circulation temperature movement sensation
pallor pulse puffiness paralysis parasthesia pain
stretch/tear ligament tissue surrounding a joint S&S: pain, edema, bruising, reduce function Treatment: Rest Ice Compression Elevation-above heart level
muscle/tendon over-stretching or tearing S&S: pain, edema, bruising, reduce function Treatment: Rest Ice- 20 on 20 off, after first 48 hrs, apple heat Compression Elevation-above heart level
complete displacement/separation of joint S&S: deformity, local pain, edema, loss of function Treatment: reduction of immobilization
partial separation of a joint surface
Disruption/break in the continuity of the structure of the bone. Classified according to: Open or closed (communication with the external environment, condition of the skin & tissue) Complete or incomplete Based on direction of fracture Displaced or not displaced Can be caused by trauma or disease process
Clinical Signs: Fractures?
Stages of Bone Healing
Hematoma formation Production of granulation tissue Callus formation Ossification Consolidation Remodeling
OPEN REDUCTION care?
Correction of bone alignment through surgical incision Includes internal fixation with use of wires, screws, pins, plates, intramedullary rods, or nails
TRACTION: SKIN or SKELETAL care?
Application of a pulling force to an injured or diseased part of body or extremity, while counter-traction pulls in opposite direction Purpose of any traction Prevent or ↓ muscle spasm Immobilize joint or part of body ↓ a fracture or dislocation Treat a pathological joint condition Used for short-term treatment until skeletal traction or surgery is possible Tape, boots, or splints applied directly to skin to maintain alignment, assist in reduction, and help diminish muscle spasms in injured extremity Traction weights 2.3 to 4.5 kg assess for skin breakdown + traction remains in place
In place for longer periods Used to align injured bones and joints Pin or wire inserted into a bone Weight ranges 2 to 20 kg
Goal: maintain anatomical re-alignment Can be accomplished by: External devices Internal devices Casts
IMMOBILZATION: EXTERNAL FIXATION?
Attached directly to bone by percutaneous transfixing pins or wires
Arm (short, long) Leg (short, long) Body (trunk) Spica (trunk and one or two extremities: single or double spica)
Inspect exposed skin regularly when slings are used with traction. Assess over bony prominences C (Continuous) Skeletal traction never interrupted A (Alignment) Pt must be in the center of bed R (Resistance) Not present, weights must hang freely O (Opposing traction) Body weight, patient high in bed L (Line of pull) Unobstructed pull, ropes do not touch pulleys
COMPLICATIONS OF FRACTURES?
Blood vessels and nerve damage Compartment syndrome Deep vein thrombosis Fat embolism Bone infection Bone malunion and nonunion pulse difficult to find
Develops when swelling and pressure occur within a confined space or compartment. The pressure causes perfusion to the muscle to be compromised. Ischemia of the muscle and nerve damage result if enough pressure builds. Early recognition is essential to avoid permanent damage to muscles and nerves.
COMPARTMENT SYNDROME S&S?
Pain that increases in severity, especially with passive stretching of the muscle and that is unrelieved with narcotic analgesics. Paresthesia Decreased or absent pulses, cynosis, cold, slow cap refill Tense skin over the limb Paralysis
COMPARTMENT SYNDROME therapeutic measures?
Early detection is single most important measure (Why?). Elevation of the extremity to heart level (NOT ABOVE). Release of restrictive devices (casts/bandages) Fasciotomy (release pressure)
DEEP VEIN THROMBOSIS:?
Veins of lower extremities and pelvis are highly susceptible to thrombosis. Precipitating factors Incorrectly applied cast or traction Local pressure on a vein Immobility darn turn into emboli if left untreated S&S: warm to touch, edema
FAT EMBOLISM SYNDROME:?
Presence of systemic fat globules from fracture that are distributed into tissues and organs after a traumatic skeletal injury Contributory factor in many deaths associated with fracture S&S: respiratory distress
Open fractures Soft tissue injuries Osteomyelitis: severe infection of bone & surrounding tissues S&S: pain, blood test for infection, CT/MRI scan
MALUNION AND NONUNION?