Musculoskeletal Disorders

HLTAP501A

Analyse Health Information

Fractures

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Fractures – Signs & Symptoms

DeformitySwellingBruisingMuscle spasmPain and tenderness

Loss of normal function

Impaired sensation

CrepitusAbnormal mobility

Shock

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Potential blood loss with fractures

Fracture site

Potential blood loss (litres)

Fracture site

Potential blood loss (litres)

Humerus 1.0 - 2.0 Pelvis 1.5 - 4.5

Elbow 0.5 - 1.5 Hip 1.5 - 2.5

Forearm 0.5 – 1.0 Femur 1.0 – 2.0

Spine/ribs 1.0 – 3.0 Knee 1.0 -1.5

Ankle 0.5 – 1.5 Tibia 0.5 – 1.5

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Types of fractures

Simple or closed

Compound or open

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Types of fractures

•Complete•Greenstick•Comminuted•Compression •Impacted•Depressed •Spiral/oblique•Longitudinal/linear•Transverse•Pathological

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Fracture repair

Haematoma formation – stops the bleeding, brings macrophages to the area

Callus formation – the endosteum and periosteum become activated and produce cartilage

Osteoblasts replace the central cartilage with cancellous bone forming a strong bridge through the bone joining the internal and external callus

Osteoclasts and osteoblasts begin to reshape the area. Takes between four months to over one year

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Fracture repair

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Factors that delay healing

InfectionFat embolismTissue fragments between the ends of the bones

Deficient blood supply Continued mobilityOld age

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Treatment

Reduction Closed

GAMPPOP applied

Open ORIF

Immobilisation External fixation

POPSplintsTractionExternal devices –

Ilizarov frame

Internal fixationNails, screws, wires,

rods, plates

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Plaster of Paris (POP) – nursing responsibilities

Frequent neurovascular observationsPOP may take 48 hours to dry – handle gently

Elevate the limb to reduce swellingPalpate the cast for ‘hot spots’ that may indicate the presence of infection

Report any seepage and mark with date and time

Correct use of sling and crutches

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Reasons for tractionTo reduce a fracture and realign bone fragments

To immobilize a fracture and maintain fracture alignment

To reduce, relieve and prevent skeletal muscle spasms

To overcome joint deformity and contractions by stretching the muscles

To rest a diseased joint

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Manual traction

Temporarily immobilises an injured area, through hands pulling on the injured body part e.g. when the doctor

manipulates and pulls the bones for realignment

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Skin traction

Immobilises a body part intermittently over an extended period, through direct application of a pulling force on the patient’s skin (adhesive or non-adhesive traction tape can be used).

Skin traction is usually used when partial immobilization and light traction forces are required

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Skeletal traction Immobilises a body part

for prolonged periods, by attaching weighted equipment directly to the patient’s bones.

Uses Kirschner wires, Steinmann pins, Denham pins, and Zimmer screws.

These are inserted into the bone and is then connected to a device that attaches to the cords used in traction

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Fixed traction

Thomas’ splint does not require gravity to achieve results.

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Balanced tractionUses suspension (which provides greater comfort for the patient but has no influence on the traction forces)

Weights usually water and this

can be reduced or increased as required.

can also be metal discs or sand

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Nursing implications for tractionFor traction to be successful, countertraction is necessary in most instances the countertraction is the patients weight, therefore, do not wedge the patients foot or place it flush with the foot of the bed Maintain the line of pull Centre the patient on the bed Ensure that weights hang freely and do not touch the floor Ropes

Ensure that nothing is lying on or obstructing the ropes, Do not allow the knots at the end of the rope to come into

contact with the pulley. Ensure that the ropes are not frayed and that they are resting

within the groove of the pulleys

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Nursing implications for tractionIn skeletal tractionNever remove the weightsFrequent skin assessment should include pin care per hospital policy

Report signs of infection at the pin sites, such as redness, drainage, and increased tenderness, to the doctor

The patient may require more frequent analgesic administration

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Nursing implications for traction In skin traction assess the skin for redness,

irritation and signs of traction slippingPerform neurovascular assessments frequentlyAssess for common complications of immobility,

including: the formation of pressure ulcers, formation of renal calculi, DVT, pneumonia, paralytic ileus, and loss of appetite

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Neurovascular observations

Circulation – warmth, colour, refill time and oedema

Neurologic status – sensation (checking for numbness, tingling, burning pain)

Movement – check range of movement and strength

Complications will show – pain, pallor, pulse changes, paraesthesia, paralysis

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Compartment syndrome

Early – pain and decreased pulse to distal areas

LaterCyanosisTingling Loss of sensationSevere painEventually renal failure

If untreated amputation

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Compartment syndrome

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Rheumatoid arthritis

Is a chronic, systemic, inflammatory, autoimmune disease

Joints and surrounding muscles, tendons and ligaments

SystemicBlood vesselsSkinHeart

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Rheumatoid arthritis - Systemic effectsSlight feverMalaise – weakness and fatigue by early afternoon

Weight lossNumb, tingling hands and feetEnlarged lymph nodesEnlarged spleenDepressionAnorexia

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Rheumatoid arthritis

Synovitis develops from congestion and oedema of the synovial membrane and joint capsule

Bone atrophy and misalignment cause deformities and restricted movements muscle atrophy, imbalance, partial dislocations

Fibrous tissue calcifies fixation of joint and immobility

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Osteoarthritis Is a chronic, progressive disorder

CausesPrimary

Idiopathic

SecondaryCongenital - CDHTraumaDisease – haemophilia,

acromegaly, gout

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Osteoarthritis – S&S

Joints commonly affected

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Osteoarthritis – S&S

Pain in joint

Crepitus

Joint swelling and warmth

Joint deformity (subluxation)

Loss of ROM

Muscle spasm and contractures

Nodules Herberden’s Bouchard’s Bunion

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Hip replacement

Treatment for fracture or osteoarthritis

Hemiarthroplasty – replacement of either femoral head or acetabulum

Total hip replacement (THR) – both are replaced

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Hip replacement – post op

Routine – observations, pain, wound, drainage, IDC

Specific Maintain abduction Log rollsHip flexion not greater

than 900

Mobilisation – NWB WB

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Hip precautions

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Gout Gout is a condition in which there are deposits of a chemical (sodium urate) in joints, causing arthritis, as well as in soft tissues and the urinary tract.

Urate or uric acid is a chemical formed from the breakdown of purines - DNA building blocks derived from protein.

Hyperuricaemia means that a person has too much uric acid in the blood - which is associated with gout. When uric acid precipitates in a joint (often the big toe) it causes an acute arthritis.

Uric acid can also be deposited in:

soft tissue, causing tophi (white chalky deposits) and tenosynovitis - tendon inflammation.

urinary tract, causing stones and potentially renal failure (since 2/3 of uric acid is excreted by the kidney)

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Osteoporosis