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Orthopedic Injuries

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    Orthopedic Trauma

    Andrea L. Williams, PhD, RN

    Emergency Education & Trauma ProgramSpecialist

    Associate Clinical ProfessorUWHC & UW-SON

    http://www.talkorigins.org/faqs/homs/rodeo.gif
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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Name that Injury!

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    Associated Conditions

    HemorrhageShock (~2L pelvis, 1L thigh& 500 ml tibia)

    Instability

    Loss of tissue

    Laceration with contamination

    Interrupted blood supplyIschemia

    Nerve damage

    Long-term Disability

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    Sprains

    Partial tear of a ligament by twisting & stretchingof a joint beyond normal ROM

    1stDegree SprainNo instability, few fibers torn.

    Minimal hemorrhage & swelling

    2ndDegree SprainNo instability, ligaments partallytorn, swelling and hemorrhage

    3rdDegree SprainUnstable, ligaments completely,

    with significant swelling & hemorrhage.

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    Sprained Knee

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    Strains & Ruptures

    Strain - Injury to a muscle or tendon from

    overexertion (back, arms, calf)

    Severe strains can cause bone avulsion

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    Joint Dislocations

    DislocationArticulating surfaces of 2 bones

    are displaced

    LuxationComplete dislocation

    SubluxationIncomplete dislocation Rotator Cuff injuriesUsually deltoid

    Common sites

    Shoulders, elbows, fingers, knees, & ankles

    Complications Posterior popliteal injury

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    Principles of Splinting (p. 1238)

    Splint joints and fractures above & below injuries

    Cover open fractures

    Document pulses, sensation, motor function

    before & after splinting Stabilize the limb with gentle in-line traction to a

    position of normal alignment

    Immobilize dislocations in a position of comfort

    with Ice, cold compresses

    Elevationto or just below level of heart

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    Shoulder Injuries

    Dislocations

    Subluxations

    Rotator cuff tendon

    injuries Sternoclavicular strain

    Treatment

    Neurovascular status

    Splint in position foundor

    Sling & secure to body

    Ice or cold compresses

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    Elbow Injuries

    Falling on an outstretched arm orflexed elbow

    Pulled elbowNursemaids elbowfrom a sudden lateral force

    Athletic injury

    Complications Volkmanns contracture Claw-like

    contraction of hand & arm deformityfrom ischemia

    Laceration of brachial artery

    Ulnar nerve damage

    Treatment Check neurovascular status

    Splint in position found

    Ice or cold compresses

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    Radial, Ulnar, Wrist Injuries

    Check neurovascular

    status

    Splint in position found

    (rigid or formable Ice & elevation

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    Hand Injury

    Boxers fracture 5th

    metatarsal bone

    Treatment

    Check neurovascularstatus

    Splint (rigid or

    semiformable) in

    position of function Ice & elevation

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    Finger Injuries

    Assess neurovascular status

    Splint in foam filled aluminum

    splint, with tongue blades, or

    tape to adjacent finger Ice & elevation

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    Pelvic Injuries

    Signs & Symptoms

    Pain

    Hypovolemic shock

    Shortening or abnormalrotation of affectedextremity

    Associated with injuries

    to the bladder, urethra,reproductive organs &sacral nerves

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    Pelvic Injuries

    Treatment of Pelvic Fractures/Ring Injuries

    Open bookVacuum mattress, Pelvic Binder, or sheet

    Control hemorrhageDirect pressure or close pelvicring

    Fluid volume replacementNormal Saline

    (ED - PRBC, FFP, Platelets., Factor VII A &/orembolization)

    External fixation/ORIF

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    Classification of Long Bone

    Injuries

    Fractures Complete or incomplete

    Open or closed

    EpiphysealCause bending or deformity

    ComminutedSeveral breaks in the bone

    Greenstick - Break in periosteum w/ibowing or buckling

    SpiralTwisted or circular break. child

    abuse ObliqueDiagonal, slanting break

    TransverseRight angle fracture

    Pathological

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    Long Bone Fractures

    Pathophysiology

    Femur fractures result from major force

    Long bone fractures from falls, MVC,MCC

    Femur neck fractures common in

    elderly

    Blood loss into a femur

    1,000-1,500 ml

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    Long Bone Fractures

    Signs & Symptoms

    Pain

    Ecchymosis & edema of the

    site

    Deformity at the site

    Shortening of affected

    extremity Internal or external rotation

    Hypovolemia or

    hypovolemic shock

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    Long Bone Fractures

    Assessment

    CirculationHemorrhage or ischemia

    Neurovascular status

    Pulses

    DeformityEdema, hematoma, wounds

    Compartment Syndrome 6 Ps Pain, Pallor, Parasthesia, Pulses,

    Paralysis, Pressure

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    Long Bone Fractures

    Treatment Immobilize

    Splint

    Control pain

    RealignIn ED

    Skeletal traction(In ED)Usually temporary. Weightsmust hang free, meticulous skin

    care External fixators

    ORIF

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    Splinting

    Types of splints

    Rigid splintbody part fit to splint

    design

    Soft or formable splint

    molded toshape or configuration of the body part

    Traction splint(Femur fractures)

    traction to stabilize and align

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    Open Fractures

    Signs & Symptoms

    Evidence of skin disruption over afracture

    Protrusion of bone through an openwound

    Pain

    Neurovascular compromise Bleeding

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    Open Fractures

    Treatment Cover the wound

    Splint

    ED or OR Woundcleansing & debridement

    Realignment

    Splint/Cast

    External fixation ORIF

    Complications -osteomyelitis, cellulitis

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    Techniques for Realignment

    Finger realignment

    Shouldar realignment

    Hip realignment

    Knee realignment

    Ankle realignment

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    Jumper Syndrome

    Vertical deceleration

    Forces transmitted upwards from lower

    extremities, pelvis, spine, chest

    Lower extremity fractures & spinal cordinjuries

    Retroperitoneal hemorrhage is the most

    common cause of shock

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    Amputations

    Classification

    Partial

    Complete

    Usually involves digits,foot, lower leg, hand or

    forearm

    Life over limbconsiderations

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    Amputations

    Classification

    Partial

    Complete

    Usually involves digits, foot, lower leg,hand or forearm

    Life over limb considerations

    Re-implantation (Favorable in Peds &with guillotine-type amputations)

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    Amputations

    Signs & Symptoms

    Obvious tissue loss

    Pain

    Bleeding

    Hypovolemic shock

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    Amputations

    Treatment

    Reattachment

    Amputation

    Rehabilitation

    Prosthesis Clinic

    Assessment & Care

    Keep body partbagged not directly

    on ice

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    Compartment Syndrome

    Signs & Symptoms

    Pain disproportionate to injury

    Sensory deficit

    Progressive muscle weakness

    Tense swollen area

    Elevated compartment

    pressures Loss of pulses

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    Compartment Syndrome

    Treatment

    Elevation of limb not above heart level

    Placement of an intracompartmental

    monitor 20 = ischemia

    > 30 = necrosis Fasciotomies to release the pressure


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