Ch. 38 ortho trauma
the tibia supports how much of the upper bodys weight
90 percent
mallet finger (baseball fracture)
Occurs when a finger is jammed into an object, resulting in an avulsion fracture of the extensor tendon
RICE for sprains and strains
Rest, ICE, compression, elevation (raise the injured part just above the level of the patients heart to decrease swelling) splinting
vertical shear
from above or below, such as when a person falls from a significant height and lands on the feet, on landing the force is transmitted through the legs to the pelvis leading to complete displacement of one or both sides of the pelvis toward the head
with a midshaft humerus fracture if it is angulated
gentle longitudinal traction may be applied to correct the deformity; but efforts should be halted if the patients pain is too severe or if the patients neurovascular status worsens
if a long bone fracture is severely angulated
gently apply longitudinal traction to attempt to realign the bone into a more natural position and improve circulation
what is the exception to attempting to straighten fractured joints witihout first obtaining medical direction
if there is a loss of distal circulation or an extended transport time to the hospital
90% of hip dislocations involve
posterior dislocation majority occur due to delceleration injuries in which a flexed knee strikes an immobile object with a great degree of force
when bleeding or swelling occurs within a compartment for any reason the pressure within it rises
pressure that is too high may preven tblood flow in vessels supplying the muscles within the same fascial compartemtn
if the pt you are treating has an airway or breathing probem or significant bleeding then
provide rapid transport to the hospital for treatment and apply individual splints en route
late sign of compartment syndrome
pulselessness
circulating myoglobin results in what
renal vasoconstriction
one way to stabilize multiple fractures when the patients overall condition is critical is to use a
scoop stretcher
what is the first sign of compartment syndrome
searing or burning pain that is localized to the involved compartment and out of proportion to the injury
petechiae
small, pinpoint hemorrhages
Spiral fractue
spirals
simple methods for controlling pain include
splinting in an anatomic position, resting and elevating the injured part, and applying ice or heat packs
what is the partial dislocation of a joint called
subluxation
nursemaids elbow
subluxation of the radial head
elbow fractures (distal humerus)
supracondylar fractures of the humerus occur often in children
angulation of a fracture means
that each end of the fracture is not aligned in a straight line and that an angle has formed between them
if a person falls from a height and lands on their feet
the force of impact may be transferred up the legs resulting in pelvic fractures
with midshaft humerus fractures what nerve is a concern
the radial nerve which may be injured by the force itself of could become entrapped within the fracture sit
lateral compression
the side of the pelvis that sustains the impact becomes internally rotated around the sacrum and the actual volume within the pelvis decreases
if musculoskeletal injuries in the extremities are suspected
they must be at least initially stabilized if not splinted before moving the patient access for pms
for a hemodinamicly unstable pt dont waist time
traction splinting rather use vacuum mattress long board or scooop stretcher
compartement syndrome
two note cards above explain this
Devascularization
when blood vessels are damaged following a musculoskeletal injury, loss of blood flow can occur in the body part supplied by that vessel a
diastasis
when the ligaments that hold two bones in a fixed positioin with respect to each other are disrupted and the space between them increases
to help remember that a strain involves a tendon note that the word strain includes a
"T"
heat therapy should generally be avoided during the initial
48-72 hours because it may increase pain and swelling during this period
a person who sustains a FOOSH may have one or more injuries as the result of forces transmitted proximally from the point impact
1.) fracture of the scaphoid bone of the hand, 2.) fracture of the distal ulna and radius 3.) fracture dislocation of the elbow, 4.) fracture dislocation of the shoulder, or 5.) fracture of the clavicle
how many bones make up the skeleton
206
if possible splint the injured hand in the position of function by placing the wrist in about
30 degrees of extension with the fingers slightly flexed,
bones decrease in density after the age of
35
time frame for crush syndrome
4-6 hours after that muscle cells begin to die and release their contents into the localized vasculature
cold packs or ice are useful for treating patients during the initial
48 hours following an injury and effectively decrease pain and swelling
Osteoporosis
A condition in which the body's bones become weak and break easily.
straddle fracture
A fracture of the pelvis that results from landing on the perineal region.
pneumatic splints are not effective for
Angulated fractures or for fractures that involve a joint because they will forcefully attempt to straighten the fracture or joint.
6 Ps of musculoskeletal assessment
Pain, Paralysis, Parasthesias, Pulselessness, Pallor, and Pressure.
Neurovascular Compromise
The loss of the nerve supply, blood supply, or both to a region of the body, typically distal to a site of injury; characterized by alterations in sensation, including numbness and tingling, or by a loss or decrease of motor function; vascular compromise is indicated by weak or absent pulses, poor skin color, and cool skin.
in a dislocation
a bone is totally displaced from the joint -dislocations occur when a body part moves beyond its normal ROM
boxers fracture is
a fracture of the neck of the fifth metacarpal it commonly occurs after punching a hard object such as a wall or a door
assessment of nursemaids
a palpable deformity may be present at the elbow from the prominence of the olecranon
signs of an arterial injury include
a pulsatile expanding hematoma diminished distal pulses a palpable thrill over the site of injury
metacarpal shaft
fractures of the metacarpals may result from a crush injury or from direct trauma
management for compartment syndrome
position extremity at heart level ( not above) coldpacks give a bolus of saline to help the kidneys flush out toxins from the resulting rhabdomyolysis
the classic sign of a radial nerve injury is
an inability to extend the wrist termed wrist drop
splinting a midshaft humerous fracture
apply a rigid splint that extends from the axilla to the elbow
sprains
are injuries in which ligaments are stretched or torn -usually result from a sudden movement of a joint beyond its normal ROM
shoulder girdle
base of the upper arm it consists of a scapula and clavicle
crush syndrome will lead to rhabdomyolysis
because of tissue death which results in the release of harmful products
greenstick fracture
bending and incomplete break of a bone; most often seen in children
comminuted fracture
bone breaks into many fragments
incomplete fracture
break through one cortex
complete fracture
breaks through both cortices
how are dislocated bones held in there abnormal place
by muscle spasms
if the brachial artery is compromised
compartment syndrome could develop
splinting a injury in an anatomic position can help relieve pressure on the
damaged nerve
what is a risk factor for deleloping a stress fractue
endocrine dysfunction
to identify the anatomic snuffbox on yourself
extend your thumb twotendons will be visible at the base of the thumb on the radial aspect of the wrist
there are two factors that contribute to compartment syndrome
external like bangages and splints applied to tight and internal like bleeding and swelling
groups of muscles are surrounded by an inelastic membrane called
fascia; thus muscles are confined to an enclosed space or compartment that can accommodate only a limited amount of swelling
fat embolism
fat droplets become lodged in the vasculature of the lungs symptoms begin within 12 to 72 hours of injury symptoms: tachy, SOB, congestion fever PETECHIAE change in mental staus and organ dysfunction
pts with long bone fractures are at risk for developing a
fat embolism
pelvic gridle
forms the base of the torso and connects the axial skeleton with the lower extremities
Colles fracture
fracture of the distal radius at the wrist
when fractues heal osteoblast play a role by invading the fracture site and allowing a callus to form
in this process new bone called osteoid is built around the fracture site a step in the process of bone remodeling
luxation
is a complete dislocation
a strain (Pulled muscle or tendon)
is an injury to a muscle and or tendon that results from a violent muscle contraction or from excessive stretching
the scaphoid also called the carpal navicular
is located just distal to the radius
what is the primary toxins released after crush injury
lactate, potassium and myoglobin there release can result in decreased blood pH (acidosis)
in women bones decrease in density after age
menopause is reached
in most cases the clavical fractures in the
middle third of the bone typically from a fall onto an outstretched hand
shoulder dislocation
most are anterior dislocations
a dislocation is considered an urgent injury becasue of its potential to cause
neurovascular compromise distal to the site of injury; if the dislocated bone presses on a nerve the patient may experience numbness or weakness distally
oblique fracture
occurs at an angle across the bone
crush syndrome
occurs because of prolonged compression force that impairs muscle metabolism and circulation
buckle fracture
occurs in the metaphysis of long bones in response to excessive compression loading on onee side of the bone the compressed cortex buckles and the opposite cortex is pulled away from the physis
transverse fracture
occurs straight across the bone
indirect injury
occurs when a force strikes one region of the body and is transferred to an area away from the point of impact
stress fracture
occurs when the muscle develops faster than the bone and places exaggerated stress on the less developed bone
anterior posterior compression pelvic ring disruptions
open book pelvic fracture: the force of the impact compresses the pelvis in the anterior to posterior directioin causing the pubic symphysis and posterior supporting ligaments to be disrupted and tear apart
cortices
outer layers of bone
the classic finding associated with a scaphoid fracture is
pain and tenderness in the anatomic snuffobx
assessment tools for compartment syndrome
passive stretching of an ischemic muscle will result in sever pian so have them felx and extend the great toe and dosiflex and plantar flex same with finger and hand flex and extention
potential blood loss from fracture sites
pelvis: 1500-3000, femur: 1000-1500, tib or fib ankle elbow: 250-500