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Orthopedic Trauma

Orthopedic Trauma. Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!.

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Orthopedic Trauma

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  1. Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON

  2. Name that Injury!

  3. Name that Injury!

  4. Name that Injury!

  5. Name that Injury!

  6. Name that Injury!

  7. Name that Injury!

  8. Name that Injury!

  9. Name that Injury!

  10. Name that Injury!

  11. Name that Injury!

  12. Name that Injury!

  13. Name that Injury!

  14. Associated Conditions • Hemorrhage – Shock (~2L pelvis, 1L thigh & 500 ml tibia) • Instability • Loss of tissue • Laceration with contamination • Interrupted blood supply – Ischemia • Nerve damage • Long-term Disability

  15. Sprains • Partial tear of a ligament by twisting & stretching of a joint beyond normal ROM • 1st Degree Sprain – No instability, few fibers torn. Minimal hemorrhage & swelling • 2nd Degree Sprain – No instability, ligaments partally torn, swelling and hemorrhage • 3rd Degree Sprain – Unstable, ligaments completely, with significant swelling & hemorrhage.

  16. Sprained Knee

  17. Strains & Ruptures • Strain - Injury to a muscle or tendon from overexertion (back, arms, calf) • Severe strains can cause bone avulsion

  18. Joint Dislocations • Dislocation – Articulating surfaces of 2 bones are displaced • Luxation – Complete dislocation • Subluxation – Incomplete dislocation • Rotator Cuff injuries – Usually deltoid • Common sites • Shoulders, elbows, fingers, knees, & ankles • Complications • Posterior popliteal injury

  19. Principles of Splinting (p. 1238) • Splint joints and fractures above & below injuries • Cover open fractures • Document pulses, sensation, motor function before & after splinting • Stabilize the limb with gentle in-line traction to a position of normal alignment • Immobilize dislocations in a position of comfort with • Ice, cold compresses • Elevation – to or just below level of heart

  20. Shoulder Injuries • Dislocations • Subluxations • Rotator cuff tendon injuries • Sternoclavicular strain • Treatment • Neurovascular status • Splint in position found or • Sling & secure to body • Ice or cold compresses

  21. Elbow Injuries • Falling on an outstretched arm or flexed elbow • Pulled elbow – Nursemaids elbow from a sudden lateral force • Athletic injury • Complications • Volkmann’s contracture – Claw-like contraction of hand & arm deformity from ischemia • Laceration of brachial artery • Ulnar nerve damage • Treatment • Check neurovascular status • Splint in position found • Ice or cold compresses

  22. Radial, Ulnar, Wrist Injuries • Check neurovascular status • Splint in position found (rigid or formable • Ice & elevation

  23. Hand Injury • Boxer’s fracture 5th metatarsal bone • Treatment • Check neurovascular status • Splint (rigid or semiformable) in position of function • Ice & elevation

  24. Finger Injuries • Assess neurovascular status • Splint in foam filled aluminum splint, with tongue blades, or tape to adjacent finger • Ice & elevation

  25. Pelvic Injuries Signs & Symptoms • Pain • Hypovolemic shock • Shortening or abnormal rotation of affected extremity • Associated with injuries to the bladder, urethra, reproductive organs & sacral nerves

  26. Pelvic Injuries Treatment of Pelvic Fractures/Ring Injuries • Open book – Vacuum mattress, Pelvic Binder, or sheet • Control hemorrhage – Direct pressure or close pelvic ring • Fluid volume replacement – Normal Saline (ED - PRBC, FFP, Platelets., Factor VII A &/or embolization) External fixation/ORIF

  27. Classification of Long Bone Injuries • Fractures • Complete or incomplete • Open or closed • Epiphyseal – Cause bending or deformity • Comminuted – Several breaks in the bone • Greenstick - Break in periosteum w/i bowing or buckling • Spiral – Twisted or circular break. ↑ child abuse • Oblique – Diagonal, slanting break • Transverse – Right angle fracture • Pathological

  28. Long Bone Fractures Pathophysiology • Femur fractures result from major force • Long bone fractures from falls, MVC, MCC • Femur neck fractures common in elderly • Blood loss into a femur – 1,000-1,500 ml

  29. Long Bone Fractures Signs & Symptoms • Pain • Ecchymosis & edema of the site • Deformity at the site • Shortening of affected extremity • Internal or external rotation • Hypovolemia or hypovolemic shock

  30. Long Bone Fractures Assessment • Circulation – Hemorrhage or ischemia • Neurovascular status • Pulses • Deformity – Edema, hematoma, wounds • Compartment Syndrome • 6 P’s – Pain, Pallor, Parasthesia, Pulses, Paralysis, Pressure

  31. Long Bone Fractures Treatment • Immobilize • Splint • Control pain • Realign – In ED • Skeletal traction – (In ED) Usually temporary. Weights must hang free, meticulous skin care • External fixators • ORIF

  32. Splinting • Types of splints • Rigid splint – body part fit to splint design • Soft or formable splint – molded to shape or configuration of the body part • Traction splint – (Femur fractures) – traction to stabilize and align

  33. Open Fractures Signs & Symptoms • Evidence of skin disruption over a fracture • Protrusion of bone through an open wound • Pain • Neurovascular compromise • Bleeding

  34. Open Fractures Treatment • Cover the wound • Splint • ED or OR Wound cleansing & debridement • Realignment • Splint/Cast • External fixation • ORIF • Complications -osteomyelitis, cellulitis

  35. Techniques for Realignment • Finger realignment • Shouldar realignment • Hip realignment • Knee realignment • Ankle realignment

  36. Jumper Syndrome • Vertical deceleration • Forces transmitted upwards from lower extremities, pelvis, spine, chest • Lower extremity fractures & spinal cord injuries • Retroperitoneal hemorrhage is the most common cause of shock

  37. Amputations Classification • Partial • Complete • Usually involves digits, foot, lower leg, hand or forearm • Life over limb considerations

  38. Amputations Classification • Partial • Complete • Usually involves digits, foot, lower leg, hand or forearm • Life over limb considerations • Re-implantation (Favorable in Peds & with guillotine-type amputations)

  39. Amputations Signs & Symptoms • Obvious tissue loss • Pain • Bleeding • Hypovolemic shock

  40. Amputations Treatment • Reattachment • Amputation • Rehabilitation • Prosthesis Clinic Assessment & Care • Keep body part bagged not directly on ice

  41. Compartment Syndrome Signs & Symptoms • Pain disproportionate to injury • Sensory deficit • Progressive muscle weakness • Tense swollen area • Elevated compartment pressures • Loss of pulses

  42. Compartment Syndrome Treatment • Elevation of limb not above heart level • Placement of an intracompartmental monitor • <20 = normal • >20 = ischemia • > 30 = necrosis • Fasciotomies to release the pressure

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