Common Musculoskeletal Injuries: Fracture (University of Damanhur, 2021-2022) PDF

# Common Musculoskeletal Injuries: Fracture ## University of Damanhur - Faculty of Nursing - Medical - Surgical Nursing II - 2021-2022 ## Prepared by: - Assist. prof. Dr. Azza Ibrahim Abd Elkader Habiba. - Assistant professor of Medical-Surgical Nursing ## Common Musculoskeletal Injuries: Fractur...

# Common Musculoskeletal Injuries: Fracture ## University of Damanhur - Faculty of Nursing - Medical - Surgical Nursing II - 2021-2022 ## Prepared by: - Assist. prof. Dr. Azza Ibrahim Abd Elkader Habiba. - Assistant professor of Medical-Surgical Nursing ## Common Musculoskeletal Injuries: Fracture - **Introduction** - **Common musculoskeletal injuries** - Contusion, strain, sprain. - Joint dislocations & subluxation - **Management of contusions, strains, sprains, joint dislocations and joint subluxation** - **Definition of fractures** - **Causes of fractures** ## Fracture - Consequences/effects of fracture to bone & adjacent structures - Types & clinical manifestations of fractures. - Diagnosis of a fracture. - Emergency management. - General treatment of fractures in hospital. - Nursing management. - Factors affecting fracture healing. - Fracture healing complications. ## Introduction - Fracture is one of the most common traumatic injuries all over the world. - It may occur any age, any time in both sexes. - Fracture consequences affect all body parts mainly the musculoskeletal system. - Fracture usually includes bone and other adjacent structures as muscle, tendons, ligaments, blood vessels, nerves & skin. ## Common Musculoskeletal Injuries - Contusion. - Strain. - Sprain. - Joint dislocations. - Subluxation - Fracture ## Contusion - It is a soft tissue injury produced by blunt force (as blow, kick, or fall). - Small blood vessels ruptured & bleed into soft tissues (ecchymosis, bruising). - A hematoma develops when the bleeding is sufficient to cause marked collection of blood (causing local pain, swelling, and discoloration). - Most contusions resolve in 1 to 2 weeks. ## Strain - Strain, or a “pulled muscle," is an injury to a muscles and tendon caused by overuse, overstretching or excessive stress. - Its manifestations depend on the degree of strains. ## Sprain - It is an injury to ligaments (that stabilize bones) and supporting muscle fibers that surround a joint. - It is caused by sudden twisting motion. - A torn ligament loses its stabilizing ability. - Blood vessels rupture & edema occurs; joint tender, painful movement. - The degree of disability and pain increases during the first 2 to 3 hours after the injury because of associated swelling and bleeding. - Sprains manifestations depend on its degree. ## Management of Contusions, Strains, and Sprains - Resting & elevating affected part to _______ - Applying intermittent ________ compress during the first 24 to 48 hours after injury to _______ - Intermittently ______ application after 24 hours to _______ - Avoid weight bearing _______ - An elastic compression bandage controls bleeding, reduces edema ?, provides support for injured tissues. - Immobilization by cast may be used ________ - Simple and gradual motion as prescribed with adequate support. - No bandage if edema present ??? - Monitor neurovascular status (motion, sensation, circulation ????) of injured extremity frequently. - Surgical intervention may be needed. - Depending on severity of injury, simple, gradual and progressive passive and active exercises may begin in 2 to 5 days ?????? - Proper use of body mechanics ???? ## Joint Dislocations - It 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." - The associated joint structures, blood supply, and nerves are distorted and severely affected. ## Medical Management of Dislocation & Subluxation - Immobilization - Reduction (i.e. displaced parts are brought into anatomical position - Analgesia, muscle relaxants, and possibly anesthesia are used to facilitate closed reduction (manual reduction). ## Management of Dislocation & Subluxation - Immobilization by bandages, splints, casts, or traction and in a stable position. - Neurovascular status is monitored. - After reduction, if the joint is stable, gentle, progressive, active and passive movement to preserve range of motion (ROM) and restore muscle strength. - Support joints during exercise sessions. ## Fractures (FRX or FX, Fx, or #) - It is a break in the continuity of bone and is defined according to its type and extent. - Fractures occur when the bone is subjected to stress greater than it can absorb ????? ## Fractures Could Be - Traumatic as direct blows, crushing forces, sudden twist and extreme muscle contractions. - Pathological fracture (bone disease as osteoporosis, bone cancer...etc). ## Consequences/Effects/Results of Fracture - Soft tissue edema. - Hemorrhage into the muscles, joints or internal bleeding. - Joint dislocations. - Tear in ligament and tendons. - Nerve injury. - Damaged blood vessels. - Internal organ trauma. ## Types of Fractures - **According to the anatomic site of fragments.** - **According to associated injuries.** - **According to appearance on X-ray.** ## Types of Fractures According to the Anatomic Site of Fragments - Fracture is named by the name of the fractured bone as # femur. ## Types of Fracture According to Associated Injuries - **Closed Fracture (Simple #):** broken bone without skin injury. - **Open Fracture:** (compound/complex #): broken bone with an open wound on fracture site, with or without bone protruding through it. - More dangerous # ???? Why ??? ## According to Appearance on X-ray - **Complete fracture:** involves a break across the entire cross-section of the bone and is frequently displaced (removed from its anatomical position). - **Green stick fracture (incomplete fracture):** usually occurs in children whose bones are still pliable/soft (like green sticks). A break occurs straight across part of the width of the bone. The break through only part of the cross-section of the bone. - **Transverse Fracture:** cuts across the bone at right angles to its long axis. - **Oblique Fracture:** The fracture line crosses the bone at an oblique angle. - **Comminuted Fracture:** bone is fragmented into more than two bone fragments. - **Impacted Fracture:** The broken ends of the bone are driven into each other/jammed (interfered) together. - **Spiral Fracture:** The fracture line has the appearance of a spiraling: twisting curve. - **Linear fracture:** A fracture that is parallel to the bone's long axis. - **Compression fracture/Wedge fracture:** usually occurs in the vertebrae, is a collapse of a vertebra due to osteoporosis or trauma as a fall from height. - **Avulsion fracture:** A fracture where a fragment of bone is separated from the main mass usually by the force of muscles and tendons. ## Clinical Manifestations - **Acute pain:** continuous and increases in severity until the bone fragments are immobilized. - **Loss of function:** the extremity cannot function properly because normal function of the muscles depends on the integrity of the bones. Pain contributes to loss of function. Abnormal movement may be present. - **Deformity:** Displacement or rotation of fracture fragments (either visible or palpable). Deformity also results from soft tissue swelling. - **Shortening of the extremity:** In fractures of long bones, there is actual shortening of the extremity because of the contraction of the muscles. The fragments often overlap by as much as 2.5 to 5 cm (1 to 2 inches). - **Crepitus:** When the extremity is examined with the hands, a grating/ crack sensation, called crepitus, can be felt. It is caused by the rubbing of bone fragments against each other. - **Local swelling and skin discoloration:** Localized edema and discoloration of the skin (ecchymosis) occur after a fracture as a result of trauma and bleeding into the tissues. These signs may not develop for several hours after the injury. ## The Diagnosis of a Fracture - **History of the injury, medical, orthopedic history.** - **Physical examination for signs & symptoms.** - **Diagnostic studies according to type and site of fracture includes:** - X-ray findings. - CT. - MRI. ## Emergency Management - Call emergency (123). - Stop injury process if possible. - Establish and maintain patent airway. - Control hemorrhage if present with gentle pressure over the fractured site. - Reassurance. - Immobilize the fractured body part before moving the patient. - Using splints before moving the patient, the extremity is supported distal and proximal to the fracture site to prevent rotation. - Splints (as rolled newspaper, wood, plastic, iron ...etc), to immobilize fracture. - It may be accomplished by bandaging the legs together, with the unaffected extremity serving as a splint for the injured one. - In an upper extremity injury, the arm may be bandaged to the chest, or an injured forearm may be placed in a sling. - The clothing is best removed from the area of any suspected fracture or dislocation. - Undress unaffected limb first then the affected limb ????? if needed. - Note and record motion and sensation status distal to the site of injury. - The splint should immobilize the joints above and the joints below the fracture. - Cover all wounds with dry sterile dressing before applying a splint. - Pad the splint to prevent local pressure. - Frequent assessment of neurovascular status ??? distal to the injury should be assessed both before and after splinting to determine the adequacy of peripheral tissue perfusion and nerve function. ## General Treatment of Fractures in Hospital - **Reduction:** restoration of the fracture fragments to anatomic alignment: - **Closed reduction:** bringing bone fragments into apposition (placing the ends in contact) through manipulation and manual traction. X-rays are obtained to verify it. - **Open reduction:** a surgical approach: fracture fragments are reduced. Internal fixation devices (metallic pins, wires, screws, plates, nails, or rods) to hold bone fragments in position until solid bone healing occurs. - **Immobilization:** to hold bone fragments in anatomical position and alignment, until union occurs. Immobilization may be accomplished by external or internal fixation: - **External fixation:** includes bandages, casts, splints, continuous traction, and external fixators. - **Metal implants used for internal fixation:** serve as internal splints to immobilize the fracture. ## Nursing Management - General care of patient with #. - Care of patients with closed #. - Care of patients with open #. ## General Care of Patient With Fractures - Edema is controlled by elevating injured extremity, applying ice as prescribed (first 24 hours only) ????. - Neurovascular status (movement, sensation, circulation) is monitored, notify orthopedic surgeon immediately if neurovascular compromisation noted. - Restlessness, anxiety, discomfort are controlled with a variety of approaches, such as reassurance, position changes, and pain relief strategies (as analgesics). - Isometric and muscle-setting exercises (to affected and unaffected part) are encouraged to ???????? - Participation in activities of daily living (ADLs) is encouraged with adequate support and assistance as prescribed to ????? - Weight bearing as prescribed. - Gradual resumption of activities is promoted within the therapeutic prescription. - With internal fixation, the surgeon determines the amount of movement and weight-bearing stress the extremity can withstand and prescribes the level of activity. ## Care of Patients With Closed Fracture - Encourage patients to return to their usual activities as rapidly as possible. - Teaches the patient how to control edema and pain by affected limb elevation and using sling as needed. - ROM exercises and isometric exercises for ?? - Teach patient using assistive devices (eg, crutches, walker, and canes). - Teach patient home care including hygiene, diet. medication and mobility. ## Care of Patients With Open Fractures - Because risk for osteomyelitis, tetanus, gas gangrene; prevention of infection is essential by: - Using strict aseptic technique in dressing. - Administration of tetanus prophylaxis if indicated. - Administer prophylactic antibiotics. - Early detection and treatment of infection. - Elevate the extremity to minimize edema. - Scheduled assessment of neurovascular status in the injured part. - Same care as in closed fracture. ## Factors Affecting Fracture Healing - The reduction of fracture fragments. - Immobilization of the fracture part. - Adequate blood supply to affected part. - The type of fracture. - Associated medical condition of patient. - Patient's age. - First aid after fracture. - Presence of infection. - Nutritional status. ## Fracture Healing Complications - **Early complications** - **Delayed complications = healing complications** ## Early Complications Includes - **Shock:** Hypovolemic shock resulting from ?? - **Fat embolism:** in long bones or pelvic bones fracture fat particles (emboli) within bone marrow may diffuse into the vascular compartment. It may occlude small blood vessels that supply the lungs, brain, kidneys. - **Compartment syndrome:** an area of body that covered with muscle fibers occurs when pressure on this area increase causing poor blood supply distal to affected area (5 Ps????). - **Compartment syndrome:** includes the "5 Ps:" pain, paralysis, paresthesias, pallor, and pulselessness. - **Venous thromboemboli:** (DVT, pulmonary embolism). - **Infection:** which can lead to septicemia lately. ## Delayed/Healing Complications Includes - Delayed union. - Malunion. - Nonunion/ununion. - Avascular necrosis of bone. - Complications of fixation devices. ## Thank You The document is a lecture presentation on common musculoskeletal injuries, specifically focusing on fractures. It outlines the definition, causes, types, diagnosis, management, and complications of fractures with a section on how to care for patients with closed and open fractures.