Chapter 57 - Musculoskeletal Trauma, Infections, & Neoplasms

• musculoskeletal injuries include:

  • blunt tissue trauma
  • disruption of tendons and ligaments
  • fractures of bony structures
  • athletic injuries
  • acute injuries
  • overuse injuries
• acute injuries are caused by sudden trauma and include injuries to soft tissues (contusion, strains, and sprains) and to bone (fractures)
• overuse injuries are chronic injuries that include stress fractures that result from constant high levels of physiological stress without sufficient recovery time
• most skeletal injuries are accompanied by soft tissue injuries
• a contusion is an injury to soft tissue that results from direct trauma and is usually caused by striking a body part against a harm object
• in a contusion, the skin is intact with hemorrhage below
• a contusion is initially black and blue, moving to brown then yellow
• a hematoma is a large area of local hemorrhage
• in a hematoma, there is pain as blood accumulates and exerts pressure on nerves
• treatment of a contusion and hematoma includes elevation of the affected region and cold application to reduce bleeding
• a laceration is an injury in which the skin is torn or its continuity is disrupted
• adequate wound healing and closure is required for a laceration in order to prevent infection
• a strain is a stretching injury to a muscle or musculotendinous unit caused by mechanical overloading
• a sprain involves the ligamentous structures surrounding the joints
• pain and swelling in a sprain subside more slowly than in a strain
• a sprain is caused by abnormal or excessive movement of the joint
• dislocation is the displacement or separation of the bone ends of a joint with loss of articulation
• loose bodies are small pieces of bone or cartilage within a joint space
• soft tissue repair is accomplished by fibroblasts from the inner tendon sheath
• capillaries infiltrate the injured soft tissue area during the initial healing process
• long collagen bundles are formed within the first 2 weeks of soft tissue healing but strong tendon pulls require 6 to 8 weeks of repair time
• treatment of soft tissue injuries:

  • elevation and cold application
  • compression (use of splints and wraps)
  • casting in severe sprains
  • immobilization until pain and swelling have subsided
• it is important to keep soft tissue mobile during healing to ensure the return of normal length
• bone fractures are classified by:

  • cause (sudden injury, stress fractures, pathologic fractures)
  • location (proximal, midshaft, distal)
  • types (open or closed)
  • pattern of fracture line (comminuted, compression, greenstick)
• signs and symptoms of a fracture:

  • pain
  • tenderness at the site of bone disruption
  • swelling
  • loss of function
  • deformity of the affected part
  • abnormal mobility
• three objectives of treating bone fractures:

  • reduction of the fracture
  • immobilization
  • preservation and restoration of function
• bones fractures are treated by closed manipulation or surgical reduction to align bones in proper orientation
• immobilization to treat bone fractures is accomplished through the use of external devices such as splints, casts, traction, and external fixation
• muscle atrophy occurs during a period of immobilization due to the joints stiffening as muscles/tendons contract and shorten
• exercise therapy should be carried out as soon as possible following immobilization for a bone fracture
• stages of bone healing:

  • hematoma formation
  • cellular proliferation
  • bony callus formation
  • ossification and remodeling
• in the hematoma formation stage of bone healing, blood clots include bone fragments
• in the hematoma formation stage of bone healing, fibrin meshwork seals off the fracture and provides framework for inflammatory cell influx, fibroblasts, and new capillary bude
• in the cellular proliferation stage of bone healing, new capillaries organize to form granulation tissue (procallus)
• in the cellular proliferation stage of bone healing, fibroblasts proliferate from surrounding bone regions
• in the cellular proliferation stage of bone healing, a fibrocartilaginous soft bridge is formed that connects bone fragments
• during the cellular proliferation stage of bone healing, maximum girth occurs at the end of 2 to 3 weeks, but it is not strong enough for load bearing
• ossification is the conversion of fibrocartilage bridge to bony callus
• in the bony callus formation stage of bone healing, osteoblast proliferration and bone deposition starts from the outside of the fracture and working towards the fracture site
• in the bony callus formation stage of bone healing, spongy bone is formed and calcification continues replacing spongy bone with mature bone