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MUSCULOSKELETAL TRAUMA A. SPRAINS & STRAINS- excessive stretching or twisting of muscle (strain) or tendon (sprain). 1.

Can be 1-3rd degree, s/s edema, pain, contusion, decreased fxn i. Tx: stop activity & rest limb, ice 24-48hrs, apply compression bandage (decrease swelling0, NSAIDS, warm after 24-48hrs & encourage limb use if cast, splint or tape. 2nd-3rd degree require immobilization through cast, splint or bandage 2. Teach stretch & warm-up, strengthening, balance & endurance exercises B. FRACTURES- break in continuity of bone 1. Can be complete or incomplete, open(compound)-bone breaks skin or closed(simple)bone doesnt break skin i. Immobilize limb in position found if suspect fracture Pelvis fracture- handle w/ care as to no damage internal organs, check bowel, urinary & distal neurovascular fxn, turn if D.O, use trapeze for back careNO WEIGHT BEARING TILL HEALED. Long bone- fat embolism huge risk, skeletal traction 8-12wks, encourage ROM unaffected side, D.O for affected side, once bone union, cast or hip spica applied Hip fracture- assoc w/ osteoporosis, bucks traction 72hrs, if femoral neck broken-prosthesis, if extracapsulare fracturepins, nails, plates 2. Phases bone healing: i. Hematoma formation (24-72hrs)granulation hematoma (3dys-2wks)callous formation & ossification- clinical union occurs here(2dys-6wks)bone consolidation & remodelling (up to 1yr) 3. Complications of fractures: i. Infection-require debridement, jet-pulsed irrigation, antibiotics. Most common=Osteomyelitis ii. Compartment syndrome- compromises circulation..EMERGENCY...assess 6 Ps: pain, paresthesia, pallor, pulselessness, paralysis, pressure. TX=fasciotomy.

*DO NOT ELEVATE EXTREMITY ABOVE LEVEL HEART. Give IV fluids, diuretics, low dose dopamine to enhance renal perfusion iii. Hypovolemic shock- if fracture damages blood vessel iv. Venous thrombosis-tx= antiembolism stockings, dorsiflexion/plantar flexion fingers & toes, ROM unaffected side, LMWH v. Fat embolism syndrome- s/s: change LOC, tachycardia, tachypnea, chest pain HTN, *petechiae around neck, axilla, chest wall tx=immobilization, fluid restriction, encourage cough deep bx C. FRACTURE TX: GOALS: re-alignment, immobilization to maintain alignment, restoration fxn 1. In emergency assess respiratory distress, bleeding & head injuryif these not present padres fractureemergency fracture care i. Check fracture, control bleeding, check VS, place pt. Supine, keep warm, immobilize fracture, use sterile gauze for open fracture, check neurovascular status 2. Re-alignment: i. Closed reduction- traction & counter traction applied manually to re-align bone Bucks traction- application Velcro boot w/ weight @ end to decrease muscle spasmscasts, external d=fixation, splints & orthosis (braces) used to immobilize ii. Open reduction- correction bone alignment through surgery, includes internal fixation w/ plates, pins, rods or nailstraction & counter traction used & skin traction used 48-72 hrs until skeletal traction 9weight or pin in bone to align) facilitates early ambulation. *check neurovascular status, complications & groin. 3. NSG INTERVENTIONS TRACTION- maintains balance between traction pull & counter traction force. *need D.O remove weight i. Check skin q8hrs for inflammation ii. Remove belt/boot skin traction q8hrs iii. Inspect pts of entry pins & wires q8 iv. Check traction equipment to ensure working properly q8-12hrs v. Verify weights-replace if not corrects

D. AMPUTATION- removal of body part due to dx or trauma 1. For traumatic amputation, ensure patent airway, put pressure on area & cover w/ dry cloth, evaluate above heart to decrease bleed. 2. For fingers & toescover dry cloth, place sealed plastic bag on ice water 3. Big toe amputation affects push-off walking 4. NSG TX: i. Check tissue perfusionskin flap pin 7 warm, check proximal pulses for strength & compare ii. Manage pain residual & phantom limb Phantompropanolol for dull, burning pain, antiepileptics carbamazepine(Tegretol) or Gabapentin(neurontin0 for knife-like pain, antispasmodics baclofen(lioresal) for muscle spasms iii. Complementary & alternative therapy ex. TENS iv. Prevent infection- broad spectrum antibiotics- initial pressure dressing & drains removed by surgeon 48-72hrs, assess inflammation, change dressing daily until sutures removed v. Promote mobility- teach ROM to prevent infection contraction hip, place trapeze above bed to help strengthen upper extremities vi. Assist pt. Into prone position q3-4hrs for 20-30min, instruct pull residual lib close to other leg & contract gluts, teach those BKA push residual limb down toward bed while supporting it on a pillow, do not elevate residual limb on pillow while supinekeep flat to prevent flexion contractions vii. Prepare for prosthetic- coordinate w/ prosthetis-orthotis, instruct bring sturdy shoes E. HIP ARTHROPLASTY- hip reconstruction or replacement 1. Leg abduction maintained (wedge between legs) while moving in bed, hips cant be lower than knees F. KNEE ARTHROPLASTY- isometric quadriceps sitting begins first day.