Traumatic Conditions of the Musculoskeletal System

Soft Tissue Trauma

Is the damage of muscles, ligaments and tendons throughout the body. A contusion is a soft tissue injury produced by blunt force, such as a blow, kick, or fall A strain is a muscle pull caused by overuse, overstretching, or excessive stress. A sprain is an injury to the ligaments surrounding a joint that is caused by a wrenching or twisting motion.

Management
Treatment of contusions, strains, and sprains consists of resting and elevating the affected part, applying cold, and using a compression bandage. REST ICE COMPRESSION ELEVATION

Dislocation
A dislocation of a joint is a condition in which the articular surfaces of the bones forming the joint are no longer in anatomic contact. The bones are literally out of joint. A subluxation is a partial dislocation of the articulating surfaces Traumatic dislocations are orthopedic emergencies

Management
The affected joint needs to be immobilized while the patient is transported to the hospital. The dislocation is promptly reduced (ie, displaced parts are brought into normal position) to preserve joint function Analgesia, muscle relaxants, and possibly anesthesia are used to facilitate closed reduction active and passive movement is begun to preserve range of motion (ROM) and restore strength

Fractures
Fractures occur when the bone is subjected to stress greater than it can absorb. Fractures are caused by direct blows, crushing forces, sudden twisting motions, and even extreme muscle contractions soft tissue edema hemorrhage into the muscles and joints joint dislocations ruptured tendons severed nerves damaged blood vessels

Types of Fracture
A complete fracture involves a break across the entire cross-section of the bone and is frequently displaced (removed from normal position). In an Incomplete fracture (eg, greenstick fracture), the break occurs through only part of the crosssection of the bone. A comminuted fracture is one that produces several bone fragments. A closed fracture (simple fracture) is one that does not cause a break in the skin.

 An open fracture is one in which the skin or mucous membrane wound extends to the fractured bone. Open fractures are graded according to the following criteria: Grade I is a clean wound less than 1 cm long Grade II is a larger wound without extensive soft tissue damage Grade III is highly contaminated, has extensive soft tissue damage, and is the most severe

Specific Types of Fracture

Avulsion: a fracture in which a fragment of bone has been pulled away by a ligament or tendon and its attachment Comminuted: a fracture in which bone has splintered into several fragments Compound: a fracture in which damage also involves the skin or mucous membranes; also called an open fracture Compression: a fracture in which bone has been compressed Depressed: a fracture in which fragments are driven inward (seen frequently in fractures of skull and facial bones)

 Epiphyseal: a fracture through the epiphysis Greenstick: a fracture in which one side of a bone is broken and the other side is bent Impacted: a fracture in which a bone fragment is driven into another bone fragment Oblique: a fracture occurring at an angle across the bone (less stable than a transverse fracture) Pathologic: a fracture that occurs through an area of diseased bone (eg, osteoporosis, bone cyst, Pagets disease, bony metastasis, tumor); can occur without trauma or a fall

 Simple: a fracture that remains contained; does not break the skin Spiral: a fracture that twists around the shaft of the bone Stress: a fracture that results from repeated loading without bone and muscle recovery Transverse: a fracture that is straight across the bone

Clinical Manifestation
Pain Loss of Function Deformity Shortening Crepitus Swelling and discoloration

Surgical Management

Reduction
Reduction of a fracture (setting the bone) refers to restoration of the fracture fragments to anatomic alignment and rotation. Usually, the physician reduces a fracture as soon as possible to prevent loss of elasticity from the tissues through infiltration by edema or hemorrhage. Before fracture reduction and immobilization, the patient is prepared for the procedure; permission for the procedure is obtained, and an analgesic is administered as prescribed. Anesthesia may be administered. The injured extremity must be handled gently to avoid additional damage.

 Closed Reduction. In most instances, closed reduction is accomplished by bringing the bone fragments into apposition (ie, placing the ends in contact) through manipulation and manual traction. The extremity is held in the desired position while the physician applies a cast, splint, or other device An open reduction and internal fixation (ORIF) is a type of surgery used to fix broken bones. This is a two-part surgery. First, the broken bone is reduced or put back into place. Next, an internal fixation device is placed on the bone; this can be screws, plates, rods, or pins used to hold the broken bone together.

Traction
Traction is a force applied in a specific direction to: Reduce and immobilize fracture To regain normal length and alignment of an injured extremity To lessen or eliminate muscle spasm To prevent deformity To give the patient freedom for in bed activities To reduce pain

 Running Traction is a form of traction in which the pull is exerted in one plane Skin traction is used in treatment of the hip fracture (Bucks extension) and femoral shaft fracture (Russells traction) Skeletal traction is applied by the orthopedic surgeon under aseptic conditions using wires, pins or tongs place through the bone. Usually done in treating fractures of the femur, humerus, tibia fibula, and cervical spine

 Balance Suspension Traction Uses additional weight to counterbalance the traction force and floats the extremity in the traction apparatus

External Fixation
Is a technique of fracture immobilization in which a series of transfixing pins is inserted through the bone and attached to a rigid external metal frame. Permits rigid support of severely comminuted open fractures, and infections in the bones Facilitates wound care Allows early function of muscles and joints Allows early patient comfort

Nursing Management
Immobilize of the fracture site Prevent Infection Wound irrigation and debridement Wound care Strict guidance of intake of Antibacterial Medicines