M5 FRACTURES

• Contusion


  Soft tissue injury by blunt force - small blood vessels rupture and bleed into soft tissue
• Contusion


  • Minor or severe; isolated or in conjunction with traditional injuries
  • Local symptoms of pain, swelling, & discoloration (black and blue)
  • May limit joint ROM; injured muscle feels weak or stiff
  • Takes 1 to 2 weeks to heal
• Dislocation


  Displacement of a bone from its normal joint position to its extent that articulating surfaces loss contact
• Dislocation


  • Causes - Trauma, disease, congenital condition
  • Signs & Symptoms - Burning joint pain, joint deformity, stiffness & loss of function, moderate or severe edema around joint
• Nursing Intervention for Dislocation

  1. Emergency! - "Naipit" na blood vessels cause no blood flow

  2. Elevate affected extremity; do not manipulate

  3. Assess affected extremity for neurovascular problem - pain, absent pulse, paresthesia, pallor, paralysis

  4. Pain medication as ordered

  5. Encourage patient to exercise
• Sprain


  Injury to ligaments and tendons surrounding joint - Stretching or tearing of ligaments
• Sprain


  • Common in ankles; wrists; and knees
  • S/SX - Pain, swelling, edema, discoloration, and decreased joint function
  • The greater the pain & swelling, the more severe
  • Causes - Sudden twisting of joint beyond normal range or motion, Rapid changes in direction or by collision, Overextending or tearing ligament while severely stressing a joint, Walking or exercising on uneven surface, Landing awkwardly; either at end of a jump or while pivoting during athletic activity
• Classification of Sprains


  • 1st Degree (Mild) - Ligament stretches excessively or slight tears in some fibers
  • 2nd Degree (Moderate) - More severe and involves partial tearing of ligament
  • 3rd Degree - Complete tearing or rupture; may cause avulsion of the bone
• 1st Degree Sprain


  • Mild, localized hematoma
  • Mild pain
  • Edema
  • Local tenderness
• 2nd Degree Sprain


  • Increased pain with motion
  • Edema
  • Tenderness
  • Joint instability
  • Ecchymosis
  • Partial loss of joint function
• 3rd Degree Sprain


  • Severe pain
  • Edema
  • Tenderness
  • Ecchymosis
  • Abnormal joint motion - Cannot move joint or put weight on it
  • Injury difficult to distinguish from fracture or dislocation
  • Brace to stabilize joint or surgical repair in certain ligament injuries is the treatment
• Treatment for Sprains


  1. Pain relievers (NSAIDs) such as ibuprofen or acetaminophen

  2. Apply ice to area to minimize swelling

  3. Immobilize with brace, splint, or cast to sustain stability
• Prevention of Sprains

  1. Tape, brace, or wrap knees, ankles, wrists, or elbows

  2. Use footwear to offer support & protection
• Strain


  Injury to a muscle or tendon from overuse, overstretching, or excessive stress; a.k.a. muscle pull - Stretching or tearing of muscle; Small blood vessels in muscle rupture & muscle fibers sustain tiny tears
• Strain


  • Common area in back muscles
  • Two Types - Acute (From a single injury), Chronic (From repetitive injuries; may result from improper management of acute strains)
  • S/SX - Inflammation, local tenderness, and muscle spasms or cramping
  • Causes - Muscles suddenly & powerfully contract, Muscle stretches unusually far, Overuse of certain muscles overtime, When one slips on ice, runs, jumps, throws, lifts heavy objects or lifts in an awkward position
• Classification of Strains


  • 1st Degree (Mild) - Mild stretching of muscle or tendon
  • 2nd Degree (Moderate) - Moderate stretching and/or partial tearing of muscles or tendons
  • 3rd Degree (Severe) - Severe muscle or tendon stretching with rupturing or complete tearing
• 1st Degree Strain


  • No loss of ROM
  • Mild muscle spasm and tenderness
• 2nd Degree Strain


  • Acute pain during precipitating event
  • Increased tenderness
  • Pain with passive ROM (PROM)
  • Edema
  • Significant muscle spasm
  • Ecchymosis
• 3rd Degree Strain

  • Immediate pain (snapping, burning, or tearing)
  • Muscle spasms
  • Ecchymosis
  • Edema
  • Loss of function
• Nursing Intervention for Strains

  1. Ice pack for 48 hours

  2. Warm treatment after swelling subside

  3. Rest for 4 to 6 weeks

  4. Permit minimal movement
• Fracture


  Break in continuity of bone - Bone subjected to stress greater than it can absorb
• Fractures

  • Caused by direct blows, crushing force, sudden twisting motion, & extreme muscle contractions
  • Result from trauma and commonly caused by substantial muscle, nerve, and other soft-tissue damage
  • Prognosis varies, depends on patient - can extent to disability or deformity; vascular damage; immobilization
• Types of Fractures

  • Complete - Bone completely separated into two
  • Incomplete - Only one part of the bone is broken
  • Greenstick - Splintering on one side of the bone with bending of bones of the other side; usually in children
  • Simple (closed) - Bone broken but no break in the skin; can be one side of bone
  • Compound (open) - Break in the skin at the time of fracture with or without protrusion of the bone
  • Transverse - Break is in a straight line across the bone
  • Greenstick Spiral - Break spirals around the bone; twisting injury
  • Oblique - Diagonal break across the bone
  • Compression - Bone is crushed, causing broken bone to appear wider or flatter
  • Comminuted - Break is in 3 or more pieces; fragments are present at fracture site
  • Segmental - Same bone is fractured in two places; "floating" segment of bone
  • Stress - Due to prolonged, repeated use of the bone
  • Pathologic - Due to other systematic diseases
  • Traumatic - Due to injury
• Fracture Eponyms


  • Barton's Fracture - Dorsal rim fracture of the radius
  • Bennett's Fracture - Fracture of the base of thumb, acute with subluxation or dislocation of the metacarpal joint of the thumb
  • Colle's Fracture - Fracture of the radius and ulna that may or may not involve wrist joint; caused by extending hand
  • Cotton's Fracture - Trimalleolar ankle fracture of the distal tibia
  • Galeazzi's Fracture - Fracture of the distal third of the radius with radioulnar dislocation
  • Malgaigne's Fracture - Bilateral fracture of the pelvic ring; causes pelvic instability
  • Monteggia's Fracture - Fracture of the shaft of the ulna with displacement of fragments
  • Neer Fracture - Shoulder and humeral displacement resulting to fracture in more than 3 fragments
  • Pott's Fracture - Fracture of the fibula including malleoli of the ankle
  • Salter-Harris Fracture - Fracture separates apart the epiphysis from the bone; usually from crush injury
  • Teardrop Fracture - Compression fracture of the body of a vertebra with separation of bone fragments
• Signs and Symptoms of Fractures

  • Subjective - Pain aggravated by motion, Tenderness
  • Objective - Loss of function, motion, Swelling, edema, Crepitus (Popping, clicking, or crackling sound), Ecchymosis (Discoloration)
• Stages of Bone Healing

  • Inflammatory Phase
  • Reparative Phase
  • Remodeling Phase
• Nursing Interventions for Fractures

  1. Emergency Care - Splint the limb above & below suspected fracture, Cold pack application & elevate extremity to reduce edema and pain, Direct pressure to control bleeding in severe fractures causing blood loss

  2. Immobilization - Splint, casting, traction with a counter weight

  3. Closed reduction - Restores displaced bone segments to their normal position

  4. Open reduction surgery - Reduce and immobilize fracture using rods, plates, & screws when closed reduction is possible, followed by application

  5. Medications - Analgesics (codeine, morphine, acetaminophen, & oxycodone), Prophylactic antibiotics (cefazolin), Tetanus prophylaxis (tetanus toxoid)

  6. Nursing Management - Observe for signs of shock, Assess affected limb for compartment syndrome, Administer IV fluids to replace fluid loss, Ease pain with analgesics to promote comfort, If with traction, reposition client to increase comfort & prevent muscle atrophy, Encourage deep breathing & coughing to avoid hypostatic pneumonia, Provide adequate fluids to prevent urinary stone formation, Provide good cast care to avoid skin breakdown, Promote ambulation as early as possible, Demonstrate how to use crutches properly, Physical therapy to restore limb mobility
• Cane


  Assistive device - Hold cane in hand opposite of affected extremity; advance cane & affected leg together
• Walker


  Assistive device - Hip level, Lift and walk, Positioned at the back when going up stairs; position in front when going down stairs
• Preventing Complications of Immobility

  1. Range-of-Motion (ROM) Exercises - Movement of joint through full ROM; prevents contractures and increase or maintain muscle tone/strength

  2. Types - Active (Carried out by client), Passive (Carried out by nurse without assistance from client), Active-Assistive (Client moves body part with assistance from nurse)
• Immobilization


  Rigid external device molded to the contours of the body to immobilize a reduced fracture, correct a deformity, or support and stabilize weakened joints
• Provide good cast care to avoid skin breakdown; do not write on cast & do not wet cast
• Promote ambulation as early as possible
• Demonstrate how to use crutches properly
• Physical therapy to restore limb mobility
• Cane


  • Single, tripod cane, quadripod cane
  • Hold cane in hand opposite of affected extremity; advance cane & affected leg together
• Walker


  • Hip level
  • Lift and walk
  • Positioned at the back when going up stairs; position in front when going down stairs
• Range-of-Motion (ROM) Exercises


  Movement of joint through full ROM; prevents contractures and increase or maintain muscle tone/strength
• Types of ROM Exercises

  • Active – Carried out by client
  • Passive – Carried out by nurse without assistance from client
  • Active-Assistive – Client moves body part as far and nurse completes remainder of movement
  • Active-Resistive – Client pushes or pulls against resistant force
• Isometric Exercises


  Active exercise through contraction/relaxation of muscle; No joint movement; Length of muscle does not change; Client increases tension in muscle for several seconds and then relaxes; Maintains muscle strength and size