Chapter 31 Orthopedic

striated

Blood vessels

scapulae and clavicles.

apply a tourniquet just below the shoulder.

A passenger fractures her patella after it strikes the dashboard.

sprain

compare it to the uninjured leg.

point tenderness.

Nondisplaced pelvic fracture

pressure in the fascial compartment is elevated.

immobilizing her to a backboard and rapidly transporting.

reduce pain and swelling.

assess the amount of air in the splint and let air out as necessary.

prevent further injury.

apply padded board splints to both sides of the leg.

immobilize the injury with a sling and swathe.

Most shoulder dislocations occur anteriorly.

splint the elbow in the position found and transport.

Pelvis

leave the toes exposed.

proximal femur.

keep her knee flexed and secure it with padded board splints.

stabilize her head and perform a primary assessment.

control the bleeding and cover the wound with a sterile dressing.

break in the continuity of the bone.

distal humerus.

the overlying skin is no longer intact.

positive indicators of a fracture.

apply gentle manual traction in line with the limb and reassess for a pulse.

stabilize the pelvis with a pelvic binder and protect the spine.

the patient is clinically unstable.

If resistance is encountered or the patient experiences severe pain

tendons

delaying transport of a critically injured patient.

bones and voluntary muscles of the body.

carefully assess the patient for breathing problems.

Displaced fracture

Pelvic fracture with hypotension

Compartment syndrome typically develops within 6 to 12 hours after an injury.

area of soft-tissue damage surrounding the injury.

Skeletal, smooth, and cardiac

also called striated muscle or voluntary muscle

tendons; fascia

also called involuntary muscle

skull, thoracic cage, pectoral girdle (shoulder girdle) , upper extremity, pelvis, lower extremity

The shinbone; the larger of the two bones of the lower leg, responsible for supporting the major weight-bearing surface of the knee and the ankle.

The outer and smaller bone of the two bones of the lower leg.

The heel bone.

Places where two bones come into contact.

A band of fibrous tissue that connects bones to bones. It supports and strengthens a joint.

A pearly white layer of specialized cartilage covering the articular surfaces (contact surfaces on the ends) of bones in synovial joints.

The area of potentially damaged soft tissue, adjacent nerves, and blood vessels surrounding an injury to a bone or a joint.

A break in the continuity of a bone.

Any break in a bone in which the overlying skin is not broken.

Any break in a bone in which the overlying skin has been broken.

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

A fracture in which bone fragments are separated from one another, producing deformity in the limb.

A fracture in which the bone is broken into more than two fragments

A fracture that occurs in a growth section of a child's bone and may lead to growth abnormalities

An incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children.

A fracture that does not run completely through the bone; a nondisplaced partial crack.

A fracture in which the bone is broken at an angle across the bone. This is usually the result of a sharp, angled blow to the bone.

A fracture of weakened or diseased bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force.

A fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone. This is sometimes the result of abuse in young children.

A fracture that occurs straight across the bone. This is usually the result of a direct-blow injury.

Tenderness that is sharply localized at the site of the injury, found by gently palpating along the bone with the tip of one finger.

Blue or black discoloration associated with a closed wound; signifies bleeding within or under the skin; also see contusion.

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling.

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called free movement.

Disruption of a joint in which ligaments are damaged and the bone ends are no longer in contact.

To return a dislocated joint or fractured bone to its normal position; to set.

A joint injury involving damage to supporting ligaments, and sometimes partial or temporary dislocation of bone ends.

Stretching or tearing of a muscle; also called a muscle pull.

An injury in which part of the body is completely severed.

The bleeding control method used when a wound continues to bleed despite the use of direct pressure and elevation; useful if a patient is bleeding severely from a partial or complete amputation.

cover open wounds with a dry, sterile dressing, and apply to control bleeding. Assess distal pulse and motor and sensory function. If bleeding cannot be controlled, quickly apply a tourniquet Apply a splint and elevate the extremity about 6 inches (15 cm), or slightly above the level of the heart. Assess distal pulse and motor and sensory function Apply cold packs if there is swelling, but do not place them directly on the skin Position the patient for transport and secure the injured area.

A flexible or rigid device used to protect and maintain the position of an injured extremity.

1. Provide gentle support and in-line traction for the limb. Assess distal pulses and motor and sensory function 2. Place the splint alongside or under the limb. Pad between the limb and the splint as needed to ensure even pressure and contact. 3. Secure the splint to the limb with bindings 4. Asses and record distal neurovascular function

1. Assess distal pulse and motor and sensory function. Support the injured limb and apply gentle traction as your partner applies oxygen, deflated splint 2. Zip up the splint, inflate it by pump or by mouth, and test the pressure. Check and record distal neurovascular function

Assess distal pulse and motor and sensory function. Your partner should support the injured limb. Place your arm through the splint to grasp the patient's hand or foot. Apply gentle traction while sliding the splint onto the injured limb your partner will inflate the splint by pump or by mouth. Assess distal pulse and motor and sensory function

asses distal and motor and sensory function. Your partner will stabilize and support the injury Place the splint and wrap it around the limb Draw the air out of the splint through the suction valve, and then seal the valve. Assess distal pulse and motor and sensory function

Longitudinal force applied to a structure.

Expose the injured limb and check pulse, motor, and sensory function. place the splint beside the uninjured limb, adjust the splint to proper length, and prepare the straps Support the injured limb as your partner fastens the ankle hitch about the foot and ankle Continue to support the limb as your partner applies gentle in-line traction to the ankle hitch and foot Slide the splint into position under the injured limb Pad the groin and fasten the ischial strap Connect the loops of the ankle hitch to the end of the splint as your partner continues to maintain traction. Carefully tighten the ratchet to the point that the splint holds adequate traction. Secure and check support straps. Assess pulse and motor and sensory functions Secure the patient and splint to the backboard in a way that will prevent movement of the splint during patient movement and transport.

After exposing the injured area, check the patient's pulse and motor and sensory functions. Adjust the thigh strap so that it lies anteriorly secured. Estimate the proper length of the splint by placing it next to the uninjured limb. Fit the ankle pads to the ankle Place the splint at the inner thigh, apply the thigh strap at the upper thigh, and secure snugly tighten the ankle harness just above the malleoli. Secure the cable ring against the bottom of the foot. Extend the splint's inner shaft to apply traction of about 10% of body weight Secure the splint with elasticized cravat bandages Secure the patient to a backboard. Check pulse and motor and sensory function

A device to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain.

when the deformity is the result of a dislocation and is severe when you encounter resistance or extreme pain when applying traction

A simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder.

A bandage or material that helps to support the weight of an injured upper extremity.

A bandage that passes around the chest to secure an injured arm to the chest.

the part of the scapula that joins with the humeral head to form the glenohumeral joint.

stabilize the fragments to prevent movement avoid neurovascular compromise align the limb for splinting

The space between the abdominal cavity and the posterior abdominal wall, containing the kidneys, certain large vessels, and parts of the gastrointestinal tract.

Blood in the urine.

The major nerve to the lower extremities; controls much of muscle function in the leg and sensation in most of the leg and foot.

TRUE

FALSE

TRUE

FALSE

Swelling within a confined anatomic compartment that produces dangerous pressure, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the elbow or knee in children

You would palpate the popliteal artery in lower extremity wounds.

An indirect force is more likely to cause a fracture or dislocation at a distant point.

point tenderness.

dislocation

serious

An AC separation occurs in the shoulder and so using a sling and swathe is an effective way to splint the injury.

avoid further neurovascular compromise

When splinting a fracture in and around a joint, be sure to stabilize the bones above and below the injured joint.

Disproportionate pain on passive stretch of muscles within the compartment is a sign of compartment syndrome.

A drawback of an air splint is that temperature or altitude changes affect the air pressure in the splint.