MSS Disorders: Trauma

1. MSS Disorders: Trauma

2. Trauma • Sprains, Strains, Dislocations • ACL Ligament Injury • Fractures

3. Sprains • Strains • Dislocations • See Handout

4. ACL Ligament Injury

5. The anterior cruciate ligament (ACL) is a tough fibrous structure that attaches the tibia (lower leg bone) to the femur (thigh bone). • This ligament helps to stabilize the knee by preventing excessive forward movement of the tibia on the femur.

6. Causes: • commonly occur in athletes participating in sports such as football, basketball, soccer, skiing and volleyball, where movements such as cutting, pivoting, single leg landing and rapid decelerations are routinely performed. • Tearing of the ACL is most commonly caused by landing awkwardly or cutting on a fully extended or slightly flexed leg with the foot turned outward.

8. S/S • Popping sound at time of injury • Swelling around knee joint • Limited ROM of knee • Inability to bear weight on affected leg

9. Diagnostics and Treatment • Diagnosis: clinical presentation & radiology tests • Treatment: surgery to reconstruct torn ligament or rehabilitate knee without surgery (won’t be able to resume high level activity). • Pre-0p rehabilitation: goal- reduce swelling and restore full ROM • Post-op rehab starts right after surgery: goal – reduce swelling & pain, work on ROM in progressive steps. May take 6-12 mos.

10. Fractures • Break in a bone • Bone Remodeling: begins within 48-72 hrs after injury • Fracture Healing Phases, p. 1066 • Hematoma forms • Fibroblasts and osteoblasts form callus • Osteoclasts absorb necrotic bone tissue • Osteoblasts continue to make new bone

11. Causes • Fall, MVA, crushing injury, bone disease (pathological fx.) • Contributing factors: poor nutrition, excessive consumption of carbonated beverages, certain drugs.

12. Classifications & Types • Complete - bone is broken into separate pieces – can sever blood vessels & nerves • Incomplete – bone does not divide • Displaced – bone is out of alignment • Open – (compound) bone breaks the skin • Closed – bone does not disrupt the skin • Types: Figure 46.1 p. 1067

14. Signs/Symptoms • Depends on fracture • Tenderness • Pain • Limb may be shortened • Deformity • Diminished ROM • Crepitation • Ecchymosis • Swelling • Wound

15. Emergency Treatment • Immobilize affected limb. Splint as it lies • Assess CSM distal to fracture • Standard x-ray, CT, MRI depending on type • Blood work – check H/H if bleeding, ESR, Ca • Assess all systems • ABCs • Treat bleeding, head or spine injury first

16. Fracture Management Goals: • Reduction (realignment) of bone ends • Immobilization of fractured bone • Prevention of deformity or further injury • Restoration of function • Promotion of early healing • Pain relief

17. HOW? • Closed Reduction • – most common intervention • MD pulls bone and manipulates back into proper position • http://www.youtube.com/watch?v=2wiIlT6_YLM&feature=related

18. Bandages & Splints • To immobilize • Perform neurovascular assessment

19. Casts • Materials used: Plaster of Paris, fiberglass • Plaster – used for large casts and weight bearing areas. Feels hot when first applied, takes 24-72 hrs to dry ( will appear shiny white, firm). Turn q 2h to promote even drying. PALM only when handling wet cast. • Fiberglass – dries quickly (within 30 minutes)

20. Elevate casted limb to reduce swelling • Observe for odor, tightness, drainage • May be cut if too tight or if there is a wound underneath • Nursing Care Box 46.2, p. 1069

21. Extremity Care After Cast Removal • Skin will be dry and flaky. • Muscles will be atrophied, weak with limited ROM. • Soak extremity to remove scales. • Move limb gently. • Support limb with pillows or orthotic device • PT, OT • Support stockings if ordered.

22. Traction • Application of a pulling force to a part of the body to provide fracture reduction (position bone in proper alignment • Purpose: reduction, reduce movement, and relieve pain. • Types: skin or skeletal • http://www.youtube.com/watch?v=2ZEWz_Ps7vo&feature=related • http://www.youtube.com/watch?v=lhYKoAwwY24&feature=related • http://www.youtube.com/watch?v=JS2S4lbteDw&feature=related

23. Buck”s Traction For hip fractures Used pre-op Relieves pain from muscle spasms Provides proper alignment

24. Buck’s Traction

25. Russell’s Traction Similar to Buck’s Extension A sling is added under the knee, this lifts the thigh Pull is in 2 directions Heel is off the bed

26. Russell's Traction

27. Bryant’s Traction Used for fracture of femur - Indicated for children less than two years old and 20-30 pounds

28. Bryant’s Traction

29. Nursing Care • Weights and Pulleys: • Must hang freely • Use prescribed amount of weight only • No knots on pulleys • Get help to reposition patient • Do not release weights for any care • Use fractured bedpan • Change bed linen from foot of bed working your way to HOB • Always maintain body alignment • HOB degree – check with hc provider • Use trapeze

30. Other nursing care: • Monitor skin integrity from irritation and/or shearing • Provide ROM to all other joints • Prevent DVT • Pain management • Prevent constipation • Divisional activities to counteract social isolation

31. Skeletal Traction

37. External Fixation

39. Hip Fracture • S/S: • Pain • Inability to stand or walk • Affected leg: • is shorter • Is externally rotated

40. ORIF • For Fractured Hip • Surgical procedure for open reduction (realignment of bone ends) • Followed by implantation of plates, screws or pins • Nursing Care, p.1072

42. Specific physical therapy treatments include range of motion, resistive exercises, flexibility, transfer training, balance exercises, bed mobility, and walking. Depending on the weight-bearing status set by the physician, a patient with ORIF or arthroplasty can either ambulate with toe-touch weight-bearing (TTWB) or weight-bearing as tolerated (WBAT). Usually, the patient will ambulate with a standard walker or rolling walker. By the first week after surgery the patient should be able to do active range of motion of the hip and perform isometric exercises of the knee and hip. Usually, the hip patient is trained on proper transfer techniques and toileting during the initial weeks of rehabilitation. The patient can ambulate with an assistive device and with assistance from a therapist. Strengthening exercises continue into the twelfth week that includes isometric and isotonic exercises to both the hip and knee. Again, weight-bearing continues from WBAT to full weight-bearing depending on the procedure and whether the fracture is stable.

43. Discharge Instructions after Surgical Repair of Hip Fracture • Do not flex hip more than 90 degrees • Do not cross legs • Get help putting on socks & shoes – another person, Velcro sneakers or mechanical aids

44. Complications of ANY Fracture • Nonunion – no healing of fracture • Malunion – malalignment of healed bone • Txs: bone grafting, US therapy • Circulatory impediment • Nerve damage • Monitor CSMs, neurovascular assessment, p.1054

45. Hemorrhage – assess for bleeding and check VS often • Infection – • DVT • Fat Embolism – fat globules from bone marrow are released into blood stream and travel to lungs. • s/s: alteration in MS, tachypnea, dyspnea , petechiae

46. Acute Compartment Syndrome – compression of muscles, nerves, blood supply from swelling • s/s: the “Ps” • Pain – severe • Parasthesia • Paralysis • Pallor • Pulselessness • Poikilothermia • TX: fasciotomy

47. Nursing Diagnoses • Acute Pain • Impaired Physical Mobility • Risk for Peripheral Neurovascular Dysfunction • Disturbed Body image • Risk for Injury • Self Care Deficit • Deficient Knowledge

48. Amputations • Surgical removal of body part • Why? • Ischemia from PVD, complications of DM • Trauma • Bone tumors, thermal injuries, congenital deformities, infection

49. Traumatic Amputation • Accidental amputations from… • If amputated body part is healthy, medical staff may attempt replantation. • This surgical procedure is performed by specialists who operate under a microscope. • What to do with amputated body part at scene of accident? • Wrap severed body part in a cool, lightly moist cloth & place in sealed plastic bag. The bag may be submerged in cold H2O for transport with person.