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NCM104 Ortho

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Musculoskeletal System206 bones which are connected at

joints.joints are held together by ligamentsand cushioned by cartilages

Tendons attach muscles to the bones

VI.Bones: The bodys frameworkA. The bone serve as the bodys

framework or skeleton

The human skeleton consists of two (2)main division1. Axial bodys upright structure with 80bones:

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a. skullb.vertebral column

c. ribs2. Appendicular- the bodys appendages with126 bones:

a. arms

b. hipsc. legs

B. Four major bone types. Their names reflecttheir shapes:

1. Long bones ex. femur2. Short bones ex. carpals3. Flat bones ex. scapulae4.Irregular bones ex. vertebral

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I. Long Bones in which length exceeds breadth andthickness.Structure:

c. Diaphysis1. shaft2. provides strength; resists bending forces3. compacts bone with central cavity

g. Metaphysis1. flared portion between diaphysis and epiphysis2. Growing portion

j. Epiphysis1. end2.primarily cancellous bone3. assist with bone development

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d. Epiphyseal plate/line1. Between metaphysis and

epiphysis2. Cartilage growth in length of

diaphysis and metaphysise. Periosteum:

1. Connective tissue covering bone2. Continues at end of bone with

joint capsule

but does not. Cover articularcartilageonesII. Short Bones

a. Equal in main dimensions

b. Found mainly in hands and feet

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Type s:1. accessory bones not normally present

2. sesamoid:a. embedded in tendons or joint capsulesb. maybe mistaken for fractures on x-ray

1. have no capsules2. edges are smooth

3. are often bilateralIII. Flat Bones- primary made up of cancellousbone tissueIV. Irregular Bones- included are:

a. sesamoid- Occur in conjunction withtendon at points in the body with pressureoccurs. Ex. Patellae

b. wormian- occur in cranial sutures

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c. Functions of bonesProvides support for the body

Allows movement/locomotionProtects a persons vital organs such as hisbrain, heart and lungs.Stores calcium and release it to the blood

stream, according to body requirementsManufactures new blood cells in the redbone marrow.

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Cartilage : Three Types2.Fibrocartilage.

a. greatest tensile strengthb. occurs in the intervertebral discs and in thesymphysis pubis.2. Elastic cartilage:

a. possesses firmness and elasticity

b. occurs in the external ear and the Eustachiantube3. Hyaline cartilage:

a. most common cartilage type

b. cushions most of the joints to help soften anyimpact

c. firm yet slightly flexibled. occurs also in part of the nasal bronchial

rings.

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A.Ligaments are strong cords of fibrous tissueIII. Ligaments and Tendons ConnectorsC.Tendons are also connect muscles to each other,

and to other tissuesIV. Muscle: Action Tissue

A. Muscles are tissue composed of muscle fibers,connective fibers, and nerve fibers.

B. Muscles can be long and tapered, short, andblunt, triangular, quadrilateral or irregular.C. Muscle fiber arrangement varies:

1. In some muscles, the fiber run parallel to the

muscle long axis.2. In others, the fibers are oblique andbipennate like the feathers of a quill pin.

3. Fibers curve cut from a narrow attachment atthe muscles end to form a triangle.

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D. Fiber arrangement is

important because of itsrelationship to a musclesfunction. The muscles and

skeleton work together toperform movement. Themuscles contract to movebones, while the joints allowthis movement to occur.

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E. The muscles and skeleton worktogether to perform movement. Themuscles contract to move bones,while the joints allow this movement

to occur.8 ways of movement1. Isotonic contractions-shorten

muscle length while maintainingmuscle tension, generatingmovement.

2. Isometric contractions-tighten a

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3. Twitch contractions- are quick, jerky reactionsto a single stimulus4. Tetanic contractions are serial, continuouscontractions, in which individual contractionscant be distinguished.5. Treppe (or staircase) phenomenon is a series

of increasingly stronger twitch contractionsoccurring in response to repeated stimuli ofconstant intensity.6.Fasciculation is an abnormal contractions

visible through the skin as a slight ripple.7.Fibrillation- an abnormal contraction in whichindividual fibers contract in an unsynchronizedway, produces muscle flutter but no effective

movement.

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b. Internal rotation is motion around a central axistoward the midline

Joint Motion3. Flexion- decreases the angle between the anterior

surfaces of articulating bones4. Extension- increases the angle between the anterior

surface of articulating bones5. Hyperextension- continues the act of extension beyond

the original anatomical position6. Abduction when seen from the front, moves a bone inthe appendicular skeleton away from the bodysmidline.

7. Adduction- when seen from the front, moves a bone in

the appendicular skeleton toward the bodys midline.8. Rotation- pivots the bone on its axis

a. External rotation is motion around a central axisaway from the midline

7. Circumduction combines a number of movements tocause the distal end of a bone to describe a circle.

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8. Inversion turns and extremity or partof an extremity inward toward the bodys

midline9. Eversion turns an extremity or part ofan extremity outward from the bodysmidline.10.Pronation turns the palm or bodysfront toward the floor11.Supination turns the palm, foot, or

bodys front toward the ceiling12. Protraction moves the mandibleforward

13. Retraction moves the protracted

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Musculo-skeletal TerminologyAtrophy wasting awayCausalgia- severe burning pain produced by severednerves that have malfunctioning nerve endings, touchcan often produce this painCircumduction- motion involves abduction, adduction,flexion and extension (360degrees) to complete a full

circle, motion of the shoulder, hip and ankle.Contracture the absence of full range of motions ofany joint. Most common is flexion contracture, the lackof full extension

Deformity- malformation or defect of any part of thebodyLeg length discrepancy an inequality betweencorresponding limbsDislocation- musculo-skeletal, traumatic injury

resulting in disruption of the continuity of a joints

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Dorsiflexion the motion of moving the body part uptoward the dorsum motion of the ankle that movesfoot up toward the leg.

Dysplasia- abnormality of developmentEversion- motion of ankle characterized by the soleof the foot facing away from the opposite foot.Inversion- motion of ankle characterized by sole of

foot facing toward the opposite footKyphosis- posterior convexity of thoracic portion ofvertebral column, normal curvature of spine,becomes pathologic if excessiveLateral- side toward the outer aspect of the body

Lordosis- concavity of the vertebral column; normalcurvature existing in cervical and lumbar areas,which may become pathologic if accentuatedMedial- side toward the midline of the body

Palsy- paralysis

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Range of motion- (ROM) the full motion a jointcan assumeRecurvatum-hyperextension ( extension

beyond neutral position)Rotation- motion involving turning of one boneon another; angle between the two bones donot change

1. external- outward rotation2. internal-inward rotation

Subluxation (traumatic injury to joint structure

resulting in partial or incomplete dislocation ofjoint surfaces.Valgus- angular deformity denoting angulationaway from the midline of the body distal to the

anatomic part named.

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FracturesIs a break in the continuity of the bone.

Kinds of fractureComplete fracture- periosteum and cortical tissue completely

severed on both sides of bones.Greenstick fracture- (incomplete) bone broken, bent, but stillsecurely hinged at one side.Causes of fracture7.In normal bones, fractures occur when more stress is placed upon

a bone that is able to absorb such as:a. Direct Force or a crushing force- in which the boneabsorbs more stress that it can endure from impact with a solidobject

b. Twisting force-(torsion- a severe twisting of a broken boneat a site different from where the force was actually applied.

c. Powerful muscle contractions- highly developed musclescontract so violently that muscle tears from bone, sometimespulling a small piece of bone with it.

d. Fatigue and stress- bone after a repeated stress

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2. Pathologic decay- Bone weakened bydisease or tumors and subject to pathological

fractures..

Classification of fracturesBroad classification :

a. Closed or Simple- when the break inthe bone has no communication to the outside

b. Open or (compound) fracture- wound

in skin communicates with fracture2. Classification as to pattern-

a. Transverse fracture- break runs acrossbone

b. Oblique- break runs in slanting

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3. Classification as to appearance:

a. Comminuted if there are three

(3) or more fragmentsb. Impacted when the fractured

ends of a bone are pushed into each

other (bone broken and wedged intoother break.c. Compression fracture- is one in

which bone, typically a vertebra,collapse on itself.

Depressed fracture-usually occurs inthe skull, with the broken bone being

driven inward.

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4. Classification in relation to thejoint:

a. Intracapsular (within thecapsule)

b.Extracapsualr (outside the

capsule)c.Intra-articular (in the joint)

5. Classification as to locationa.Proximalb.Midshaftc.Distal

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Signs and Symptoms

2.Pain ( especially at the time of

injury)3.Tenderness at the site4.Swelling5.Loss of function6.Deformity7.Crepitus (grating sensation eitherheard or felt as bone ends rub

together)8.Discoloration9.Bleeding from an open would

with protrusion of bone ends

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Treatment1.Principles of fracture treatment

a. Reduction or realignment of bone fragmentb.Maintenance of realignment by

immobilizationc.Restoration of function

2. Reduction is accomplished by:a. Closed manipulation in which a cast or sling

is usedb. Internal fixation in surgery (open reduction)

in which various type of holding device areused.

c. External fixation, also in surgery, in whichpins are inserted into the bone above and below

the fracture and held in place by a clamping deviced. traction

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3. Immobilization- the most importantelement in obtaining union of fracturefragments:

a. In closed reductions, this isaccomplished by application of plaster

cast. Once the fracture endsanesthesia, to include the joint aboveand below the fracture line.

b. In open reduction-immobilization is done by the nails,screws, pins, wires or rods which areinserted with or without plates. Suchdevices usuall sta in the atient

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4.Restoration of function-

This aim of treatment is anongoing process actually

begins with the maintenanceof function of the unaffectedjoints and extremities.

Healing of the fractured partwill be faster if normal

circulation of the rest of the

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Stage of Bone Healing:2.The repair of a fracture takes place in anorderly sequence.

a. Formation of hematomaWhen a bone is fractured, blood

extravagates into the area between and

around the fragments and the bone marrow.The clot begins 24 hours after the fractureoccurs. This local clots serve as a fibrinnetwork for subsequent cellular invasion.

b. Cellular Proliferation-takes placeat the fracture site after several days. Thecombination of periostial elevation and thegranulation tissue containing blood vessels,

fibroblasts and osteoblasts produce a

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c. Callus formation- After the followingweeks minerals are being deposited in the

osteoid forming a large mass ofdifferentiated tissue bridging the fracturecalled the callus.d.Ossification- final laying down of bone,

is the stage in which the fracture ends knittogether.

e. Consolidating and Remodeling- when

consolidation is completed, the excess cellsare absorbed. The primary cancellous boneis remodeled, compact bone being formed

according to stress patterns. Remodelingcontinues as bone is formed in relation to

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The average period for firm union ofvarious bones are as follows:

Clavicle 3-4 weeksRadius-ulna 6-13 weeksMetacarpals 4 weeksFemur 12 weeks

Fibula 12-14 weeksPhalanges 3weeksHumerus 6 weeksLower3rd radius 4 weeks

Tibia 8-12 weeksTarsals 6-8 weeksMetatarsals 5-6 weeks

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Complication in Healing

2.Interruption in the sequence of fracturehealing are caused by:

a. original injuryb. debridement- process of removing

the dead tissues

c. Loss of bone substance-lack ofvitamin Dd. Soft tissue interposed between

bone ends.

e. Infectionf. Loss of circulationg. Interrupted or improper

immobilization

h. Inadequate fixation

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2. Complications to bone itself:a. Aseptic/Avascular necrosisb. Non-Unionc. Mal-uniond. delayed union

3. Possible Complications from fracturesA. Pulmonary Embolism (may occur without

clinical symptom)Early Clinical Features

9.Sub-sternal pain10.Dyspnea

11.Rapid week pulseRecommended NursingInterventionAdminister oxygen notify physician immediately asto pain and vital sign

Most common fracture type location

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B. Fat EmbolismClinical Features

3.Mental confusion

4.Apprehension5.Restlessness due to hypoxia6.Fever7.Tachycardia

8.Dyspnea

Recommended Nursing InterventionIt is advisable to have a standing order to draw bloodgases at first sign of mental confusionNotify physician, immediately, administer oxygen

Most common fracture typeLower extremities or multiple fractures

C G G

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C.Gas GangreneEarly Clinical Features

Mental aberration followed by signs of infectionRecommended Nursing Intervention

Notify physician immediately of mental status, vitalsigns, and appearance of wound

Most common fracture type location

Compound especially with small open area

D.TetanusEarly Clinical Features

Maybe none until patients has tonic twitching anddifficulty in openings mouthRecommended Nursing Intervention

Notify physician immediately.Most common fracture type

Compound

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Signs and symptoms of

injury to the blood vessels,viscera, nerves and tendons2.Change in size

3.Changes in skin temperature andcolor or appearance4.Changes in function or motion

5.Abnormal or decreased sensationof the affected extremity6.Signs of hemorrhage including

drainage or bleeding

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DislocationDislocation- displacement of a bone from itsnormal joint position to the extent thatarticulating surfaces loss contact

Causes

TraumaDiseaaseCongenital condition

Sign and symptomsBurning pain to jointDeformity of jointStiffness and loss of joint function

Moderate or severe edema around joint

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C. Nursing Considerations

To lessen swelling, elevate the affectedextremity immediately. Keep it elevateduntil after dislocation is reducedbecause manipulation increasesswelling.Assess affected extremity for signs ofneurovascular problems such as pain,

absent pulse, paresthesia, pallor andparalysisBecause condition causes severe, give

pain medication per doctors order.

S i

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SprainIs an incomplete tearing of joint capsule or ligamentssurrounding a joint, which does not disrupt ligamentcontinuity or cause joint instability.

CauseSudden twisting of joint beyond its normal range ormotion

Signs and SymptomsPain at jointEdema around jointDiscoloration around jointDecreased joint function

Nursing considerationsTo reduce swelling, apply cold treatment, such as ice bagor a cold pack, for the first 48 hours.

Then, after swelling is controlled, apply arm treatment

such as warm compresses or a heating padProvide care to atient with extremit in cast or in

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Various FracturesA.Mandibular fractures

What to observe with patient is in Bartons bandage

a. loosening of teeth, dental occlusionb.difficulty of breathing

Mouth care

Liquid dietB.Rib fractures

Can occur from direct or indirect trauma. The 5th to 9thribs are most involved.

Assessment

l.Tendernessm.Respiratory status, including depth of ventilators,signs of hemo/pneumothoraxn.Subcutaneous emphysema/crepitations

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2. Treatmenta. analgesicsb.Pulmonary toilet to prevent respiratory

complicationsc. Chest strapping may be contraindicated, as it

can reduce respiratory expansion.

C. Sternal Fractures - are usually caused by motorvehicle accidents.Assessment

Swelling tenderness over sternum

TreatmentFracture of the sternum if, displaced may be treatedwith internal fixation with wire sutures

D.Fracture of the upper extremity

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D.Fracture of the upper extremityCaused by either a direct blow or a fall on to the

outreached arm or headAssessment of patient with possible fracture of

the shoulder or upper arma. Remove clothing so that the entire upper body

may be visualized.b. If possible, the patient should be standing or

seated upright without back support so that anyabnormal body contours, such as may be caused byclavicle displacement or abnormal positions, such asthe shoulder droop, may be visualized.

c. The area on the affected side may be

supported with the shoulder in the position of greatestcomfort and the elbow in flexion.2. Treatment:

a. Treatment for upper extremity and shoulder

girdle fractures are based on the patients age, the site

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Fracture of the Clavicleheal rapidly but it is difficult to maintain

complete immobility during the early stages ofhealing.

Note: Open reduction is generally avoided

unless necessary because surgery increasesthe incidence of nonunion. Surgery is indicatedwhen the bone is considerably fragmented orwhen underlying soft tissues must be repaired

or explored for damage.Conservative treatment may consist of

closed reduction, if necessary, followed by atleast 3 weeks of immobilization in a spica cast

or in a figure of eight bandage. In cases where

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Fractures of ScapulaUncommon

Associated with more serious injurieswhich require the patient to be confinedto bed.It can be treated by application of ice andadministration of analgesicsIn the absence of serious injury, mostpatients with scapular fractures, may be

ambulatory with the involved extremitysupported in a sling for approximately 2weeks

Some types of scapular fractures cannot

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Fractures of proximal HumerusApproximately 85% of these fractures

are undisplaced or minimally displaced aretreated conservatively.Conservative treatment consists of a fewweeks of rest, in a sling or a collar and cuff,

followed by a program of exercises.Closed reduction followed by immobilization ina sling or spike cast or open reduction andinternal fixation may be necessary

In certain cases, fractures of the anatomic orsurgical neck can interrupt blood supply to thehead of the humerus, causing avascularnecrosis. Such cases require surgical

replacement of the devitalized humeral head

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Fractures of the humeral shaft1.Most often treated with a hanging

cast which reduces the fracture andhelps maintain bone alignment.2.Hanging cast cannot be used when

the patient is under 12 years of age oris confined to bed. In such cases,abduction splints, shoulder spica castor skeletal traction may be used.3. Open reduction and internalfixation is avoided unless necessarybecause this increases the incidence

of non union.

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Fractures in the elbow areaDepending on the injury, these fracture may be treated

by open reduction and inter fixation, closed reduction by

manipulation with or without general anesthesia closedreduction by skeletal traction, or no reduction.

Displaced fractures of the radius, ulna or bothOpen reduction and internal fixation

For undisplaced fractures- may be treated by casting alone.Cast are usually required for 6-8 weeks for children and atleast 12 weeks for adults

Undisplaced Colles Fracture- may be immobilized in aplaster splint or cast for 4 to 5 weeks.

Displaced Colles fractures may be reduced by:1. simple manual traction2. molding a hardening plaster cast3. manual traction fixed skeletal wires which areincorporated into a cast

4. percutaneous pinning of the forearm itself

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L Fractures of Distal Forearm- are treated by:1. casting alone2. close reduction followed by a cast or plaster

splint for 3 to 4 weeks.3. Less common fracture is open reduction and

internal fixation or transosseous K- wires whichre incorporated into a plaster cast, after closed

reduction under general anesthesia.Carpal Fractures:

1. No reduction is needed for the majority ofcarpal fractures. A short arm cast, which incorporatesthe thumb, is used to immobilize the size forapproximately 10 weeks. Open reduction and internalfixation is necessary only in certain cases.

Pelvic fractures- caused by motor vehicle

accidents, falls from great heights, and crush injuries.

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Assessmenta. local swelling and tenderness

b. stable fracture (unilateral fracture ofsuperior and inferior pubic rami, fracture ofiliac ring)Note: public stability is not affected

c. Unstable fracture (bilateral fracture othe superior and inferior pubic rami, unilate

fracture of the superior pubic rami and

sacred-iliac joint or a fracture of dislocationthe sacro-iliac joint and the symphysis pubi

1. instability of pelvic ring

2. hip deformity

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d. Associated complications such asinternal hemorrhage and

extravasations of urine.

Treatment

e.Bed rest for 1 to 7 das thenprogress from partial to full weightbearingf.Unstable fractures pelvic externalfixation with half-pins to recreate astable pelvis. Early mobilization and

ambulation.

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Fractures of the Lower extremitiesAssessment:

d.Remove clothing so that entireextremity may be visualized. Cut clothing

along seems when necessarye.Support extremity at all times; includejoint above and below the suspected

injuryf.Assess for neurovascular changes distalto the fractureg.Assess for change in length, shape orali nment

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Treatmentb.Proximal femur fractures

1. hip spica (only in children)2.skeletal traction (only in young

patients)3. skin traction to disengage bone

fragments, and prevent muscle spasms prior tosurgery4.open reduction and internal fixation

a. Type of fixation dependent onangle and location of the line of fractures.

b. pins through trochanter andfemur

c. nails through femoral neck intofemoral head

d. plates with screws into femoral

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b. Supracondylar and condylar femurfractures

1. Skeletal traction2. Internal fixation with intramedullary

rods, nails, plates and screw.c. Femoral shaft fractures

1. continuous skeletal traction (Russelltraction)

2.open/closed reduction with insertion ofintramedullary rodsd. Tibial fracture (depending on severity)

1. Casting if incomplete and closed2.External fixation

3.Traction

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e. Fractures of the ankle area

1. Casting2. Open reduction and internalfixation

3.Traction4.External fixation5.Splints

Nursing Interventions (Patients with Fractures)

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Nursing Interventions (Patients with Fractures)Enhance comfortEnsure adequate oxygenation of tissuesTake measures toward restring the function of thefractured bonesMaintain total body mobility while keeping the injuredpart at restProtect against infection in the absence of an intact first

line of defense against infection

Provide adequate nutrition for healingPrevent constipation

Promote urinary eliminationPrevent additional trauma to soft tissuesAssist is allaying anxietyAssist patient to attain optimal level of independenceHelp prevent boredomProvide care to patients in cast, traction, external

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Compression fracture of vertebral body

2.Cervical SpineThese are stable fractures of there isno dislocation of the posterior facets

or the intervertebral disc joints and ifthere is no communution of the body.They will remain stable until healed.

Neurologic deficit is not commonbecause the spinal longitudinalligaments and annulus fibrosis act to

restrain displacement of the fracture.

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2. Thoracic spineWedge compression fracture: is most common.

In this injury, one or more vertebral bodiescollapse anteriorly, become wedge shaped andcreate a prominence of the spinous process. Thevertebral body may shatter and the fragments

may be displaced.3. Midlumbar spineExcessive load secondary to muscle contractionalone may produce a compression fracture,

especially in osteoporotic bone.Midlumbar compression fracture withoutsignificant damage to the anterior structuralcolumn of the spine may be considered stableand rarel associated with neurolo ic deficit.

4 Other compression fracture

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4. Other compression fracturea. Codfish spine: occurs when vertebral body is

invaded by both its adjacent discs; a biconcave profile is

produced. It is most often seen in advanced cases ofosteoporosis. A result of chronic compressive stress.b.Burst or explosive fracture: occurs from extreme

compressive loads.C. Incidence

All signsMost common in the lumbar areaThe most frequent compression fracture of the thoracicspine is the wedge compression fracture

High incidence of paraplegia vertical fracturesMost compression fractures are stableThe most common cause of compression fracture amongelderly is osteoporosis

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D. EtiologyTraumatic origin

3.Diving accident4.Automobile accident5.Falls or blows to the head

6.Falls in sitting position

Nontraumatic origin9.Osteoporosis

10.Multiple myeloma11.Bone cancer; sarcomas and primaryand metastatic

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AssessmentB.History

Mechanism of injury

Progression of symptomsLimitation of functionDescription of pain

Past history of cervical orthoraco-lumbar spine disease orinjury

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B. Physical Exam2.Positioning and appearance of spine3.Sensation of trunk and extremitiesPain with palpation at the level of injuryNeurologic deficit may be present

6.Abdominal exampresence of bowel soundpresence of bowel distensiontenderness and/or rigiditydistension

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Common medical/surgical

interventionsB.Cervical compressionfractures; dependent on severity

of fractureApplication of halo apparatusSkeletal traction on a frame with a

skull tongs may be usedHead halterCervical range of motion exercises

B Thoracolumbar compression fractures:

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B. Thoracolumbar compression fractures:1. Initially, bed rest on a firm mattress. Sitting is notpermitted. Logroll only

2. As the symptoms subside, progressive, musclestrengthening exercises may be prescribed for theentire spine.3. If indicated a reinforced lumbar corset maybeneeded for comfort.

4. If there is severe pain, a body with the spine intraction maybe applied for about 6 weeks followed bya reinforced corset for another 4-6 weeks.5. The use of braces or body cast to treat stable

flexion compression fracture does little for patientother than extend the period of disability.6. sit-up exercises are discouraged.7. With severe deformity a molded plaster jacketmaybe applied to prevent progressive deformity (12-16 weeks) replaced with a corset for an additional 2

Nursing Intervention

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Nursing Intervention

A. Monitor neurovascular status

1. Assess the neurologic status of thetrunk and extremities.

2. Maintain proper positioning.

a. protect head and spine fromexcessive flexion and extension.

b. maintain immobilization of thecervical spine with sandbags if

applicable until treatment is initiated.3. Utilize special beds/frames orlogrolling for turning or positioning.

B. Promote comfort

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C. Discuss patients feeling and fears.

D. Promote mobility within prescribed

restrictions.E. Promote self-care within activity restrictions

F. Discuss changes in body image.

G. Discuss how lifestyle maybe altered due to

injury.H. Provide bowel and bladder rehabilitation

program.

I. Provide diversionary appropriate for patient'sage and activity level.

J. Provide calm, restful environment.

K. Provide patient education regardingprogressive muscle strengthening exercises asindicated.

Care for patient in cast

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Care for patient in castNursing Care of Patient in Cast

B.Definition of Plaster Cast- is atemporary immobilization device whichis made up of gypsum sulfateanhydrous by calcination when mixed

with water swells and forms intoa hardcement.

C.Funcitons

1. To immobilize2. To prevent or correct deformity

3. To support, maintain and protectrealigned bone.

4. To promote healing and early weight-

C Casting Materials

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C. Casting Materials

1. Plaster of paris

2. Synthetic Materials:a. Polyester / cotton knit

b. Fiberglass

c. ThermoplastD. Cast can be applied to the

extremities, to the trunk, and toextremity and trunk as in spices.

It can be applied to encase the wholearea where it should be applied or itcan be applied as a splint or mold.

E. Complications of Casts

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E. Complications of Casts1. Neurovascular compromise.2. Incorrect fracture alignment

3. Cast syndrome, superior mesentericartery syndrome

a. occurs with body castsb. traction on superior mesenteric

artery causes decrease in blood supply tobowel.

c. signs and symptoms: abdominalpain, nause a and vomiting

4. Compartment syndrome ( acompartment syndrome is a conditionwhich increased pressure within a limitedspace, compromises the circulation and

function of the tissues within that space.

. r nc p es n app y ng p as er

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p pp y g pcastI. Provide for maximal comfort and alleviation of

complications

1. Application of padding is the fist step in theprocedure. Padding materials include the following:a. Wadding sheetb. Roll of cottonc. Stockinetted. felt

II. Maintain desired position throughout cast application.III. Use caution in handling of the cast until it has set or

become hardened.

1. It can be applied as a combination, like stockinette andsheet wadding.2. Apply it to include the joint above and joint below theinjured part.3. Apply it in circular motion and mould it as you do the

procedure by the palmar hypothenar.

G Contraindications of Plaster

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G. Contraindications of PlasterCast Application

1. Pregnancy

2. Skin disease

IV. Prepare the patient for the castapplication by providing appropriateeducation.

V. Provide the patient with privacy,before and during the castapplication.

H. Applying a Plaster Cast

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pp y g(Circular Cast application)

1. Check for the doctors order

2. Inform and prepare the patient for theprocedures.

Explain to the patient and/or his relativethe need for placing the affected part of thebody in a cast. Show an illustration of thetype of the cast to be applied to help themvisualize how it is and what it is for thepatient to have it. They made them aware ofthe approximate duration for the body to

remain in cast, the limitation and discomfortarising from immobilization. Plan should bemade to allow the period of immobilizationless bore some and frustrating.

if possible, a good cleansing bath and

shampoo be given to the patient. The

3. Ready all things needed for the application.

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y g pp

4. Position the extremity (by the doctor).5. Apply padding including the joints above and

below the fracture line with thicker pads onbony prominences.6. Soak the plaster cast into a bucket with

water, leave it undisturbed until bubblescease, one after the other.

7. Grasp both ends of the casts, when bubblescease, towards the center without squeezingit.

8. Free the end of the cast and hand operator.

9. Apply cast in circular motion until the wholearea is covered and molding it, during theprocess of the application, by the palm.

10. Support the cast while applying with thehypothenar eminences.

11. Handle the cast with care

Moving patient or transferring with wet cast must be

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g p gavoided as much as possible. If this is necessary, care must betaken to maintain the integrity of the cast.

The excess plaster cast is trimmed by means of a

trimming knife. Cast spilled on the kin is easily removed bywiping it with a damp cloth.

To hasten drying of the cast several ways can be used;exposure to open air or electric fan, exposure to a heat lampand placing the patient in a warm room.

Care should be taken in protecting the patient from rapiddrying of the cast as this will result to a dry outer layer whilethe inner layer remains wet, preventing pneumonia to developand preventing body fluid loss from excessive sweating.

Complains of discomfort should be investigated andappropriate measures be given to bring about comfort.

Patients in body or spica cast is turned every 4-6 hours topromote ever drying of the cast. Finishing touches of the driedcast.

Edges that are extremely rough to begin with, should be

I Care of patient in cast

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I. Care of patient in castThe duration of keeping the body or part of itin the cast is at least one month. It varies

among patients. Factors that influences theduration are:

1. age of the patient2. part of the body affected

3. the degree of injury or affection of thepart.

During the entire period that the patient is incast the nurse responsibility is focused on thefollowing:

1. neuro-vascular checks2. preservation of the efficiency of the

cast.

3. maintenance / promotion of the

integrity of the system of the body.

J Neurovascular checks

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J. Neuro vascular checks

In all casted patients, color, motion

temperature and sensation of toes or fingersshould be observed every 30 minutes forseveral hours. After cast application, longer ifthere is so much edema and then regular every3 hours.

Circulatory impairment results insymptoms of coldness, edema, cyanosis, pain,and finally numbness in the toes or finger. Theblanching sign will indicated whether or notthere is an adequate circulation. When the nailof the thumb great toe is compressed andimmediately released, the color should go fromwhite to pink with the same speed as in theuncasted limb. If not, the circulation is slow and

the toes or fingers need closer observation.

Nerve Function Test

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Nerve Function Test

Nerve Action by the

Nurse-Test for

sensory function

Action by the

Patient

Test for MotorfunctionRadial Prick web space part

between thumb and

index finger

Hyper extend thumb

or wrist

Median Prick distal surface

of index finger

Oppose thumb and

little finger, flex

wristUlnar Prick distal end of

small finger

Abduct all fingers

Peroneal Prick lateral surfaceof great toe and

medial

Surface of second

toe

Dorsiflex ankleextend toes

Tibial Prick medial and

lateral surfaces sole

of foot

Plantar flex ankle

and flex toes

K Psychological implication and

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K. Psychological implication andgoing home in cast

To relieve patients apprehensions andanxieties that crowd their minds withtheir cast on, the nurse can help the

patient make a start toward resolvingsome of the problem by helping thembecome or remain as independent as

possible.Bladder or bowel elimination in

children with hip spica if placed in

Bradford frame, it is so arranged that a

Instrument for cast removal:

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Instrument for cast removal:1. Cast cutter (manual, electric)2. Cast spreader

3. Trimming knife4. Bandage scissors5. Plaster shears

Points to remember

9. After the cast is removed, support the part withpillow, maintaining the same position thatexisted in the cast.

10.Move the extremity gently.11.Observe the skin and for any abrasions and

plaster sores.12.Mask skin with mild soap followed by application

of oil or lanolin.

II. Kinds of Cast, its indication and what to observe

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Kind of Cast Indication What to observe Remarks

A. Cast for theupper

extremities1. Short armcircular cast

Affection of the wrist orthe fingers

Signs of impairedcirculation on fingerssuch asa: cyanosis of the skinb. Coldness of the skinc. Loss of function

d. Numbnesse. Pulselessness theextremityf. Severe paing. Marked swelling2. Nerve damage due topressure on the nerveas it passes over thebody prominences.

j.Pain is increasing inpersistence & localizedk.Anesthesia ornumbness

1. Avoidinsertionsof foreignbodiesinside

2. Avoid

soiling thecast.

3. Reports forsings &weaknessof the cast.

4. Maintainproperalignmentof castedextremity

5. Propersupport of

cast

2. Long armcircular

Affections of theradius-ulna

3. Hanging cast Fracture of the shaft of

the uterus4. FuenstersCast/ Munster

Fractures of the radius-ulna w/ callusformation

5. Short armposterior mold

Affections of the wrist7 finger w/ infections oropen wound.

6. Long armposterior mold

Affections of radiusulna with infection andopen wounds

7. Sugar tong Affections of theshoulder, upper portionof the humerus w/infection & open wound

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