Musculoskeletal Disorders: Fractures, Immobilization, and Osteoporosis

Introduction

• Focus: Understanding musculoskeletal disorders, specifically fractures, immobilization, and osteoporosis.
• Preparation: Eliminate distractions, read associated textbook pages, engage actively in learning.
• Objective: Develop knowledge, skills, and attitudes necessary to provide safe, competent, and compassionate nursing care.

Learning Objectives

• Understand the pathophysiology and classification of fractures.
• Identify clinical manifestations of fractures and prioritize nursing assessments.
• Recognize medical and nursing management of fractures.
• Understand osteoporosis and its implications on fractures.

Fractures

Pathophysiology and Classification

• Definition: Interruption of bone integrity, complete or incomplete.
• Types: Trauma, pathological, stress, avulsion, etc.
• Classifications: Stable/unstable, simple/compound, complete/incomplete, etc.
  • Additional Types: Linear, impacted, oblique, comminuted, compression, spiral.

Clinical Manifestations

• Symptoms: Pain, immobility, muscle spasms, deformity, edema, warmth, ecchymosis, numbness, and crepitus.
• Nursing Assessment Priorities:
  • Musculoskeletal system: range of motion, muscle strength.
  • Skin: color, temperature, lesions, pulses, edema.
  • Pain assessment.
  • Patient safety: mobility, need for assistance.

Medical Management

• Diagnostics: X-ray, CT, MRI.
• Treatments:
  • Reduction (alignment) and immobilization.
  • Pain management.
  • Reduction types: closed, open (internal fixation), external fixation.

Casting and Immobilization

• Types: Fiberglass, plaster, walking boots.
• Considerations:
  • Plaster casts: Avoid getting wet.
  • Fiberglass casts: Can get wet with care.
  • 3D printed casts: Allow for skin monitoring.

Complications

• Compartment syndrome: Requires understanding of neurovascular assessments.
• Fat embolism: Common in long bone fractures.
• General: Risk of infection, skin breakdown, pressure injuries.

Specific Fractures

Hip Fractures

• Common in older adults: Falls often lead to fractures (or vice versa).
• Presentation: Leg shortened, adducted, externally rotated.
• Management: Often requires surgery (total/partial hip replacement).

Rib Fractures

• Risk: Atelectasis, pneumonia due to pain limiting breathing.
• Management: Supportive care, breathing exercises.

Humerus Fractures

• Concerns: Mobility issues, balance, risk of falls.

Osteoporosis

Overview

• Definition: Degenerative disease reducing bone mass and strength.
• Causes: Post-menopausal women, aging men, medications, diseases affecting bone metabolism.
• Symptoms: Often silent until fractures occur.

Risk Factors

• Nutrition: Importance of calcium and vitamin D.
• Exercise: Weight-bearing exercises promote bone density.

Management

• Medications: To slow bone loss or promote growth.

Patient Education

• Teens: Focus on prevention through diet and exercise.
• Older Adults: Managing existing condition, preventing falls.

Conclusion

• Review and understand key concepts, meet learning objectives.
• Test understanding and fill knowledge gaps as necessary.