Musculoskeletal Injuries and Management

Overview

• Focus on differentiating between contusions, strains, sprains, and dislocations.
• Management of fractures and complications including fracture reduction, immobilization, and casting.

Contusions

• Definition: Soft tissue injury, similar to a bruise.
• Symptoms: Bruising, swelling, tenderness.
• Impact on Bone: Generally no impact on the bone unless coupled with more severe injuries.

Strains

• What is Affected: Muscles.
• Causes: Pulled muscles, overuse, improper body mechanics, twisting, stretching.

Sprains

• What is Affected: Joints and ligaments.
• Causes: Overuse, trauma, wrenching, twisting.

General Treatment for Musculoskeletal Injuries

• R.I.C.E Method: Rest, Ice, Compression, Elevation.
  • Rest: Limit use of the injured area.
  • Ice: Apply ice 20-30 minutes every 1-2 hours for the first 24-48 hours to reduce swelling.
  • Compression: Use bandages like Ace bandages; ensure it's not too tight to avoid circulation issues.
  • Elevation: Keep the injured area at heart level to maintain perfusion.

Dislocations

• Common Sites: Shoulders, hips, fingers, knees, elbows.
• Emergency: Can impair circulatory function.
• Diagnosis: Typically confirmed with X-ray.
• Treatment: Reduction often under conscious sedation, immobilization post-reduction.

Fractures

• Definition: Break in the continuity of the bone.
• Symptoms: Pain, crepitus, deformity, loss of function, muscle spasms.
• First Steps in Management:
  • CMS Checks: Circulation, Movement, Sensation.
  • Immobilization: Splints, casts, slings, etc.
  • Pain Management: Often includes opioids and non-opioid options.

Open Fractures

• Risk: High risk of infection (osteomyelitis).
• Management: Antibiotics, surgical intervention, and sterile dressings.

Complications of Fractures

• Fat Embolism: Usually impacts lungs; presents with confusion, dyspnea.
• Delayed Union, Malunion, Nonunion: Delays or failures in bone healing.
• Compartment Syndrome: Requires immediate intervention to restore perfusion.
• Infections: Especially with open fractures.
• Vascular and Nerve Damage: Risk of necrosis or paralysis.

Cast Care

• Drying Time: 15 minutes initial, 48 hours full drying.
• Do Not: Get wet, insert objects into the cast.
• Monitor for: Pressure ulcers, odors, and itching.

Pin Site Care

• Involves: Cleaning pin sites with sterile technique.
• Importance: To avoid infection.
• Patient Role: Monitor for signs of infection and ensure proper hygiene.

Traction

• Purpose: Align and stabilize fractured bones.
• Types: Skin traction, skeletal traction.
• Nursing Role: Ensure proper alignment, monitor skin integrity, and check equipment.

Key Terms

• CMS: Circulation, Movement, Sensation.
• R.I.C.E: Rest, Ice, Compression, Elevation.
• Fat Embolism: A complication often affecting lungs.
• Compartment Syndrome: A surgical emergency requiring prompt intervention.