Musculoskeletal chapter 54 w/ ppt included

4-6 weeks

3rd degree sprain/sprain surgical repair may require immobilization of affected extremity post op for ??

surgical repair of torn tendon or muscle

3rd degree strains may require?

greenstick fracture

An incomplete disruption where one side of the bone is bent and the other is fractured; generally seen in children because of the flexibility of their bones

non-displaced fracture

Bone fragments are well approximated within the site of disruption.

fracture

Disruption "break" in the continuity of a bone

depressed fracture

Disruptions in which fragments of bone are forced inward; frequently seen in facial and skull fractures involving blunt trauma

Hx of how injury occurred CT or radiography physical exam

Dx of fracture

compartment syndrome

Excessive pressure in an enclosed compartment of body due to bleeding or edema; orthopedic emergency, blocks and impedes blood flow to the extremity

soft tissue damage

External fixators are frequently used when there is significant ___________ at the fracture site

compression fracture

Fracture caused by excessive force along the axis of cancellous (spongy internal layer of bone) bone leading to the bone collapsing on itself; representative in vertebral compression fractures from falls of significant heights

comminuted fracture

Fracture that has several disruptions producing shattered bone fragments within the fracture site

displaced fracture

Malalignment of bone fragments at the fracture site

skeletal traction

Pins, tongs, screws, and wires are surgically secured to the bone, and weight is then applied to provide realignment

Grade I open fracture

Presence of a puncture wound, minimal injury to the soft tissues, and vasculature remains intact

manual traction

Pulling force applied by the hands of the provider

grade II open fracture

Puncture wound, fragments of broken bone, moderate skin and muscle contusions, and significant wound contamination

Rest the injured extremity up to 72 hours to allow the ligaments or tendon time to heal. Ice applied for no longer than 30 minutes three to five times per day for 24 to 72 hours after injury. This promotes vasoconstriction and decreases bleeding and fluid collection in the injured area Compression ACE wrap to minimize further swelling. Elevate - to minimize dependent swelling

RICE

1st and 2nd degree

RICE treats _____ degree sprains and strains

impacted fracture

Segments of bone are wedged into each other at the fracture line.

grade III open fracture

Severe damage to soft tissues, nerves, muscles, and blood vessels. The open fracture site is considered extremely contaminated and contains numerous comminuted fractures.

Burr holes (surgically created hole in the skull to relieve pressure), craniotomy (bone flap removed for access to brain tissue then replaced), craniectomy (bone flap removed and not replaced)

Skull injury with blunt force: If at risk for or showing signs of elevated pressure within the brain: Operative treatment via ______________ followed by ORIF with plates and screws

strain

Tearing or stretching of muscle or tendon, usually as a result of overextension, overexertion, or overstitching.

incomplete fracture

The disruption occurs through part of the bone cortex; however, there is no displacement of bone fragments.

complete fracture

The disruption spans across the width of the bone, causing bone fragments.

oblique fracture

The fracture line occurs usually at a 45-degree angle across the cortex of the bone.

spiral fracture

The fracture wraps around the shaft of the bone.

fascia

These compartments are surrounded by tough connective tissue linings called?

Typically nondisplaced: Closed reduction, immobilization with splint/cast Displaced: Operative ORIF with pins, plates, and screws followed by immobilization with cast/splint

Tx for metacarpal/phalanges fracture

immobilization with splint operative: ORIF

Tx of clavicle fracture, caused by blunt force to chest, falling on shoulder or outstretched hand

Nonoperative: Skeletal/Skin traction and immobilization with cast/brace Operative: ORIF with intramedullary rod/nail

Tx of femur fracture

Highly dependent on the specific location of the fracture within the acetabular/femoral region; commonly requires operative ORIF with nails, plates, and screws; potentially also requires partial and/or total hip replacement

Tx of hip fracture

Operative ORIF, fusion, cervical traction, immobilization

Tx of spinal fracture with compromised neurological function or damage to spinal cord

Nonoperative immobilization with a stiff cervical collar, observation

Tx of spinal fracture with no neurological compromise

Nondisplaced: Closed reduction and immobilization with splint/cast, pressure dressing Displaced: Operative ORIF with traction, pins/screws, or application on an external fixator

Tx of wrist fracture

valgus knee torques (knock-knee); muscular strength; laxity (flexibility)

Women are nine times more likely than men to sustain an ACL tear because of several biomechanical and neuromuscular factors. Women have a greater degree of ___________-, have less _________, and have more knee __________-, which puts them at higher risk of ACL injury.

splints

a form of nonrigid immobilization to maintain alignment of bone fragments

bucks traction

a form of skin traction commonly used for femur and hip fractures.

fasciotomy

a procedure in which the surgeon makes incisions on both the medial and lateral aspects of the extremity down through the fascia, relieving the pressure

cervical traction

an example of skeletal traction where a halo device, or Crutchfield tongs, is applied to stabilize the cervical fracture.

bursitis

an inflammation of the bursa, a sac located between bone or muscle or tendon that contains lubricating fluid to decrease friction with movement.

cast or splint

applied following realignment of a bone with closed reduction treatment of a fracture

ankle sprains

are the most frequently occurring orthopedic injury and are responsible for 40% of all athletic injuries, totaling an annual number of five million.

- swelling - ecchymosis - deformity due to strain, tearing or rupture of the ligaments, tendons or muscles - intolerance to palpation, unable to bear weight on the injured side

assessment and examination of the extremity with a sprain or strain

over 40

bursitis and tendinitis is more common in people this age because of lack of elasticity and prone to tearing

overuse, repetitive minor impact, or a sudden, more significant impact to the affected area

causes of bursitis or tendonitis

chronically unstable joints, bursitis, tendinitis

complications that can occur with strains and sprains

fall from significant heights

compression spinal fractures occur from this type of action

ligament

connect bone to bone or bone to cartilage and provide stability to joints

tendons

connect muscle to bone and facilitate movement

open (compound) fracture

disruption in which pieces of bone protrude through the skin, creating an external wound that exposes the fracture site; graded based on their severity

narcotics and anti-inflammatory meds

effective in controlling pain and inflammation. They allow the patient to gradually regain movement and function of the injured area.

Overextension Overexertion Overstretching

etiology of inversion and eversion sprains

underlying fracture

extreme pain assessed with a sprain or strain might indicate underlying ?

Abx

for open fractures with contaminated wounds to prevent osteomyelitis

closed (simple)

fracture that is contained within the skin

young people and elderly (both have porous bone)

fractures occur most commonly in these people ; also more frequently suffer from chronic bone disorders that increase the risk of pathological fractures (Cushings, osteoporosis, osteogenesis imperfecta, neoplasms, anorexia, and Paget's disease)

US ; MRIs

highly effective and low cost to identify strains and sprains, but ____ may be more definitive

6 months to 1 y

how long does it take for a fracture to heal ?

up to 72 hr

how long to rest a strain/sprain?

distal to proximal

how to wrap an ACE wrap

acceleration and deceleration injuries

hyperflecion and hyperextension spinal fracture occurs from ?

30 min 3-5x/d for 24 to 72 hr

ice should be applied to a strain or sprain for no longer than? ____times per day for ??hrs

nonoperative observation

if a person suffers a blunt force skull injury and is not showing any signs of elevated brain pressure

medications and substance abuse

impair mental judgment and function and contribute to motor vehicle accidents and falls, thus producing bone fractures and other traumatic injuries.

third degree / severe sprain

include the complete tearing of a ligament, which renders the patient unable to ambulate because of joint instability. Symptoms include severe pain, ecchymosis, and edema.

tendinitis

inflammation of the tendon

sprain

injury to ligaments r/t overextension, overexertion, or overstretching

Traction

involves the use of weights and force to reduce the fracture and relieve muscle spasms. ;can be used in conjunction with any of the other previously mentioned forms of fracture treatment.

muscle atrophy and contractors

movement and function of extremities with fractures should be maintained with narcotics and antiinflammatories to prevent these complications

physical therapy

needed following surgery for repair of a 3rd degree strain or sprain

general anesthesia

needed to ensure complete muscle relaxation for proper bone realignment.

ACL tears

occurs mostly from noncontact injuries from sports that involve twisting and jumping. Basketball, football, soccer, and gymnastics generate the highest number of these injuries

open surgical repair of 3rd degree strain

open incision and the use of thick suture material to reattach the torn muscle and tendon

avulsion fracture

overstretching of ligament or tendon, separating a small segment of bone at the insertion site

disability, increased risk for repeated injuries, and the need for surgical intervention.

patient noncompliance to therapeutic treatment regimens for sprains and or strains can cause future?

neurovascular compromise of the injured area and may necessitate immediate medical intervention to prevent permanent damage

presence of the 6 P's may indicate what ?

ORIF (open reduction internal fixation) of a fracture

requires a surgical incision that enables the surgeon to accurately visualize the wound and ensure proper realignment. It requires the use of plates, screws, rods, and other hardware to realign the fractured bone segments. Irrigation and debridement might be needed for open fractures that are contaminated with dirt and foreign matter.

casts

rigid immobilization constructed of fiberglass or plaster. They are used on weight-bearing extremities.

hemorrhage from the initial injury, extended compression from casts and splints, burns, venous thrombosis, and excessive exercise.

sources of edema that could cause compartment syndrome

second degree / moderate sprain

sprain that results from a moderate amount of tearing in the ligament fibers. The joint remains intact and the ligament is not completely torn. Increased swelling, ecchymosis, pain, and altered weight-bearing mobility are evident in these patients.

first degree/ mild

sprain which demonstrates stretching and/or minimal tearing of ligament fibers. Edema and pain may be evident, but joint function remains intact and patients are able to ambulate with slight discomfort.

inversion and eversion prains

sprains caused by ankle rotation.

hypoxia of tissue

stimulates increased tissue permeability causing more blood and fluid to leak into the already restricted compartmental space

third degree / severe

strain that includes the rupture of the muscle or tendon causing considerable internal bleeding, pain, inflammation, and ecchymosis. Surgical repair may be needed if there is extensive tearing in the muscle or tendon.

first degree / milk

strain which demonstrates minimal inflammation and pain. Symptoms can last for several days, but range of motion remains unaffected.

second degree / moderate

strain which is resulting from actual tearing of the muscle and tendon fibers. This injury is often painful with severe muscle spasms, extensive inflammation, and ecchymosis that appear several hours or days after the initial injury. Symptoms can last for several weeks.

ability to perform self care

strains and sprains can alter patient mobility, impacting ?

open or arthroscopic w/ use of graft

surgical repair of a 3rd degree strain/sprain usually involves ?

external fixation of a fracture

the application of a series of rods and pins to the area surrounding the fracture, creating an external frame to stabilize and align the displaced fragments

closed reduced

the most frequent type of nonsurgical fracture treatment in which the fractured bone segments are manually manipulated and realigned while the patient is under general anesthesia.

Observation, treat pain with analgesia/epidural, deep breathing exercises with use of incentive spirometry to maintain pulmonary hygiene

treatment of Rib fracture

avoid activities that aggravate the irritation rest affected area anti-inflammatory medications

treatment of bursitis or tendonitis

elbow, hip, shoulder or knee

typical joints that bursitis/tendonitis occurs in

NSAIDs

used to minimize pain and inflammation with sprains and strains

skin traction

utilizes a flexible harness, boot, or belt to secure the extremity while 5 to 10 lb of weight is applied to relieve muscle spasms

arthroscopic surgery (for 3rd degree sprain)

utilizes small scopes to visualize and repair the injured area. Ligament repairs usually require the placement of a graft from the patient, typically the patellar tendon or hamstring. Donor graft can also be used for surgical ligament repair.

pain, pressure, paralysis, pallor, paresthesia, and pulselessness

what are the 6 Ps

the 6 p's

what are the most common symptoms of compartment syndrome ?

loading force

what causes compression fractures

CSM (color, sensation and movement)

what to assess with use of an ACE wrap for compression