods, wires, or nails inside bones to realign bones

External Fixation

• Holds fractured bone fragments with metal pins through fragments and compression device outside skin

Open Reduction Surgery

• Surgeons cut open the tissue, and realign the fracture fragments

Close Reduction Surgery

• It's a non-surgical procedure
• The bone frgamnets are realigned, in the proper position

Amputation

• Surgical removal of limb or extremity
• Reasons include, poor circulation, severe accidents, cancerous tumor, serious, infection, frostbite

General Types of Amputation

• Open or Guillotine amputations: All tissues are cut at the affected bone without creating flaps of soft tissue. Leaves open wound at stump
• Closed/Myoplastic/Flap Amputation: Site is closed with a flap of skin

Complications of Amputation

• Include Hemorrhage, infection, phantom limb, problems with immobility, flexion contracture

Nursing Consideration during Amputation

• Patient requires longer hospital stay

Amputation May Be Done Under

• General or spinal anesthesia

During Amputation

• Regular wound care and dressing changes are observed
• Monitors wound healing and any conditions that might interfere with healing
• Monitor the patient for phantom pain
• Provide emotional support, including counseling
• Activities to help restore the ability to carry out daily activities and promote independence
• Exercises to improve muscle strength and control
• Use of artificial limbs and assistive devices may begin 10-14 days after surgery and the sutures are alternately taken alternately
• Wounds should fully heal in 4-8 weeks

Bone Resection and Bone Grafting

• Bone spur is the removal of portion or growth of bone
• Indications include bone spurs, pain or inceasing joint range of motion

Bone Graft

• Surgical procedure that used the transplanted bone to repair and rebuild deceased or damaged bones

Bone Graft Risk included

• Infection
• Bleeding
• Blood clots
• Nerve damage
• Complications from anesthesia
• Infections from donated bone

Planter Fasciitis

• Happens due to Plantar Fascia being damaged

Spinal Fusion

• Surgery to permanently connect 2+ vertebrae of the spine
• To improve stability and correct a deformity

Nursing Spinal Consideration

• Monitor pain or signs of infection
• Warn the patient of possible blood clots in the legs