Presentation is loading. Please wait.

Presentation is loading. Please wait.

Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON.

Similar presentations


Presentation on theme: "Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON."— Presentation transcript:

1 Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON

2 Name that Injury!

3

4

5

6

7

8

9

10

11

12

13

14 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

15 Sprains Partial tear of a ligament by twisting & stretching of a joint beyond normal ROM –1 st Degree Sprain – No instability, few fibers torn. Minimal hemorrhage & swelling –2 nd Degree Sprain – No instability, ligaments partally torn, swelling and hemorrhage –3 rd Degree Sprain – Unstable, ligaments completely, with significant swelling & hemorrhage.

16 Sprained Knee

17 Strains & Ruptures Strain - Injury to a muscle or tendon from overexertion (back, arms, calf) Severe strains can cause bone avulsion

18 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

19 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

20 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

21 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

22 Radial, Ulnar, Wrist Injuries Check neurovascular status Splint in position found (rigid or formable Ice & elevation

23 Hand Injury Boxer’s fracture 5 th metatarsal bone Treatment –Check neurovascular status –Splint (rigid or semiformable) in position of function –Ice & elevation

24 Finger Injuries Assess neurovascular status Splint in foam filled aluminum splint, with tongue blades, or tape to adjacent finger Ice & elevation

25 Pelvic Injuries Signs & Symptoms Pain Hypovolemic shock Shortening or abnormal rotation of affected extremity Associated with injuries to the bladder, urethra, reproductive organs & sacral nerves

26 Pelvic Injuries Treatment 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

27 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

28 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

29 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

30 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

31 Long Bone Fractures Treatment Immobilize Splint Control pain Realign – In ED Skeletal traction – (In ED) Usually temporary. Weights must hang free, meticulous skin care External fixators ORIF

32 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

33 Open Fractures Signs & Symptoms Evidence of skin disruption over a fracture Protrusion of bone through an open wound Pain Neurovascular compromise Bleeding

34 Open Fractures Treatment Cover the wound Splint ED or OR Wound cleansing & debridement Realignment Splint/Cast External fixation ORIF Complications - osteomyelitis, cellulitis

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

36 Jumper 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

37

38 Amputations Classification Partial Complete Usually involves digits, foot, lower leg, hand or forearm Life over limb considerations

39 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)

40 Amputations Signs & Symptoms Obvious tissue loss Pain Bleeding Hypovolemic shock

41 Amputations Treatment Reattachment Amputation Rehabilitation Prosthesis Clinic Assessment & Care Keep body part bagged not directly on ice

42 Compartment Syndrome Signs & Symptoms Pain disproportionate to injury Sensory deficit Progressive muscle weakness Tense swollen area Elevated compartment pressures Loss of pulses

43

44 Compartment Syndrome Treatment Elevation of limb not above heart levelElevation of limb not above heart level Placement of an intracompartmental monitorPlacement of an intracompartmental monitor –<20 = normal –>20 = ischemia –> 30 = necrosis Fasciotomies to release the pressureFasciotomies to release the pressure


Download ppt "Orthopedic Trauma Andrea L. Williams, PhD, RN Emergency Education & Trauma Program Specialist Associate Clinical Professor UWHC & UW-SON."

Similar presentations


Ads by Google