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Orthopedic Trauma
Andrea L. Williams, PhD, RN
Emergency Education & Trauma ProgramSpecialist
Associate Clinical ProfessorUWHC & UW-SON
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Name that Injury!
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Associated Conditions
HemorrhageShock (~2L pelvis, 1L thigh& 500 ml tibia)
Instability
Loss of tissue
Laceration with contamination
Interrupted blood supplyIschemia
Nerve damage
Long-term Disability
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Sprains
Partial tear of a ligament by twisting & stretchingof a joint beyond normal ROM
1stDegree SprainNo instability, few fibers torn.
Minimal hemorrhage & swelling
2ndDegree SprainNo instability, ligaments partallytorn, swelling and hemorrhage
3rdDegree SprainUnstable, ligaments completely,
with significant swelling & hemorrhage.
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Sprained Knee
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Strains & Ruptures
Strain - Injury to a muscle or tendon from
overexertion (back, arms, calf)
Severe strains can cause bone avulsion
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Joint Dislocations
DislocationArticulating surfaces of 2 bones
are displaced
LuxationComplete dislocation
SubluxationIncomplete dislocation Rotator Cuff injuriesUsually deltoid
Common sites
Shoulders, elbows, fingers, knees, & ankles
Complications Posterior popliteal injury
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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
Elevationto or just below level of heart
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Shoulder Injuries
Dislocations
Subluxations
Rotator cuff tendon
injuries Sternoclavicular strain
Treatment
Neurovascular status
Splint in position foundor
Sling & secure to body
Ice or cold compresses
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Elbow Injuries
Falling on an outstretched arm orflexed elbow
Pulled elbowNursemaids elbowfrom a sudden lateral force
Athletic injury
Complications Volkmanns contracture Claw-like
contraction of hand & arm deformityfrom ischemia
Laceration of brachial artery
Ulnar nerve damage
Treatment Check neurovascular status
Splint in position found
Ice or cold compresses
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Radial, Ulnar, Wrist Injuries
Check neurovascular
status
Splint in position found
(rigid or formable Ice & elevation
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Hand Injury
Boxers fracture 5th
metatarsal bone
Treatment
Check neurovascularstatus
Splint (rigid or
semiformable) in
position of function Ice & elevation
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Finger Injuries
Assess neurovascular status
Splint in foam filled aluminum
splint, with tongue blades, or
tape to adjacent finger Ice & elevation
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Pelvic Injuries
Signs & Symptoms
Pain
Hypovolemic shock
Shortening or abnormalrotation of affectedextremity
Associated with injuries
to the bladder, urethra,reproductive organs &sacral nerves
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Pelvic Injuries
Treatment of Pelvic Fractures/Ring Injuries
Open bookVacuum mattress, Pelvic Binder, or sheet
Control hemorrhageDirect pressure or close pelvicring
Fluid volume replacementNormal Saline
(ED - PRBC, FFP, Platelets., Factor VII A &/orembolization)
External fixation/ORIF
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Classification of Long Bone
Injuries
Fractures Complete or incomplete
Open or closed
EpiphysealCause bending or deformity
ComminutedSeveral breaks in the bone
Greenstick - Break in periosteum w/ibowing or buckling
SpiralTwisted or circular break. child
abuse ObliqueDiagonal, slanting break
TransverseRight angle fracture
Pathological
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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
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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
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Long Bone Fractures
Assessment
CirculationHemorrhage or ischemia
Neurovascular status
Pulses
DeformityEdema, hematoma, wounds
Compartment Syndrome 6 Ps Pain, Pallor, Parasthesia, Pulses,
Paralysis, Pressure
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Long Bone Fractures
Treatment Immobilize
Splint
Control pain
RealignIn ED
Skeletal traction(In ED)Usually temporary. Weightsmust hang free, meticulous skin
care External fixators
ORIF
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Splinting
Types of splints
Rigid splintbody part fit to splint
design
Soft or formable splint
molded toshape or configuration of the body part
Traction splint(Femur fractures)
traction to stabilize and align
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Open Fractures
Signs & Symptoms
Evidence of skin disruption over afracture
Protrusion of bone through an openwound
Pain
Neurovascular compromise Bleeding
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Open Fractures
Treatment Cover the wound
Splint
ED or OR Woundcleansing & debridement
Realignment
Splint/Cast
External fixation ORIF
Complications -osteomyelitis, cellulitis
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Techniques for Realignment
Finger realignment
Shouldar realignment
Hip realignment
Knee realignment
Ankle realignment
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Jumper Syndrome
Vertical deceleration
Forces transmitted upwards from lower
extremities, pelvis, spine, chest
Lower extremity fractures & spinal cordinjuries
Retroperitoneal hemorrhage is the most
common cause of shock
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Amputations
Classification
Partial
Complete
Usually involves digits,foot, lower leg, hand or
forearm
Life over limbconsiderations
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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)
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Amputations
Signs & Symptoms
Obvious tissue loss
Pain
Bleeding
Hypovolemic shock
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Amputations
Treatment
Reattachment
Amputation
Rehabilitation
Prosthesis Clinic
Assessment & Care
Keep body partbagged not directly
on ice
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Compartment Syndrome
Signs & Symptoms
Pain disproportionate to injury
Sensory deficit
Progressive muscle weakness
Tense swollen area
Elevated compartment
pressures Loss of pulses
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Compartment Syndrome
Treatment
Elevation of limb not above heart level
Placement of an intracompartmental
monitor 20 = ischemia
> 30 = necrosis Fasciotomies to release the pressure
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