FRACTURE o Loss of function

o Ecchymoses
 Is a break in the continuity of a bone o Paresthesia
 It occurs when the stress placed on a bone is
greater than what the bone can absorb CLINICAL MANIFESTATIONS
 With fracture, not only there is bone damage, Altered neurovascular status
there will also be damages to the muscles, the
nerves, the tendons, the ligaments, the skin and  Injured muscles, blood vessels and nerves
the joints.  Ischemia from compression
 Altered sensation, poor capillary refill response
Types of Fracture  Pain and pallor
 Loss of active motion
 Complete-involves the entire cross section of the  Shock
bone  Hemorrhage
 Incomplete - involves a portion of the cross  Tachycardia, tachypnea, low BP. clammy skin,
section of the bone poor mental status, etc.
 Pathologic-diseased bone (osteoporosis)
 Closed-simple; skin is not broken DIAGNOSTIC EVALUATION
 Open-compound; skin is broken
 X-ray and other imaging studies will reveal the
Grade 1-minimal soft tissue injury integrity of the bone
Grade 2-laceration >1cm w/o extensive soft tissue
flaps  Blood studies like CBC and electrolytes with
Grade 3 - Extensive soft tissue injury including skin, blood loss and extensive muscle damage, Hb
muscle, nerves, etc. and Hct will reduce

PATTERNS OF FRACTURE  Arthroscopy- detects joint damage

 Greenstick - one side of the bone is. broken  Angiography - nerve damage
while the other side is bent
 Nerve conduction velocity and EMG
 Transverse - straight across the bone
MANAGEMENT OF FRACTURE
 Oblique - at an angle across the bone PRINCIPLE OF MANAGEMENT

 Spiral twists around shaft of the bone Factors influencing choice of management include:
 Type of fracture
 Comminuted bone splintered into more than 3  Location of fracture
fragments  Severity of fracture
 Soft tissue damage
PATTERNS OF FRACTURE  Age and health status of patient
 Depressed-fragments are driven inward GOALS OF FRACTURE MANAGEMENT
 Compressed- bone collapses in on itself
 Avulsion fragment of bone is pulled off by  To gain and maintain correct position and
ligament or tendon alignment
 Impacted fragile of bone is wedged into other  To regain the function of involved part
bone fragment  To return patient to usual activity in the shortest
 Fracture dislocation fracture complicated by time and at the least expense
being out of the joint
 Others are fractures described according to MANAGEMENT OF FRACTURE
anatomic locations Involves a 3-step process:

FRACTURE OF SPECIFIC SITES  Reduction - setting of the bone; refers to

restoration of the fracture into the correct
 Clavicle anatomic position and alignment
 Proximal of humerus
 Shaft of humerus  Immobilization maintains reduction until healing
 Elbow and forearmed occurs
 Wrist/ Colles fracture
 Hand  Rehabilitation regaining normal function of the
 Hip affected part
 Femoral shaft
 Knee MANAGEMENT OF FRACTURE

CLINICAL MANIFESTATIONS  Closed reduction bone fragments are brought

into position by manipulation under local
o Pain at the site of injury anesthesia
o Swelling
o Tenderness  Traction uses force to correct the fracture
o False motion and crepitus
o Deformity
  Open Reduction with Internal Fixation (ORIF) -
Operative technique to reduce, align and
stabilize fractured bone.
COMPLICATIONS OF FRACTURE
 Muscle atrophy
 Loss of ROM
 Pressure sores
 Diminished respi, cardio-vascular, GI functions
resulting in possible major problems
 Venous stasis, thromboembolism
 Infection
 Shock
FRACTURE HEALING
 Healing of fracture depends on the type, extent
of damage, location and pattern of fracture
 Healing also depends on the patient's age, health
status and degree of mobility.
COMPLICATIONS
 Bone union problems
 Delayed union takes longer to heal than
expected
 Non union-fractured bones failed to unite
 Mal union- union occurs but faulty or mal
aligned
JOINT DISLOCATION
 Occurs when the surfaces of the bones forming
the joints are no longer in anatomic contact.
 This is a medical emergency because of
associated disruption of surrounding blood and
nerve supplies.
JOINT DISLOCATION
The most common joints to dislocate:
 Shoulder
 Elbows
 Fingers
Mechanism of injury can be anterior, posterior, lateral or
medial force.
JOINT DISLOCATION-MANIFESTATIONS
 Pain
 Deformity
 Change in the length of extremity
 Loss of normal movement
 Swelling and other manifestations may be noted
with soft tissue involvement or fracture
MEDICAL MANAGEMENT
 Immobilize the extremity while patient is
transported to hospital
 Secure reduction of dislocation as soon as
possible to prevent circulatory or nerve
impairments (usually closed reduction under
anesthesia)
 Stabilize reduction until joint structures are
healed to prevent permanently unstable joint or
septic necrosis of bones
NURSING MANAGEMENT
 Maintain immobilization until doctor sees the
patient
 Monitor neurovascular status before and after
reduction
 Administer pain medications and NSAID's as
prescribed
 Ensure proper use of immobilization device after
reduction
 Provide health teaching on activity restrictions
and need for follow up
KNEE INJURIES
 Knee ligament provides stability to the knee
joint
 These ligaments promote rotational stability
(anterior cruciate ligament (ACL and posterior
cruciate ligament (PCL)}
 These ligaments prevent parts and valgus
instability (medial and lateral collateral
ligaments)
KNEE INJURIES
 Pieces of cartilage that stabilize the knee
internally are known as the medial and lateral
menisci
 Anterior cruciate ligament injuries and medial
menisci tears are common due to sports injuries
KNEE INJURIES - MANIFESTATIONS
 Severe stresses are applied to the knee during
many sports activities (i.e. Soccer)
 Injury to the knee structures occurs during
flexing and twisting of joint
 Torn cartilage causes pain, tenderness, joint
effusion. swelling. clicking sensations and
decreased ROM
 Patellar tendon may rupture
KNEE INJURIES - MANAGEMENT
 Special assessment techniques are done to detect
anterior cruciate ligament injury
 Some injuries may be immobilized with cast,
splint or brace
 Minimal injuries may be treated with physical
therapy
Surgery:
 ACL reconstruction/repair
 PCL reconstruction/repair
  Meniscectomy (arthroscopic or open)
Concussion
SPRAIN  is an injury to the head that usually occurs when
the moving head hits an object (Head to object)
 ls an injury to the ligamentous structures
surrounding a joint, usually caused by a wrench With severe blow, both types may cause brain injuries
or twist resulting in a decrease in joint stability
CONTUSION AND CONCUSSION
Common sprain:
 Ankle  Hemorrhage to injured part causes Ecchymoses
 Knee from the ruptured small blood vessels (may be
associated with fracture)
SPRAIN-MANIFESTATIONS
 Pain, swelling and discoloration
 Rapid swelling -due to extravasations
 Tenderness especially on passive movement of  Hyperkalemia may be present with extensive
joints contusions. resulting in destruction of body
 Pain that increases in intensity as swelling tissue and blood loss
becomes worse
 Limited ROM/ immobility

MANAGEMENT:

 R.I.C.E.
 NSAID's and analgesic
 Assistive devices.
 Cast and other materials for immobilization
 Surgery

R.I.C.E.

 Rest
 Immobilization
 Cold compress
 Elevation of extremity

 Warm compress-is applied in after 24 hours

STRAIN

 ls microscopic tearing of the muscle caused by

excessive stretching force, or overuse

 Note: There are 642 skeletal muscles

Commons sites:

 Neck
 Calf
 Back, etc.

STRAIN

 Hemorrhage into the muscles

 Swelling
 Tenderness
 Pain with isometric contraction
 Spasms may be present Limited range of motion

STRAIN MANAGEMENT

 R.I.C.E.
 NSAID's and analgesic as prescribed o Brace
and immobilizing materials
 Use of assistive devices with or without weight-
bearing Warm compress after 24 hours may be
applied

Contusion
 is an injury to the soft tissue produced by blunt
force (kick, blow or fall) (Object to head)