Musculoskeletal Trauma Tissue is subjected to more force than it can absorb Severity depends on: ◦ Amount of force ◦ Location of impact

Musculoskeletal Trauma Mild to severe Soft tissue Fractures ◦ Affect function of muscle, tendons, and ligaments Complete amputation

Soft Tissue Trauma Contusion ◦ Bleeding into soft tissue ◦ Significant bleeding can cause a hematoma ◦ Swelling and discoloration (bruise)

Soft Tissue Trauma - Sprain Ligament injury (Excessive stretching of a ligament) Twisting motion Overstretching or tear ◦ Grade I—mild bleeding and inflammation ◦ Grade II—severe stretching and some tearing and inflammation and hematoma ◦ Grade III—complete tearing of ligament ◦ Grade IV—bony attachment of ligament broken away

Soft Tissue Trauma To decrease swelling and pain, and encourage rest ◦ Ice for first 48 hours ◦ Splint to support extremities and limit movement ◦ Compression dressing ◦ Elevation to increase venous return and decrease swelling ◦ NSAIDs

Fractures Break in the continuity of bone ◦ Direct blow ◦ Crushing force (compression) ◦ Sudden twisting motions (torsion) ◦ Severe muscle contraction ◦ Disease (pathologic fracture)

Fractures Classification of Fractures Closed or simple Open or compound Displaced or Non-displaced Stable or unstable Direction of the fracture line ◦ Oblique ◦ Spiral ◦ Lengthwise plane

Fractures – Emergency Care Immobilize before moving client Joint above and below Check pulse, color, movement, sensation before splinting Sterile dressing for open wounds

Musculoskeletal – Fractures Treatment Primary Goal – reduce fracture- ◦ Realign and immobilize Medications ◦ Analgesics, antibiotics, tetanus toxoid Closed Reduction – Manual and Cast; External Fixation Device Traction; Splints; Braces Surgery ◦ Open reduction with internal fixation ◦ Reconstructive surgery ◦ Endoprosthetic replacement

Acute Compartment Syndrome Serious condition in which increased pressure within one or more compartments causes massive compromise of circulation to the area Prevention of pressure buildup of blood or fluid accumulation Pathophysiologic changes sometimes referred to as ischemia- edema cycle

Emergency Care - Acute Compartment Syndrome Within 4 to 6 hr after the onset of acute compartment syndrome, neuromuscular damage is irreversible; the limb can become useless within 24 to 48 hr. Monitor compartment pressures. (Continued)

Emergency Care (Continued) Fasciotomy may be performed to relieve pressure. Pack and dress the wound after fasciotomy.

Other Complications of Fractures Shock Fat embolism syndrome: serious complication resulting from a fracture; fat globules are released from yellow bone marrow into bloodstream Venous thromboembolism (Continued)

Other Complications of Fractures (Continued) Infection Ischemic necrosis Fracture blisters, delayed union, nonunion, and malunion

Musculoskeletal Complications (continued) Muscle Atrophy, loss of muscle strength range of motion, pressure ulcers, and other problems associated with immobility Embolism/Pneumonia/ARDS ◦ TREATMENT – hydration, albumin, corticosteroids Constipation/Anorexia UTI DVT