Musculoskeletal Trauma/Test 4

Question 1

Musculoskeletal Trauma Definition:

Answer 1

a complete or partial interruption of osseous tissue

Question 2

Musculoskeletal Trauma usually occurs….

Answer 2

as a result of a blow to the body, a fall or accident.

Question 3

Musculoskeletal incidence is highest among

Answer 3

15-30 year olds and women over 65 (osteoporosis)

Question 4

Humerus fractures are

Answer 4

common among young and middle aged adults

• elderly d/t neuromuscular instability
• People in high risk occupations
• Disease processes; cancer renal failure, chronic degenerative disease

Question 5

Stable trauma:

Answer 5

aligned

Question 6

Unstable trauma:

Answer 6

displaced

Question 7

Diagnostic tests:

Answer 7

Xray
MRI
CT Scan

Question 8

Pt history indicates…

Answer 8

a mechanism of injury associated with:

• Immediate localized pain
• decreased function
• Inability to bear weight or used affected part
• guarding
• may or may not be accompanied by obvious bone deformity.
• excessive motion
• crepitus (do not attempt to elicit this sign)
• soft tissue edema
• inflammatory changes
• ecchymosis
• sensory changes

Question 9

Process of Bone Healing:

Answer 9

Immobilization and proper re-allignment of bone fragments must occur

Question 10

Factors that impede bone healing:

Answer 10

• Age-hormones
• Medications- steroids, anticoagulants
• Metabolic disorders or diseases-diabetes, cancer, malnutrition, immunodeficiency, osteoporosis
• inadequate blood supply
• site and extent or soft tissue injury
• Infection
• Excess motion of the fracture fragments
• Excessive edema at the tx site
• Bone necrosis

Question 11

Peripheral Neurovascular Assessment Neuro:

Answer 11

• Sensation
• Movement
• pain
• paresthesia
• paresis/palsy

Question 12

Peripheral Neurovascular Assessment Vascular:

Answer 12

• Color
• Temperature
• Edema
• Capillary refill
• Peripheral pulse

Question 13

Physiological splintage

Answer 13

*Guarding, muscle spasm, and avoidance of use

Question 14

External orthopedic splinting

Answer 14

*Casts, plaster splints, and braces

Question 15

Internal fixation:

Answer 15

*Screws, plates or rods to hold opposing ends together

Question 16

Fracture reduction: Closed reduction-

Answer 16

• Manual manipulation (non-surgical)

* Casting, external fixation, splint, braces to immobilize for healing

Question 17

Fracture reduction: Open reduction-

Answer 17

• May use plates, screws, pins

* ORIF- Open reduction with internal fixation for joints

Question 18

Fracture reduction can be a combination of:

Answer 18

Closed and open reduction

Question 19

Objectives for treatment:

Answer 19

• reduce the fracture by realigning the fracture fragments
• Maintain the fragments in correct alignment by immobilization
• Restore function and prevent excessive loss of joint mobility

Question 20

Traction:

Answer 20

Temporary immobilization to reduce bone fracture. -prevent/reduce muscle spasm-immobilize a joint or part of the body-reduce a fracture or dislocation-treat a joint pathologic condition.(Hip, femur, knee, back), correct alignment and prevent further soft tissue damage. Can provide some relief from pain and muscle spasms.

Question 21

Complications of traction: Skin

Answer 21

• Pressure over bony sites cause breakdown.

* Persistent skin pressure can cause peripheral neuro vascular injury

Question 22

Buck’s tx:

Answer 22

Simple form provides pull on the affected limb

Question 23

Russell traction:

Answer 23

Allows some movement. Permits flexion of the knee joint. Used for fx of the femur when surgery is contraindicated

Question 24

Skin traction is _____ pounds

Answer 24

7-10
Buck's
Russell's
Bryant's (children)
Pelvic belt
Head halter

Question 25

Skeletal Tractions:

Answer 25

* Overhead arm (90-90) * Lateral arm * balanced suspension

Question 26

The purpose of trochanter rolls:

Answer 26

is to maintain alignment while in bed

Question 27

Reduction

Answer 27

realignment of bone fractures

Question 28

Fixation-

Answer 28

immobilization of fragment sites

Question 29

Casts are:

Answer 29

fiberglass or plaster

Question 30

Types of casts:

Answer 30

* sugar-tong splint * posterior splint * short arm cast * long arm cast * body jacket cast(cast syndrome-abd pain, pressure, n/v) * hip spica * long leg cast * short leg cast * cylinder cast

Question 31

Jones dressing:

Answer 31

bulky padding material, splint, ace wrap or bia cut stockinette

Question 32

Internal Fixation: ORIF

Answer 32

* preferred method to manage a femoral fracture * pins, plates and screws * surgically inserted at the time of realignment * stainless steel, titanium

Question 33

External fixation:

Answer 33

* metallic device composed of metal pins that are inserted into the bone and attached to external rods to stabilize fracture. * Can be used alone or in conjunction with plaster * Provides extremely rigid fixation. * Alignment evaluated by x-ray

Question 34

Common Drug Therapy: Tetanus

Answer 34

*If fracture is open

Question 35

Drug therapy: Antibiotics

Answer 35

* Bone penetrating - cefazolin (Ancef, Kefzol) * Preventive measure

Question 36

Drug therapy: Analgesics

Answer 36

Treatment for pain

Question 37

Drug therapy: Skeletal Muscle Relaxant

Answer 37

* Soma (Carisoprodol) * Flexeril (cyclobenzaprine) * Robaxin (methocarbamol)

Question 38

Drug Therapy:

Answer 38

* Antibiotics * Analgesics * Skeletal muscle relaxant

Question 39

Hip Fracture d/t advanced age:

Answer 39

* Elderly prone to falls * d/t neuromuscular instability * Inability to correct postural imbalance * Inadequacy of local tissue shock absorbers * Underlying skeletal strength * Bone remodeling is altered * Muscle mass and strength decrease * Loss of motors neurons * Tendons and ligaments less flexible

Question 40

Hip Fracture misc risk factors:

Answer 40

* osteoporosis * female * caucasian * decreased estrogen * prior hip fractions * alzheimer disease * residing in institution * sedentary lifestyle * inadequate calcium and vit D * excessive intake of protein * caffeine intake * smoking * use of ETOH * psychotropic drugs

Question 41

Classification of hip fractures:

Answer 41

* Intracapsular (femoral neck) * Extracapsular fracture (intertrochanteric) * Subtronchanteric fracture

Question 42

Intracapsular (femoral neck) hip fracture:

Answer 42

* Occurs within the hip joint and capsule * Can disrupt blood supply * R/F nonunion and avascular necrosis

Question 43

Extracapsular hip fracture (intertochanteric):

Answer 43

* Occurs outside the hip joint below to an area (2 inches) of the lesser trochanter * Complications: malunion and shortening of the affected extremity.

Question 44

Subtronchanteric hip fracture:

Answer 44

*below the lesser trochanter

Question 45

S/S of a hip fracture:

Answer 45

* Severe pain at the fracture sight * Inability to move leg voluntarily * Shortening and external rotation of leg * Other s/s consistent with those of any fracture

Question 46

Hip Fracture surgical management:

Answer 46

* Reduction and stabilization of fracture * Insertion of an internal fixation device (ORIF) - pin, screw, nail, plates * Occasionally may replace hip joint (hip arthroplasty)