Care of Patients with Musculoskeletal Trauma and Orthopedic Surgery

1. Care of Patients with Musculoskeletal Trauma and Orthopedic Surgery

2. Classification of Fractures • A fracture is a break or disruption in the continuity of a bone. • Types of fractures include: • Complete • Incomplete • Pathologic

3. Clinical Manifestations of Fractures • Edema and swelling • Pain upon movement • Muscle spasm • Deformity • Ecchymosis • Loss of function • Crepitus

4. Complications of Fractures;Acute Compartment Syndrome • Infection • Compartment syndrome - serious condition in which increased pressure within one or more compartments causes massive compromise of neurovascular function to the area.

5. Compartment SyndromeEmergency Care • Within 4 to 8 hrs after the onset of acute compartment syndrome, neuromuscular damage is irreversible; the limb can become useless within 24 to 48 hr. • Fasciotomy may be performed to relieve pressure.

6. Other Complications of Fractures • Venous thromboembolism • Fat embolism syndrome - serious complication resulting from a fracture; fat globules are released from yellow bone marrow into bloodstream • Complications of fracture healing – delayed union, non-union

7. Collaborative CareFracture Reduction • Open reduction (ORIF) • Traction - application of a pulling force to the body to provide reduction, alignment, and rest at that site • Types of traction – skin and skeletal

8. Traction (Cont’d) • Traction care: • Maintain correct balance between traction pull and countertraction force • Care of weights • Skin inspection • Pin care • Assessment of neurovascular status

9. Fracture ImmobilizationCasts • Rigid device that immobilizes the affected body part while allowing other body parts to move • Cast materials - plaster, synthetic acrylic, fiberglass • Types of casts for various parts of the body - arm, leg, brace, body

10. Casts (Cont’d) • Cast care and patient education • Cast complications—infection, circulation impairment, peripheral nerve damage, complications of immobility

11. Immobilization Device

12. Fiberglass Synthetic Cast

13. Fracture of the Hip • ORIF – post-operative management • Femoral Head Prosthesis

14. Fractures of the HipTotal Hip Arthroplasty • Postoperative management: • Assessment of bleeding • Management of anemia • Prevention of dislocation, infection, and thromboembolic complications • Neurovascular assessment

15. Hip Flexion After Total Hip Replacement

16. Prevention of Complications • Hip precautions • Management of pain • Promotion of self-care

17. Total Knee Arthroplasty • Postoperative care: • Continuous passive motion machine • Ice packs • Pain management • Neurovascular assessment

18. Continuous Passive Motion Machine

19. Amputations • Surgical amputation • Traumatic amputation • Levels of amputation • Complications of amputations—hemorrhage, infection, phantom limb sensation, flexion contracture

20. Common Levels of Amputation

21. Phantom Limb Sensation • Phantom limb sensation is a frequent complication of amputation. • Patient complains of pain at the site of the removed body part, most often shortly after surgery. • Pain is intense burning feeling, crushing sensation, or cramping.

22. Management of Pain • Phantom limb pain must be distinguished from stump pain because they are managed differently. • Recognize that this pain is real and interferes with the amputee’s ADLs.

23. Exercise After Amputation • ROM to prevent flexion contractures, particularly of the hip and knee • Trapeze and overhead frame • Firm mattress • Prone position for 30 minutes 3 to 4 times daily

24. Residual Limb Care

25. Preparation for Prostheses • Devices to help shape and shrink the residual limb and help patient adapt • Wrapping of elastic bandages • Individual fitting of the prosthesis