MUSCULOSKELETAL DISORDERS Second Degree/ Moderate Grade Sprain

 Partial tearing of the ligament

Contusion/Bruise  Increased edema, tenderness, pain with motion, joint
 An injury produce by blunt force instability and partial loss of normal joint function.
causing small blood vessels to
rupture and bleed into soft tissue Third Degree/ Severe Grade Sprain
 Signs: Pain, swelling and discoloration  Ligament is completely torn or ruptured
 Resolve in 1-2 weeks  It may also cause avulsion
 Severe pain, increase edema, and abnormal joint motion
STRAIN
 Excessive stretching, over use or excessive stress or injury of CAUSES
Muscle and Tendon (NAON, 2013)  Falling
 Twisting
 Experiencing trauma to the joint
 Walking or exercising on an uneven surface
 Landing awkwardly from a jump

Management for SPRAIN, Strain, Contusion

P - protect from further injury
R - rest
I - ice -Intermittent application of cold packs during the first 24-
72 hours
C - Compression bandage
E - Elevate the affected part
Acute Strains Chronic Strains
 Results from abrupt and  Results from repetitive Other Nursing Interventions
single injurious incident. injuries and from
improper management of  Monitor Neuro vascular status (circulation, motion and
acute strains. sensation)
 Immobilized the affected part
Degrees of Strains  Limit joint activity
First Degree  Administer NSAID’s and muscle relaxant
 Mild stretching of the muscle or tendon  Document and report decrease sensation, motion and
 With no loss of ROM increase in pain
 Gradual onset of palpitation induce tenderness and mild
muscle spasm JOINT DISLOCATION
 Displacement of the bone from its normal joint position to
Second Degree the extent that articulating surfaces loss contact.
 Involves moderate stretching or partial tearing of the
muscle or tendon CAUSES
 Include acute pain, followed by tenderness at the site with  Trauma
increase pain with passive ROM, edema, muscle spasm and  Car and motor accidents
ecchymosis.  Contact sports
 Falls
Third Degree Common Joint Dislocations
 Severe tearing or stretching of the muscle or tendon with  Shoulder (50.6 %)  Knee
ruptures  Fingers (10.1 % )  Wrist
 Ss ans sx: acute pain described by tearing, snapping,  Toes (7.6 %)  Jaw
burning, muscle spasm, ecchymosis, edema, and loss of  Hip (7.3 %)  Clavicle
function  Elbow (6.5 %)  Ribs

SPRAIN

 Excessive stretching/tearing of he LIGAMENTS cause by

twisting motion or hypertension of a joint. (NAON,2013)

Degree or Grade of Sprains

First Degree/Mild Grade Sprain

 Tears of the ligaments and mild localized hematoma
formation
 Ss and sx: mild pain, edema, and local tenderness
 Signs and Symptoms
 Acute pain
 Change or awkward positioning of the joint
 Decrease ROM
 Bilateral assessment from affected to non affected

Diagnostic Test

 X ray - confirm the diagnosis and reveal any associated

fracture
 Physical exam

Medical Management

 Immobilize the joints - splints, cast and traction

 Analgesic, muscle relaxant and anesthesia
 Manual manipulation
 Surgery
 Active and passive exercise

Nursing Intervention

 Assess level of pain and neurovascular check q 15 minutes

 Splint
 Educate on proper exercises and activities
 Educate on the danger signs: Increasing pain numbness or
tingling an increase edema on the affected part
 Analgesics- NSAIDs

CONGENITAL HIP DISLOCATION

 Displacement of the head of the femur from the acetabulum

INITIAL MANIFESTATION
 Limitation of abduction

CLINICAL SIGNS AND

SYMPTOMS

Ortolani’s Click
TYPES  To relocate a dislocated hip by abduction of the flexed hip
with gentle anterior force
SUBLUXATION  Supine, flex the knees and place thumb on bend knees and
 Partial disarticulation of the joint fingers at hip point, or
 Bring femur 90 degrees to hip, the abduct.
COMPLETE DISLOCATION  Positive - the hip is reducible.
 The bones are literally out of the joint/complete
disarticulation of the joint.
 Barlow’s Test
Grades of Open Fractures
 To identify a dislocate hip adduction of the flexed hip with (Halawi, Morhood, 2015)
gentle posterior force.
 With an infant on back, bend knee Type 1 - clean wound less than 1 cm long
 Affected knee will b lower Type 2 - a larger wound without extensive soft tissue damage or
 Additional skin fold with knees bent. avulsions
 Barlow’s positive - hip joint is unstable/ the femoral head Type 3 - most severe with highly contaminated and has extensive
has palpable instability within the acetabulum. soft tissue damage.

Types of Fracture

COMPLETE FRACTURE
 Periosteum and Cortical tissue completely broken on both
sides of bones.
 Entire circumference of the bone is impaired

INCOMPLETE FX
 Bone broken, bent, but still securely at one side.

COLLABORAIVE MANAGEMENT
 Positioning - the hip in abduction
 Casting
 Traction
 Surgery

BONE FRACTURE Fracture According to Pattern

 Break or crack - in the continuity of bone.
 A complete or incomplete disruption in the continuity of Transverse
bone.  Breaks run across the bone

Spriral
 Breaks coil around the bone

Causes of Fracture OBLIQUE

 Trauma  Breaks runs in slanting direction.
 Direct force or crushing force
 Twisting force
 Powerful muscle contraction
 Stress and fatigue
 Pathologic disease

Types Fracture According to Broad Classification

Simple /Closed LONGITUDINAL
 Break in the bone  Breaks run parallel with bone
has no communication
to the outside and has
no open wound.

Open/Compound
 The broken end of
the bone has been move
and it pierces the skin. COMMINUTED
 Bone splintered into fragment
 3 more fragment
Impacted Epiphyseal Fracture
 The fractured end bones are pushed into each other  Fracture through the epiphysis.

Stress Fracture
 Results from repeated use of bone and muscle
Pathologic
 Occurs through an area of diseased bone
Linear Skull Fracture
 A break in cranial bone resembling a thin line, without Fracture Dislocation
splintering, depression, or distortion of bone.  When a fracture is accompanied by a bone out from the
joint.

COMPRESSION
 Is one in which bone typically the vertebra collapses itself.

Fractures (Location)
COLLES’ FX
 Complete fracture of the radius bone of the forearm close
to the wrist.
 Upward displacement of the radius.

DEPRESSED
 Usually occurs in the skull with the broken bone being driven
inward.

Smith Fracture
 is a fracture of the distal radius.
 The radius is the larger of the two bones in the arm.
OTHER TYPES OF FRACTURE  The end of the radius bone toward the hand.
Avulsion
 A fragment of a bone has been pulled away by a tendon
and its attachment.
  Pain relievers
Pott’s Fx
 Fracture of bimalleolar ankle BONE REDUCTION
 putting the fractured bone back in its original state.
 Restore the fractured fragment to anatomic alignment and
positioning
 Types: Closed or Open reduction

Close Reduction with External Fixator

(CREF)
 Manual manipulation
 Cast
Clinical Manifestations  Pins, wires, screws are located externally.
 Bruising over the site (discolored with swelling) and acute
pain
 Reduced movement of extremity or muscle
 Odd appearance (Abnormal)
 Crepitus - Crackling sounds
 Edema and Erythema
 Neurovascular impairment…6 P’s (Pain, Pallor, Paralysis,
Paresthesia, Pulseness (late sign), poikolothermia)

Clinical Manifestations
 Shortening of the limb
 Tenderness of the site Open Reduction with Internal Fixation
 Deformity  Surgically done
 Localized edema/Ecchymosis  Using pins, wires, screws and plates directly to the bone.
 Loss of function  After open, then cast application.

Principles in Management of Fracture Nursing Interventions

(4 R’s) (Reduction)
 Monitor for disorientation and confusion - LOC
 Do Neurovascular checks
 RECOGNITION - assess the type of fracture, signs and
 Encourage the use of OHT
symptoms.
 Check dressings for bleeding and infection
 REDUCTION - Close and Open reduction
 Empty hemovac
 RETENTION - Cast, Traction, External fixators, Braces
 Turn to un-operative side ONLY.
 REHABILLITATION - to achieve optimum level of
 Place 2 pillows between legs while turning or when lying on
functioning
the side
 Implement measures to prevent thrombus formation
Emergency Management
 Assist patient in getting in and out of bed
 Analgesics
 Assess Neurovascular status before and after splinting
 Immobilized- Splinting, Bandaging, lings
 Stop bleeding - applying pressure with a clean cloth Union of Various Bones
 Cover with sterile dressing - opened fracture Clavicle- 3-4 weeks Lower third radius- 6 wks
 Apply ice wrapped in towel to the injury Phalanges- 3 weeks Tibia- 8-12wks
 Elevate extremity Metacarpals- 4 weeks Tarsals- 6-8wks
 NPO (nothing by mouth) Radius/Ulna- 6-13 weeks Metatarsals- 5-6 wks
 Clothes are gently remove from the uninjured site Humerus- 6 weeks
first then from the injured site. Femur- 12 weeks
Fibula- 12-14 weeks
Nursing Interventions
Complication of Fracture
 Compartment Syndrome
 Pain management with prescribed medications
 Watch out for Compartment Syndrome and Fat embolism  Hypovolemic shock
 Assess mental status and respiratory system: Confusion,  Fat embolism
Restless, Increased respiration, DOB  Tetanus
 Assess neurovascular status- 6 P’s
COMPARTMENT SYNDROME
MEDICAL MANAGEMENT
 Immobilization and alignment (Splint, Cast, Traction)  occurs when too much pressure within the muscle
 Reduction (Close and Open) compartments found within the fascia.
 Fluids  Arm, foot, hand, abdomen (rare)
 Effect: Ischemia leading to muscle and nerve necrosis
CAUSES

 Hemorrhaging (bleeding) or swelling present after an injury.

 External factors like a cast or traction

Assess the 6 P’s:

 Pain (Early sign)
 Paresthesia (Early sign too)
 Pallor
 Paralysis
 Poikilothermia
 Pulselessness (late sign)

Nursing Interventions for Compartment Syndrome

 Perform neurovascular checks (6 P’s)

 Keep the extremity AT HEART level
 Loosen and remove restrictive items
 Notify the physician
 Prepare for Bivalvement and Windowing of the cast, or
fasciotomy (severe cases)

FASCIOTOMY

 The only treatment for ACS.

 muscle compartment is open- to decrease swelling,
pressure and restore blood flow.