Exam 3 Study Guide - Musculoskeletal Trauma

Question 1

Fracture

Answer 1

• Break or disruption in continuity of a bone tht often affects mobility & sensory perception
• Classified by extent of break

Question 2

Complete Fracture

Answer 2

Break is across entire width of bone; bone is divided into 2 distinct sections

Question 3

Incomplete Fracture

Answer 3

Break is only through part of the bone

Question 4

Open or Compund

Answer 4

Skin surface over broken bone is disrupted & causes an external wound

Question 5

Closed or Simple

Answer 5

Does not extend through skin & therefore has no visible wound

Question 6

Pathologic (spontaneous) Fracture

Answer 6

Occurs after minimal trauma to a bone tht has been weakened by disease

Question 7

Fatigue (stress) Fracture

Answer 7

Results from excessive strain & stress on bone

Question 8

Compression Fracture

Answer 8

• Produced by a loading force applied to long axis of cancellous bone
• Commonly occur in vertebrae of older pts w/ osteoporosis

Question 9

Complication of Fractures - Acute Compartment Syndrome

Answer 9

• Incrd pressure w/in 1 or more compartments reduces circulation to area
• Pressure can be external or internal
  > external: tight, bulky dressings/casts
  > internal: blood or fluid accumulation
• Complication
  > infection
  > persistent motor weakness
  > contracture
  > myoglobinuric renal
  > amputation in extreme cases
• Early signs of acute compartment syndrome: pressure, paresthesia, pallor, paralysis
• Late signs: pain, cyanosis, dcrd pulses, pulselessness (rare), necrosis

Question 10

Complication of Fractures - Crush Syndrome

Answer 10

• Systemic complication
  > results from severe or prolonged pressure, hemorrhage, & edema after a severe fracture or crush injury
• Myoglobin is released into circulation, where it can occlude distal renal tubules & result in kidney failure
• Rhabdomyolysis: myoglobulin in bloodstream
• Priority of care is to prevent Acute Tubular Necrosis
• Hypovolemic Shock
  > from blood loss
• Venous Thromboembolism
  > DVT & PE

Question 11

Complication of Fractures - Fat Embolism Syndrome

Answer 11

• Fat globules are released from yellow bone marrow into bloodstream w/in 12-48hrs after an injury or illness
  > globules clog small blood vessels tht supply vital organs & impair organ perfusion
• Early Signs:
  > altered mental status (earliest sign)
  > incrd resps, pulse, & temp
  > chest pain
  > dyspnea
  > crackles
  > low arterial oxygen lvl
• Petechiae is a classic mani, but is usally last sign to develop
• Can result in resp failure or death, often from pulm edema

Question 12

Complication of Fractures - Infection

Answer 12

• Superficial skin wound infections
• Deep wound abscesses
• Bone infection (osteomyelitits)
• Clostridial infections can lead to gas gangrene or tetanus & may result in loss of extremity

Question 13

Complication of Fractures - Chronic Complications

Answer 13

• Ischemic necrosis
  > from loss of blood supply to bone
• Delayed Union
  > fracture tht has not healed w/in 6mnths of injruy

Question 14

Fractures - Assessment

hx
CMs

Answer 14

• Hx
  > mechanism of injury
  > med hx: DM, osteoporosis, CKD
  > drug hx; including substance abuse
• CMs
  > depends on specific traumatic event
  > moderate to severe pain
  > edema: could be rapid & result in neurovascular compromise
  > ecchymosis (bruising): bleeding into underlying soft tissues
• Check for neurovascular compromise
  > skin color & temp; distal to injury
  > movement
  > sensation; any numbness or tingling (paresthesia)
  > pulses; distal to fracture site
  > capillary refill (least reliable)
  > pain

Question 15

Fractures - Assessment

lab
imaging

Answer 15

• Lab
  > no special lab tests available for assessment of fractures
  > H/H: low bc of bleeding caused by injury
  > Erythrocyte Sedimentation rate (ESR) may be elevated: indicates inflamm response
  > Incrd WBC: indicated bone infection
  > Elevated serum calcium & phosphorus: during healing, bone releases these elements into blood
• Imaging
  > x-rays
  > CT: usefule for fracture of complex structures; joints, spine, pelvis
  > MRI: useful in determining amnt of soft tissue injury

Question 16

Nonsurgical Management

immobilization
cast care
neurovascular

Answer 16

• Closed reduction & immobilization w/ a bandage, splint, cast, or traction
  > for small, closed incomplete bone fractures in hand or foot, reduction is not required
• Cast care
  > 4 primary groups of casts: arms, legs, braces, & body or spica casts
• Prevent neurovascular dysfunction or compromise
  > primary nursing concern
  > assess neurovascualr status every hr for first 24hrs & then every 1-4hrs

Question 17

Nonsurgical Management

elevate & ice
drug
mobility
infection

Answer 17

• Elevate extremity higher than heart
• Ice for first 24-48hrs
• Drug therapy
  > opioid & non-opioid analgesics, anti-inflamm drugs, muscle relaxants
  > Meperidine (Demerol) should never be used for older adults bc it has toxic metabolites tht can cause seizures & other comps
• Improve physical mobility & prevent comps of impaired mobility
  > PT/OT
• Prevent infection
  > proper wound care
  > IV antibiotics
  > wound vacuum-assisted closure system; VAC

Question 18

Surgical Management

Answer 18

• If needed to realign bone for healing process
• Open reduction w/ internal fixation (ORIF) most common method of reducing & immobilizing a fracture
  > open reducton
  > internal fixation
  > external fixation

Question 19

Open Reduction

Answer 19

Allows surgeon directly view fracture site

Question 20

Internal Fixation

Answer 20

• Uses metal pins, screws, rods, plates, or prostheses to immobilize the fracture during healing
• After bone achieves union, metal hardware may be removed, depending on location & type of fracture

Question 21

External Fixation

Answer 21

• Pins or wires are inserted through skin & affected bone and then connected to rigid external frame
• Incrd risk for pin site infection

Question 22

Amputation Types

Answer 22

• Elective
  > r/t comps of peripheral vascualr disease, arteriosclerosis
• Traumatic
  > often result of accidents

Question 23

Levels of Amputation for Lower Extremities

Answer 23

• Toe
• Mid-foot
• Syme
  > most of foot is removed, but ankle remains
• Below-knee
• Above-knee

Question 24

Complications of Amputations

Answer 24

• Hemorrhage
• Infection
• Phantom limb pain
  > more common in pts who had chronic limb pain b4 surgery & less common in those who have traumatic amps
  > sensation is felt in amputated part immediately after surgery & usually dimishes over time
  > if sensation persists & is unpleasant or painful, it is referred to as phantom limb pain
• Neuroma
  > sensitive tumor consisting of damaged nerve cells
  > mroe common in upper extrem amputations
• Flexion Contractures
  > hip or knee flexion contractures are seen in pts w/ amps of lower extrems

Question 25

Amputation Intervetnions - Emergency Care for Traumatic Amputations

Answer 25

- Stop bleeding, stabilize pt - Wrap amputated part in a clean or sterile cloth - Place it in water tight sealed plastic bag - Place bag in ice water; but **never** directly on ice - Avoid contact btwn body part & water to prevent tissue damage

Question 26

Amputation Intervetnions -Assess Tissue Perfusion

Answer 26

- After surgical closure, the skin flap at end of remaining limb should be pink in a light-skinned person & not discolored in a dark-skinned pt - Tissue should be warm, not hot

Question 27

Amputation Intervetnions ## Footnote basic info

Answer 27

- **Manage pain** > pain meds > IV infusions of calcitonin (Miacalcin, Calcimar) during week after amp can reduce phantom limb pain > massage > heat > TENS unit > ultrasound therapy per PT - **Prevent infection** - **Promote mobility & prep for prosthesis** - **Promote body image & lifestyle adaptation**