Musculoskeletal Disorders

1. Musculoskeletal Disorders HLTAP501A Analyse Health Information

2. Fractures

3. Deformity Swelling Bruising Muscle spasm Pain and tenderness Loss of normal function Impaired sensation Crepitus Abnormal mobility Shock Fractures – Signs & Symptoms

4. Potential blood loss with fractures

5. Types of fractures • Simple or closed • Compound or open

6. Complete Greenstick Comminuted Compression Impacted Depressed Spiral/oblique Longitudinal/linear Transverse Pathological Types of fractures

7. Fracture repair • Haematoma formation – stops the bleeding, brings macrophages to the area • Callus formation – the endosteum and periosteum become activated and produce cartilage • Osteoblasts replace the central cartilage with cancellous bone forming a strong bridge through the bone joining the internal and external callus • Osteoclasts and osteoblasts begin to reshape the area. Takes between four months to over one year

8. Fracture repair

9. Factors that delay healing • Infection • Fat embolism • Tissue fragments between the ends of the bones • Deficient blood supply • Continued mobility • Old age

10. Reduction Closed GAMP POP applied Open ORIF Immobilisation External fixation POP Splints Traction External devices – Ilizarov frame Internal fixation Nails, screws, wires, rods, plates Treatment

12. Plaster of Paris (POP) – nursing responsibilities • Frequent neurovascular observations • POP may take 48 hours to dry – handle gently • Elevate the limb to reduce swelling • Palpate the cast for ‘hot spots’ that may indicate the presence of infection • Report any seepage and mark with date and time • Correct use of sling and crutches

13. Reasons for traction • To reduce a fracture and realign bone fragments • To immobilize a fracture and maintain fracture alignment • To reduce, relieve and prevent skeletal muscle spasms • To overcome joint deformity and contractions by stretching the muscles • To rest a diseased joint

14. Manual traction • Temporarily immobilises an injured area, through hands pulling on the injured body part • e.g. when the doctor manipulates and pulls the bones for realignment

15. Skin traction • Immobilises a body part intermittently over an extended period, through direct application of a pulling force on the patient’s skin (adhesive or non-adhesive traction tape can be used). • Skin traction is usually used when partial immobilization and light traction forces are required

17. Skeletal traction • Immobilises a body part for prolonged periods, by attaching weighted equipment directly to the patient’s bones. • Uses Kirschner wires, Steinmann pins, Denham pins, and Zimmer screws. • These are inserted into the bone and is then connected to a device that attaches to the cords used in traction

18. Fixed traction • Thomas’ splint does not require gravity to achieve results.

19. Balanced traction • Uses suspension (which provides greater comfort for the patient but has no influence on the traction forces) • Weights • usually water and this can be reduced or increased as required. • can also be metal discs or sand

20. Nursing implications for traction • For traction to be successful, countertraction is necessary in most instances the countertraction is the patients weight, therefore, do not wedge the patients foot or place it flush with the foot of the bed • Maintain the line of pull • Centre the patient on the bed • Ensure that weights hang freely and do not touch the floor • Ropes • Ensure that nothing is lying on or obstructing the ropes, • Do not allow the knots at the end of the rope to come into contact with the pulley. • Ensure that the ropes are not frayed and that they are resting within the groove of the pulleys

21. Nursing implications for traction • In skeletal traction • Never remove the weights • Frequent skin assessment should include pin care per hospital policy • Report signs of infection at the pin sites, such as redness, drainage, and increased tenderness, to the doctor • The patient may require more frequent analgesic administration

22. Nursing implications for traction • In skin traction assess the skin for redness, irritation and signs of traction slipping • Perform neurovascular assessments frequently • Assess for common complications of immobility, including: • the formation of pressure ulcers, • formation of renal calculi, • DVT, • pneumonia, • paralytic ileus, and • loss of appetite

23. Neurovascular observations • Circulation – warmth, colour, refill time and oedema • Neurologic status – sensation (checking for numbness, tingling, burning pain) • Movement – check range of movement and strength • Complications will show – pain, pallor, pulse changes, paraesthesia, paralysis

24. Compartment syndrome • Early – pain and decreased pulse to distal areas • Later • Cyanosis • Tingling  Loss of sensation • Severe pain • Eventually renal failure • If untreated  amputation

25. Compartment syndrome

26. Rheumatoid arthritis • Is a chronic, systemic, inflammatory, autoimmune disease • Joints and surrounding muscles, tendons and ligaments • Systemic • Blood vessels • Skin • Heart

27. Rheumatoid arthritis - Systemic effects • Slight fever • Malaise – weakness and fatigue by early afternoon • Weight loss • Numb, tingling hands and feet • Enlarged lymph nodes • Enlarged spleen • Depression • Anorexia

28. Rheumatoid arthritis • Synovitis develops from congestion and oedema of the synovial membrane and joint capsule • Bone atrophy and misalignment cause deformities and restricted movements  muscle atrophy, imbalance, partial dislocations • Fibrous tissue calcifies  fixation of joint and immobility

29. Osteoarthritis • Is a chronic, progressive disorder • Causes • Primary • Idiopathic • Secondary • Congenital - CDH • Trauma • Disease – haemophilia, acromegaly, gout

30. Osteoarthritis – S&S • Joints commonly affected

31. Osteoarthritis – S&S • Pain in joint • Crepitus • Joint swelling and warmth • Joint deformity (subluxation) • Loss of ROM • Muscle spasm and contractures • Nodules • Herberden’s • Bouchard’s • Bunion

32. Hip replacement • Treatment for fracture or osteoarthritis • Hemiarthroplasty – replacement of either femoral head or acetabulum • Total hip replacement (THR) – both are replaced

33. Hip replacement – post op • Routine – observations, pain, wound, drainage, IDC • Specific • Maintain abduction • Log rolls • Hip flexion not greater than 900 • Mobilisation – NWB  WB

34. Hip precautions

35. Gout • Gout is a condition in which there are deposits of a chemical (sodium urate) in joints, causing arthritis, as well as in soft tissues and the urinary tract.Urate or uric acid is a chemical formed from the breakdown of purines - DNA building blocks derived from protein. • Hyperuricaemia means that a person has too much uric acid in the blood - which is associated with gout. When uric acid precipitates in a joint (often the big toe) it causes an acute arthritis. Uric acid can also be deposited in: • soft tissue, causing tophi (white chalky deposits) and tenosynovitis - tendon inflammation. • urinary tract, causing stones and potentially renal failure (since 2/3 of uric acid is excreted by the kidney)

36. Osteoporosis