+ All Categories
Home > Documents > Orthopedic Trauma

Orthopedic Trauma

Date post: 20-Mar-2016
Category:
Upload: calum
View: 159 times
Download: 10 times
Share this document with a friend
Description:
Orthopedic Trauma. Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. Name that Injury!. - PowerPoint PPT Presentation
Popular Tags:
44
Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON
Transcript

Orthopedic Trauma

Andrea L. Williams, PhD, RNEmergency Education & Trauma Program

SpecialistAssociate Clinical Professor

UWHC & UW-SON

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Associated Conditions• Hemorrhage – Shock (~2L pelvis, 1L thigh

& 500 ml tibia)• Instability• Loss of tissue• Laceration with contamination• Interrupted blood supply – Ischemia• Nerve damage• Long-term Disability

Sprains• Partial tear of a ligament by twisting & stretching

of a joint beyond normal ROM– 1st Degree Sprain – No instability, few fibers torn.

Minimal hemorrhage & swelling– 2nd Degree Sprain – No instability, ligaments partally

torn, swelling and hemorrhage– 3rd Degree Sprain – Unstable, ligaments completely,

with significant swelling & hemorrhage.

Sprained Knee

Strains & Ruptures• Strain - Injury to a muscle or tendon from

overexertion (back, arms, calf)• Severe strains can cause bone avulsion

Joint Dislocations• Dislocation – Articulating surfaces of 2 bones

are displaced– Luxation – Complete dislocation– Subluxation – Incomplete dislocation– Rotator Cuff injuries – Usually deltoid– Common sites

• Shoulders, elbows, fingers, knees, & ankles

– Complications• Posterior popliteal injury

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• Elevation – to or just below level of heart

Shoulder Injuries• Dislocations• Subluxations• Rotator cuff tendon

injuries• Sternoclavicular strain• Treatment

– Neurovascular status– Splint in position found

or– Sling & secure to body – Ice or cold compresses

Elbow Injuries• Falling on an outstretched arm or

flexed elbow• Pulled elbow – Nursemaids elbow

from a sudden lateral force• Athletic injury• Complications

– Volkmann’s contracture – Claw-like contraction of hand & arm deformity from ischemia

– Laceration of brachial artery– Ulnar nerve damage

• Treatment– Check neurovascular status – Splint in position found– Ice or cold compresses

Radial, Ulnar, Wrist Injuries• Check neurovascular

status• Splint in position found

(rigid or formable• Ice & elevation

Hand Injury• Boxer’s fracture 5th

metatarsal bone• Treatment

– Check neurovascular status

– Splint (rigid or semiformable) in position of function

– Ice & elevation

Finger Injuries• Assess neurovascular status• Splint in foam filled aluminum

splint, with tongue blades, or tape to adjacent finger

• Ice & elevation

Pelvic InjuriesSigns & Symptoms

• Pain• Hypovolemic shock• Shortening or abnormal

rotation of affected extremity

• Associated with injuries to the bladder, urethra, reproductive organs & sacral nerves

Pelvic InjuriesTreatment of Pelvic Fractures/Ring Injuries

• Open book – Vacuum mattress, Pelvic Binder, or sheet• Control hemorrhage – Direct pressure or close pelvic

ring• Fluid volume replacement – Normal Saline

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

External fixation/ORIF

Classification of Long Bone Injuries

• Fractures– Complete or incomplete– Open or closed– Epiphyseal – Cause bending or deformity– Comminuted – Several breaks in the bone– Greenstick - Break in periosteum w/i

bowing or buckling– Spiral – Twisted or circular break. ↑ child

abuse– Oblique – Diagonal, slanting break– Transverse – Right angle fracture– Pathological

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

Long Bone FracturesSigns & Symptoms

• Pain• Ecchymosis & edema of the

site• Deformity at the site• Shortening of affected

extremity• Internal or external rotation• Hypovolemia or hypovolemic

shock

Long Bone Fractures

Assessment• Circulation – Hemorrhage or ischemia

– Neurovascular status– Pulses

• Deformity – Edema, hematoma, wounds• Compartment Syndrome

– 6 P’s – Pain, Pallor, Parasthesia, Pulses, Paralysis, Pressure

Long Bone FracturesTreatment

• Immobilize• Splint• Control pain• Realign – In ED• Skeletal traction – (In ED)

Usually temporary. Weights must hang free, meticulous skin care

• External fixators• ORIF

Splinting• Types of splints

– Rigid splint – body part fit to splint design

– Soft or formable splint – molded to shape or configuration of the body part

– Traction splint – (Femur fractures) – traction to stabilize and align

Open FracturesSigns & Symptoms

• Evidence of skin disruption over a fracture

• Protrusion of bone through an open wound

• Pain• Neurovascular compromise• Bleeding

Open FracturesTreatment

• Cover the wound• Splint• ED or OR Wound

cleansing & debridement• Realignment• Splint/Cast• External fixation• ORIF• Complications -

osteomyelitis, cellulitis

Techniques for Realignment• Finger realignment• Shouldar realignment• Hip realignment• Knee realignment• Ankle realignment

Jumper SyndromeJumper Syndrome• Vertical deceleration• Forces transmitted upwards from lower

extremities, pelvis, spine, chest• Lower extremity fractures & spinal cord

injuries• Retroperitoneal hemorrhage is the most

common cause of shock

AmputationsClassification

• Partial• Complete• Usually involves digits,

foot, lower leg, hand or forearm

• Life over limb considerations

AmputationsClassification

• Partial• Complete• Usually involves digits, foot, lower leg,

hand or forearm• Life over limb considerations• Re-implantation (Favorable in Peds &

with guillotine-type amputations)

Amputations

Signs & Symptoms• Obvious tissue loss• Pain• Bleeding• Hypovolemic shock

AmputationsTreatment

• Reattachment• Amputation• Rehabilitation• Prosthesis Clinic

Assessment & Care• Keep body part

bagged not directly on ice

Compartment SyndromeCompartment SyndromeSigns & Symptoms

• Pain disproportionate to injury• Sensory deficit• Progressive muscle weakness• Tense swollen area• Elevated compartment

pressures• Loss of pulses

Compartment SyndromeTreatmentTreatment

• Elevation of limb Elevation of limb not abovenot above heart level heart level• Placement of an intracompartmental Placement of an intracompartmental

monitormonitor– <20 = normal<20 = normal– >20 = ischemia>20 = ischemia– > 30 = necrosis> 30 = necrosis

• Fasciotomies to release the pressureFasciotomies to release the pressure


Recommended