Multiple trauma part 2

• - Sprain- injury to the ligamentous structures surrounding a joint, caused by wrenching or twisting motion. Classified according to the amount of ligament fibers torn.
• first degree sprain-few fibers, mild tenderness,slight swelling second degree sprain- more swelling and tenderness
• -third degree sprain- complete tearing of the ligament extremely

- Strain- stretching of a muscle and its fascial sheath

• - S/S- pain, edema, decrease in function, bruising
• -Minor sprains/strains-usually self-limiting (3-6 weeks)
• - X-ray taken to rule out fracture or widening of the joint structure
• - Surgical repair may be necessary

• - Health Promotion- elastic support bandages, taping before exercise, stretching and warm-up exercise before vigorous activity - Acute Intervention- RICE and analgesia
• - Ambulatory and Home Care- instructed in use of ice and elevation for 24 to 72 hours after injury

• - Dislocation-severe injury of the ligamentous structures that surround a joint resulting in complete displacement or separation of the articular surfaces of the joint
• - Subluxation- partial or incomplete displacement of the joint surface
• - S/S- asymmetry of the musculoskeletal contour, local pain, tenderness, loss of function in the injured part, swelling of the soft tissue in the joint region
• - X-ray studies performed to determine the extent of shifting of the involved structures, joint may be aspirated for blood or fat cells from the synovial fluid

• - Dislocation needs prompt attention-possibility of avascular necrosis
• - First goal of management-realign dislocated joint by a closed reduction performed under local or general anesthesia or surgical reduction (open reduction)
• - After reduction, extremity is immobilized by taping or a sling
• - Nursing management aimed at pain relief, support/protection of the joint, exercise program

• - A disruption or break in the continuity of the structure of the bone. Mostly traumatic etiology but may also be secondary to disease.
• - Fracture are classified by: Type, Communication with the environment, Location and Stable (periostium is intact across the fracture and either external or internal fixation has rendered the fragments stationary

Clinical Manifestaions: Localized pain, Decreased function, Inability to use the part, and Guarding. (Immobilize if suspect a fracture and it is Important to monitor the epiphyseal plate in children)

Collaborative Care: Anatomic realignment of bone fragments (reduction), Immobilization to maintain alignment, and Restoration of function of the injured part.

• - external fixation- cast or external fixator
• - internal fixation- pins and rods
• - maintenance of traction
• - open fracture-communication to or from the fracture through the skin…tetanus prevention is important…broad spectrum antibiotic (cephalosporin) prophylactically
• - Drug Therapy
• muscle spasm (pain)-muscle relaxants (Soma, Flexeril)
• - Nutritional Therapy
• adequate protein (1 Gm. Per kilo)
• vitamins D, B, C
• calcium

In Stages:

• - fracture hematoma- bleding around fracture site create a hematoma.
• - granulation tissue (hematoma converted) composed of young blood vessels, fibroblasts, osteoblasts…new bone substance called osteoid
• - callus formation (mineral deposits) composed cartilage, osteoblasts, calcium, phosphorus) starts at the end of the first week
• - ossification-2-3 weeks after fx. Can be changed from skeletal traction to a cast
• - consolidation –radiographic union
• - remodeling-excess tissue is absorbed, union is complete

• Influence healing: age, initial displacement, site of the fx., blood supply to the area
• Impede/arrest healing: inadequate immobilization and reduction, infection, excess movement, poor nutrition

- Direct complications:

• problems with bone union-
• avascular necrosis-
• bone infection- soft tissue injuries can lead to devitalized and contaminated tissue,medium for infection. open fractures require surgical intervention (debridement and irrigation) and antibiotics (7-10 days)

- Indirect complications:

• compartment syndrome - compression of the structures within closed compartments of the upper and lower extremities formed by facial sheaths or bone
• venous thrombosis - compression stockings, sequential compression device, ROM. prophylactic anticoagulant medication (warfarin, heparin, aspirin) (low molecular weight heparin being used with good results-no need for monitoring of prothrombin time.
• fat embolus - occurs with fractures of the long bones or multiple fractures. can also occur after total joint replacement, spinal fusion, liposuction, crush injuries, bone marrow transplant.S/S-initial manifestations 24 to 48 hrs. after injury, when they travel to the lungs it causes hemorrhagic interstitial pneumonitis (chest pain, tachypnea, cyanosis, dyspnea, apprehension, tachycardia, decreased arterial oxygen…leads to mental status changes (memory loss, restlessness, confusion, elevated temperature and headache)