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Management of Musculoskeletal Trauma

Case Study. A 60 y/o client with chronic renal failure has fallen and suffered a non-displaced fracture of the right tibia and fibula. A cast has been applied. The client's phosphorus level is 6.0 (normal 3.0

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Management of Musculoskeletal Trauma

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    1. Management of Musculoskeletal Trauma Chapter 69

    2. Case Study A 60 y/o client with chronic renal failure has fallen and suffered a non-displaced fracture of the right tibia and fibula. A cast has been applied. The client’s phosphorus level is 6.0 (normal 3.0 – 4.5 mg/dL).

    3. Case Study Questions What changes would you expect to see in the calcium level? What is responsible for maintaining calcium and phosphorus equilibrium? How will the patient’s lab values impact healing?

    4. Sports Related Injuries Contusions Strains Sprains Knee Injuries Tendon Ruptures Dislocations and Subluxations Rotator Cuff Injuries

    5. Care of Sprains and Strains Rest Ice Compression Elevation

    6. Case Study An 18 year old basketball player fell to the floor during a game. Prior to the fall the player felt the right knee give way. A fan in the stands reported hearing a “pop”.

    7. Case Study Questions What do you think has occurred? What would be the first priority of care? What diagnostics would you expect to see ordered? What diagnostic test/surgical procedure will be scheduled? What are the contraindications to this procedure? What should be done post-procedure? Occurred: dislocation, cartilage tear, ligament tear Priority: immobilization, RICE Diagnostics: CT, MRI Procedure: Arthroscopy Contraindications: inability to flex knee 40 degrees; infected joint Post-procedure: monitor for bleeding; straight leg raising exercises Occurred: dislocation, cartilage tear, ligament tear Priority: immobilization, RICE Diagnostics: CT, MRI Procedure: Arthroscopy Contraindications: inability to flex knee 40 degrees; infected joint Post-procedure: monitor for bleeding; straight leg raising exercises

    10. FRACTURES

    12. Fractures: Complications Acute compartment syndrome Shock Fat embolism syndrome (FES) Complications from thromboembolism DVT Pulmonary Embolism Infection Avascular Necrosis Fracture Blisters Delayed union, nonunion, and malunion

    14. Stryker Intracompartmental Pressure Monitor

    15. Fractures: Interventions Emergency care Reduction or realignment of bone ends Immobilization Nonsurgical management NIC neurovascular monitoring (1133) Closed reduction Bandages and splints Casts traction

    16. Fractures: Interventions Surgical management Open reduction with internal fixation External fixation with closed reduction Circular external fixation Procedures for nonunion Electrical bone stimulation Bone grafting Ultrasound fracture treatment

    18. Crush Syndrome Occurs when multiple compartments are injured Potentially life-threatening Characteristics: Acute compartment syndrome Hypovolemia Hyperkalemia Rhabdomyolysis Acute tubular necrosis

    19. Amputations Removal of part of the body Surgical traumatic Levels of amputation Upper extremity Lower extremity Complications Hemorrhage Infection Phantom limb pain Problems of immobility Neuroma Flexion contactures

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