Types of Muscle Contraction • Tone- partial contraction even when not in use, for constant readiness • Isotonic- muscle gets shorter, thicker • Work is produced: walking, running, weight lifting • Isometric- no change in muscle length • No movement produced • Pushing against immovable objects
Effects of Aging on Muscle • About age 40 • Loss of muscle cells, size • Loss of power (hunchback/kyphosis develops) • Decrease in height • Exercise (weight training) can delay progression of aging on muscles
Musculoskeletal Trauma • Strains • Sprains • Dislocations • Fractures • Compartment Syndrome
Strain • Injury to muscle or tendon due to overuse or overstretching • Chronic strain-repeated use of muscles • Acute strain-sudden severe pain • Rest, possibly immobilization • Ice, 20-30 minutes on, 1 hr off, for 24 hrs • Heat for comfort after 1st 24 hrs • Rupture may require surgery
Sprain • Injury to ligaments surrounding a joint • Caused by sudden twist, wrench, or fall • Symptoms:Pain, edema, loss of motion, ecchymosis • Treatment • Rest • Ice • Compression • Elevation • After edema decreases, a cast may be applied
Dislocation • Articular surfaces of joints no longer in contact • May hinder blood supply, damage nerves, tear ligaments, rupture muscle attachments • Traumatic-can be orthopedic emergency • Congenital-present at birth • Pathologic-caused by disease
Dislocation • Symptoms • Local joint pain • Loss of function • Change in length of extremity • Change in contour of joint
Fracture • Break in continuity of bone • Usually involve soft tissue damage • Blood vessels, nerves, tendons • Caused by • Trauma • Disease process • High risk • Tumors, osteoporosis, poor coordination or vision, syncope, general weakness
Types of Fractures • Greenstick (incomplete) • Closed (simple, complete) • Open (compound) • Impacted (telescope) • Spiral • Comminuted
Greenstick • Most often in children • Break not all way through • Splinters on one side, bends on other
Closed • Uncomplicated • Break complete through bone • Skin in tact
Open/Compound • Bone broken completely • Skin also broken, allows bone to protrude through skin • Greater risk of infection
Impacted/Telescoping • One part of the bone is driven into another
Spiral • Twists around the shaft of the bone • From a twisting force
Comminuted • Bone splintered into many unaligned fragments
The brain can be affected directly by damage to the nervous system tissue and bleeding. It can be affected indirectly by blood clots which form under the skull, but compress the underlying brain tissue (subdural or epidural hematoma).
A simple fracture is a break in the bone without damage to the skin.A linear skull fracture is a break in a cranial bone resembling a thin line, without splintering, depression, or distortion of bone.
A depressed skull fracture is a break in a cranial bone (or "crushed" portion of skull) with depression of the bone in toward the brain.A compound fracture involves a break in, or loss of skin and splintering of the bone.
Concussion Prevention • Attention to safety, including the use of appropriate athletic gear, such as bike helmets and seat belts, reduces the risk of head injury.
Skull Fracture: Prevention • 1. Use car seats or seat belts whenever in a motor vehicle. • 2. Use helmets whenever biking, skating, climbing, or playing contact sports. • 3. Use equipment designed specifically for the type of sport or recreation in which you are participating.
4. Provide appropriate supervision for children of any age. • 5. Do not allow children to bike or skate at night. • 6. Provide highly visible clothing. • 7. Teach children to obey traffic rules and signals. • 8. Educate individuals about risks of various work, recreational, or sport activities and how to avoid injury.
Healing • Determined by • Age of client • Type of injury or disease process • May take weeks, months, or years to heal
Healing Sequence • Hematoma forms • Granulation tissue formation • Soft callous formation-temporary splint • Callous ossification-calcium salt deposits form rigid bone and bind ends together • Remodeling-excess bone removed by osteoclastic activity
Fracture Complications • Can delay healing or be life threatening • Infection • open skin or hardware placed • Fat embolism • fat from bone marrow travels to lung or heart • Compartment syndrome • Neurovascular impairment
Fat Embolism • Usually occurs within 24-72 hours post injury • Can occur up to a week post injury • Small lung area involved • Pain, tachycardia, dyspnea • Large lung area involved • Severe pain, dyspnea, cyanosis, restlessness, shock
Fat Embolism Treatment • Bed rest • Gentle handling • Oxygen • IV fluids
Complications of Fractures • Fat embolism • Cause • Clinical manifestations/assessment • Medical management/nursing interventions
Compartment Syndrome • Progressive constriction of blood vessels and nerves can lead to permanent damage • Can occur with any orthopedic injury • Untreated
Compartment Syndrome Emergency • Pain not relieved by narcotic analgesics • Paresthesia (numbness, tingling) • Paralysis • Treatment is to relieve pressure • Remove cast/dressing • Fasciotomy
Complications of Fractures • Compartment syndrome • Cause • Clinical manifestations/assessment • Medical management/nursing interventions
(From Beare, P.G., Myers, J.L. . Adult health nursing. [3rd ed.]. St. Louis: Mosby.) Compartment syndrome.
Other Complications of Fractures • Shock • Cause • Clinical manifestations/assessment • Medical management/nursing interventions
Other Complications of Fractures • Gas gangrene • Cause • Clinical manifestations/assessment • Medical management/nursing interventions
Other Complications of Fractures • Thromboembolus • Cause • Clinical manifestations/assessment • Medical management/nursing interventions
Medical-Surgical Management • Treatment of a Fracture • Immediate • Realign the fracture • Maintain the alignment • Regain function
Method of Treatment Depends on • First aid given • Location of injury • Severity • Type of fracture • Age and condition of client
Casts • For stabilization, immobilization, support, and protection • Plaster or synthetic/fiberglass • Synthetics, non-weight bearing parts of body • Casts should extend to joints above and below affected part
Casts Continued • Cast should by dry, odorless, shiny, resonant • Underlying moisture causes cast to feel cool, smell musty, and sound dull on percussion
Types of Casts • Long and short leg • Spica cast, treats part or all of one or more extremities • Walking cast • Body cast • Windowing-cut a hole over a body area to relieve pressure, such as for abdominal distention
Client Teaching - Casts • Plaster casts should dry from inside out • DO NOT USE A HAIR DRYER or Heat Lamp • Heat during application is normal and will subside, 10-15 minutes • Avoid indentation, rest on pillow to dry • Synthetic casts dry in minutes
Traction • Two forces pulling in opposite directions • Consists of weights and counterweights • Can be used to reduce a fracture, immobilize an extremity, decrease muscle spams, correct or prevent deformity
Types of Traction • Skeletal • Requires surgical insertion of pins or wires through bones • Continuous • Fx of femur, tibia, cervical spine (Head tongs) • Skin • Non-surgical • Shorter period of time • Tapes, traction strips, cervical halters, pelvic belts • Manual
You Need to Know • Which type traction • What it is being used for • How it works • Associated complications • Extent of the injury • Movements and positions allowed