TRAUMATIC INJURIES AFFECTING THE MUSCULOSKELETAL SYSTEMFracture a break in the continuity of the bone

Signs and Symptoms* pain aggravated by motion* loss of motion* shortening of the extremity* crepitus* swelling/discoloration (ecchymosis)* affected extremity colder than contralateral part

Types of fractureA. Open/Compound bone protudes through a break in the skinB. Closed/Simple skin remains intactC. Complete bone completely separated into two partsD. Incomplete only a part of the bone is brokenE. Communited - bone broken into several fragments.F. Depressed - bone fragments are in-driven.G. Compression - collapsed of a bone fragment.H. Greenstick - splintering on one side.I. Pathologic - results from other primary disease. J. Impacted- a bone fragment is driven into another bone fragmentK. Avulsion- pulling of a bone fragment by ligaments or tendon attachment

TYPES OF FRACTURES

CAUSES OF PATHOLOGIC FRACTUREOsteoporosisBone CystBone TumorPagets DiseaseMultiple Myeloma

FIRST AID FOR FRACTUREI- ImmobilizationC- Control bleeding/ Cover open packsE- Elevate affected extremity

T- TransportE- Emotional or Psychological careA- Assess overall conditions

Complications of FracturesA. HemorrhageB. ShockC. Avascular NecrosisD. Fat emboli (long bones)E. OsteomyelitisF. Gasgangrene

COMPLICATIONS OF FRACTUREA. AVASCULAR NECROSIS - any interference of the blood supply to a particular bone; most often affects head and neck of the femur.

SIGNS AND SYMPTOMS:Asymptomatic during early stagesIntermitttent or constant pain on weight bearingLimitation of joint motionX-ray shows calcium loss and structural collapse

TREATMENT:1. Surgery: Bone graft, prosthetic fitting/replacement Arthrodesis (joint fusion)

B. GAS GANGRENE -it is caused by the anaerobic-Gram positive saprophytic bacterium, Clostridium welchii or Chlostridium perfringens.

SIGNS AND SYMPTOMS:EdemaProfuse drainage of gas bubbles with characteristic fruity odorVesicles filled with red, watery fluid, crepitus produced by gas; necrotic tissue

Treatment:Wound irrigation with antiseptics and antibioticsHyperbaric oxygen therapy

C. OSTEOMYELITIS-it is an infection of osseous tissue involving the cortex of the bone and or marrowTYPES:Exogenous-an infection that enters from outside the bodyHematogenous-an infection that results from sites of infection elsewhere in the body

SIGNS AND SYMPTOMS:Low grade feverMalaisePain, tenderness, increased swelling and warmth of the area and purulent drainage from the sinus tract

TREATMENTAntibioticsDebridement of open fractures to remove necrotic tissue

D. FAT EMBOLISM SYNDROME- It results when the fracture occurs and fat globules are freed from the bone marrow and from the tissue that has sustained damage.

SIGNS AND SYMPTOMS:Changes in mentation: confusion, apprehension,agitation, restlessness, lethargy, deliriumRespiratory manifestations: tachypnea over 30, dyspnea, wheezes, rales and scattered infiltrates seen on x-rayPetechiae on neck, axillae, and upper chestHypoxemia, hypocapnea, elevated blood PH

TREATMENT:Oxygen therapy by nasal cannula or Venturi maskMechanical ventilation with PEEPIV Glucose and alcoholHeparinLow molecular weight dextranSteroidsImmediate immobilization and adequate support during turning and positioningABG analysisMorphine

Management of Fracture A. Close reduction - realignment of bones without surgery.B. Open reduction - surgical realignment of bone fragments. * Internal Fixation - application of screws, pins, plates, nails, to hold fragments in alignment. * External Fixation - sturdy external frame with multiple pins through bone; used with extensive open fractures with soft tissue damage, if infected fractures do not heal properly, with multiple trauma.