Musculo-skeletal Injuries Nursing Management

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NURSING MANAGEMENT OFPERSONS WITH MUSCULO-SKELETALINJURIES

Prepared by Marjorie Ming MPH,RN/M 2008


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MUSCULO-SKELETAL INJURIES

Definition of Terms

1. Muscle: A type of tissue composed of contractile cells orfibres that effects movement of an organ or part of thebody. Muscle tissue also has the ability to shorten orcontract, has properties of irritability, conductivity &elasticity.

Three types: smooth, striated, cardiac based onhistological structure.

2. Muscular: Pertaining to muscles.

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Definition of Terms

3. Musculo: Combining form pertaining to muscle

4. Skeletal (Skeleton): a) A dried up body

(Tabers Psychlopedic Med. Dictionary)

b) Hard framework of bones of animals;

c) supporting framework or structure of a thing.

(Little Oxford Dictionary)

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MUSCULO-SKELETAL INJURIES: Types

Fractures: the long bone is most commonlyinvolved. Composed of the shaft or diaphysis &the flared end or metaphysis.

In children the two important segments are thephysis (growth region) epiphysis which is directlyadjacent to the joint.The epiphysis fuses to the metaphysis at theend of the growth periodInjury to long bones in childhood can result ingrowth retardation or arrest in longitudinalgrowth of limb.

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MUSCULO-SKELETAL INJURIES: Types

Classification of Fractures

a) according to type of injury to the bone orsurrounding tissue e.g. transverse (across thebone); oblique (at an angle across the bone);comminuted (displaced fragments of bone).

b) open or closed: in an open # the skin is brokendue to penetration of bone fragment or externaltrauma

c) Soft tissue injury is also probable with fractures.

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Types of Fractures

1. Greenstick: A crack; bending of bone withincomplete fracture.

Only affects one side of the boneCommon in skull fractures & in young childrenwhen bones are pliable.

2. Comminuted: Bone completely broken in spiral,transverse or oblique direction (direction offracture in relation to the long axis of the bone).

Bone broken in several fragments.

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Types of Fractures

3. Open or Compound: Bone exposed to the airthrough a break in the skin

Can also be associated with soft tissue injuryInfection is a common complication (exposure)

4. Closed or Simple: Skin remains intact.

Chances for Infection are greatly decreased.

5. Compression: Frequently in vertebral fractures.

Fractured bone is compressed by other bones.

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Types of Fractures

6. Complete: Bone broken disruption of bothsides of the periosteum.

7. Impacted: One part of fractured bone is driveninto another.

8. Depressed: Usually in skull or facial injuries.

Bone or fragments of bone are driven inwards.

9. Pathological: Break caused by diseaseprocess.

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Treatment of Fractures

1.Simple Reduction: Manipulation to return boneto normal anatomical position (Closed Fractures)Casts are generally applied to maintain reducedfracture in proper alignment.

2. Traction: Skin & Skeletal used to maintainalignment of reduced fracture

a)Skeletal Traction: More Reliable & Effective(most commonly used Russels & ThomasSplint with Pearson attachment)b)Skin Traction: Many types, the oldest is Bucks Traction

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Treatment of Fractures

b) Skin Traction (Bucks) contd.: Applied for shortperiods on young patients with knee injuries orelderly patients prior to surgical repair offractured hip.

Bryants traction is used primarily for childrenunder 3 years with fractured femurNeck Halters & Pelvic Traction: are also typesof skin traction.

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Immobilization for Spinal Injuries: - HaloTraction; Jewett-Taylor Brace;

Stryker Frame: Most easily maintains CervicalTraction; Skeletal traction may be necessary.Halo Traction: Popular because it allows earlymobility of patient, often follows after surgery.Jewett-Taylor Brace: Generally applied beforegetting the patient out of bed (for stabilizing).

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Other Treatment Modalities:

1.Special Beds:The Nelson Bed to prevent movements ofbody parts & prevent complications.CircOlectric Bed Facilitates immobility &frequent turning for optimal care.

2. Bandages:

3. Slings:

4. Splints:

5. Plaster Casts:

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Clinical Manifestations: Depends on the location,type, and nature of the causative injury.

Fractures: generally characterized by pain,abnormal positioning, oedema, immobility ordecreased range of motion, ecchymosis, guarding,and crepitus.

Childhood fractures involve clavicle, tibia, ulna &femur; distal forearm # the most common type.Fractures to the pelvis are usually associated withmotor vehicle crashes. Epiphyseal injuries arecommon in children.

Exact location is determined by X-ray.

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Clinical Management: Two basic types

1.Reduction to realign displaced or fragmentedbones.2.Immobilization to facilitate healing.Closed Reduction aligns the bone by manualmanipulation using conscious sedation or painmanagement during the procedure.Open Reduction requires surgical alignmentand fixation of the bone, using pins, plates, wiresor screws. For open fractures surgery is donefor debridement to remove dead tissue & cleanthe wound.

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Complications of Fracture Reductions

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COMPLICATIONS

CLINICAL THERAPY

Infection:

*Acute (in open fractures)

*Chronic (osteomyelitis)

Debridement, drainage,

culture, and antibiotictreatment.

Neurovascular injury fromphysical nerve damage

Nerve repair

Vascular injury

Vascular repair, amputation,tendon lengthening.

Malunion or delayed union:undesired healed bone length

Corrective osteotomy,prolonged immobilization.

Nonunion

Surgical Internal Fixation

Leg Length Discrepancy

She lift.


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Nursing Considerations Involve:

Prevention of and Correction of alterationsin the musculoskeletal systemEnable patients to achieve and maintainoptimal mobilityPreventing ComplicationsUtilize Preventive, Restorative andRehabilitative methods.

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1. Preventive & Restorative measures include theuse of bandages, splints, tractions, & casts.

2. Rehabilitative measures include the use ofSpecial Beds & Halo Traction.

Bandages: apply pressure; immobilize a bodypart; prevent or reduce oedema; correctdeformity, & secure splints in place.

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ICE: Immobilize; Cold treatment; Elevatearea.Observe: casted extremities frequentlyespecially when cast is drying: for pulse,warmth, pain, paresthesia.Bandaged Extremities: in the 1st 20 mins.then 2 hrly. after application for circulation.

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Nursing Considerations Involve: Diagnoses

1.Pain, related to injury2.Risk for impaired skin integrity, related totreatment3.Risk for infection related to open fracture ortrauma4.Impaired physical mobility related to treatment5.Health seeking behaviours related to lack of information about treatment and expectedoutcome.

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Nursing Considerations

1.Plan and Implement Care2.Maintain Proper Alignment3.Monitor Neurovascular Status4.Promote Mobility5.Discharge Planning and Home Care Teaching.6.Prevent Complications7.Notify physician immediately of sign ofcomplications.

**Major complication is compartment syndromeorcompromise of circulation & tissue function.

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Compartment Syndrome

Clinical Manifestations: begin about 30 after tissueischaemia starts. [* Late signs]

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Major Manifestations are:

Check Extremities for:

Paresthesia: tingling, burning, loss of 2-point discrimination

Colour

Temperature

Pain: unrelieved by medication (childcrying)

Capillary refill

Pressure: skin is tense, cast appears tight

Peripheral pulse

Pallor*: pale, grey or white skin tone

Oedema

Paralysis*: weakness or inability to moveextremity

Sensation

Pulselessness*: weak or absent pulse

Motor ability; Pain


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Strains, Sprain and Dislocations

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Condition

ClinicalManifestations

Clinical Therapy

Strain: Stretching ortearing a muscle ortendon

*Vary by type &severity.

Pain is either acute orchronic.

Rest & support ofinjured part until itheals & normal activityrecurs

Sprain: Stretching ortearing of a ligament

Oedema, Joint

Immobility, Pain

First 24 hours: Rest,Ice Compression,Elevation. Graduallyincrease mobility

Dislocation: Completedisplacement of anarticular joint surface

Pain, Tenderness,Swelling & Instability ofjoint


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Open or ClosedReduction &Immobilization.Dependent on site &severity of injury.


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DISCUSSION

QUESTION S & ANSWERS

REFERENCES

Ball J. and Bindler R, 3rd. Ed. 2003,Paediatric Nursing Caring for ChildrenPrentice Hall, New Jersey

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Musculo-skeletal Injuries Nursing Management

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