Musku

• Contusions


  Soft tissue injury produced by blunt force causing blood vessels to rupture and bleed into soft tissues (ecchymosis or bruising)
• Strain


  Pulled muscle or tendon due to overuse, overstressed, overstretched
• Sprain


  Injury to the ligaments that surrounds a joint due to a twisting motion or hyperextension of a joint. Blood vessels rupture and edema occurs
• Nursing management for contusions, sprains, strains


  1. Rest - promotes healing and prevents further injury

  2. Ice (20-30mins for 24-48 hrs) - for vasoconstriction to minimize pain, bleeding and swelling

  3. Compression - provides support, reduce edema and stops bleeding

  4. Elevation - minimizes swelling
• Joint dislocations


  Condition in which the articular surfaces of the distal and proximal bones that form the joint are no longer in anatomic alignment
• Complete dislocation


  Bone is literally out of the joint
• Subluxation


  Partial dislocation and does not cause as much deformity as a complete dislocation
• Medical management for joint dislocations


  1. The affected joint needs to be immobilized by splints, cast or traction

  2. Prompt reduction and displaced parts are placed back in proper anatomic position to preserve joint function and prevent AVN or avascular necrosis

  3. Analgesia, muscle relaxants, and possibly anesthesia are used to facilitate closed reduction

  4. Neurovascular status is assessed at a minimum of every 15 minutes until stable

  5. After reduction, if the joint is stable, gentle, progressive, active and passive movement is begun to preserve range of motion (ROM) and restore strength
• Anterior Cruciate Ligament (ACL) Tear


  • The ACL is a ligament that runs in front of the knee and helps to keep the tibia (shinbone) from moving too far forward in relation to the femur (thighbone)
  • One of the major ligaments in the knee that helps stabilize the joint
• Causes of ACL tear


  • Popping sound with immediate swelling
  • High-impact activities or collisions
  • Sudden changes in direction
  • Landing badly after a jump
• Meniscal Tear


  • The menisci are two c-shaped pieces of cartilage that act as a cushion between the thigh bone (femur) and the shin bone (tibia)
  • It helps absorb shock and provides stability to the knee joint
• Causes of meniscal tear


  • Meniscus tears frequently occur during activities that involve twisting or rotating the knee
  • Increased risk if you are bearing weight
• Management for ACL and meniscal tear


  1. RICE

  2. Arthroscopy

  3. Surgical repair

  4. Rehab
• Fracture


  Break in the continuity of the bone
• Closed fracture


  Bone broken but skin is intact
• Open fracture


  Break in the skin at the time of fracture, with or without bone protrusion
• Grading of open fractures


  • Grade 1 - clean wound less than 1 cm long
  • Grade 2 - larger wound without extensive soft tissue damage
  • Grade 3 - most severe, highly contaminated, has extensive soft tissue damage
• Types of fractures


  • Complete fracture - bone completely separated into two parts (transverse or spiral)
  • Incomplete fracture - only part of width of bone broken
  • Greenstick fracture - splintering one side of bone with bending of the other side, occurs only with pliable bones
  • Comminuted fracture - bone broken into several fragments
• Open reduction


  Internal fixation devices maybe used to hold the bone fragments in position
• Immobilization


  Bandages, casts, splints, continuous tractions and external fixators
• Close reduction


  Closed reduction
• Casts


  A rigid external immobilizing device that is molded to the contours of the body
• Compartment syndrome


  • Most serious complication
  • Tight and rigid cast or splint that constricts a swollen limb
  • Occurs when increased pressure within a confined space (cast, splint) compromises blood flow and tissue perfusion
  • Ischemia and irreversible soft tissue damage occurs within hours if not corrected
• 6 Ps of critical limb ischemia


  • Pain
  • Poikilothermia (perishing cold)
  • Pallor
  • Paresthesia
  • Pulselessness
  • Paralysis
• Pressure ulcers


  • Pressure on soft tissues
  • May result to pressure necrosis - very painful "HOT SPOT" and tightness under the cast
  • With drainage and foul odor smell
• Common sites for pressure ulcers


  • Lower extremities - heel, dorsum of the foot, patella, head of fibula
  • Upper extremities - medial epicondyle of humerus, ulnar styloid
• Disuse syndrome


  • Deterioration of body systems due to unavoidable musculoskeletal inactivity
  • Atrophy and loss of strength
• Isometric exercises


  Tense and contract muscles without moving the underlying bone
• Fracture complications


  • Shock
  • Fat embolism (hypoxia, tachypnea, tachycardia, and pyrexia. Tachypnea, dyspnea, crackles, wheezes, precordial chest pain, cough, large amounts of thick white sputum, and tachycardia. Edema and hemorrhages in the alveoli impair oxygen transport, leading to hypoxia. Petechial rashes)
  • Compartment syndrome
  • DVT/Pulmonary embolism
  • Delayed union/Malunion/Nonunion
• Other complications


  • Atelectasis and pneumonia
  • Constipation and anorexia
  • Urinary stasis and infection
  • Venous thromboembolism