Local pain

Tenderness

Loss of function of the injured part

Swelling of the soft tissues in the region of the joint

• X-ray - determine extent of displacement of structures
• Joint Aspiration - determine presence of hemarthrosis or fat cells. Fat cells in aspirate indicate a probable intraarticular fracture.

The first goal of management is to realign dislocated portion of joint in its original anatomic position.

This can be accomplished by a closed reduction, which may be performed under local or general anesthesia or intravenous (IV) conscious sedation. Open reduction via surgery is needed in some cases.

• Pain control
• Immobilization of joint
• Gentle ROM as ordered

• Shoulder weakness
• Pain - especially when arm is abducted between 60 and 120 degrees (the painful arc)
• Decreased ROM
• Drop Arm Test - arm falls suddenyl when patient's arm is abducted 90 degrees and asked to lower arm slowly

The shoulder should not be immobilized for too long because “frozen” shoulder or arthrofibrosis may occur.

Pendulum exercises and physical therapy begin the first postoperative day.

• Localized tenderness
• Pain with flexion, internal rotation, & extension of knee
• Effusion
• "click", "pop", "lock", "give way"

• Must be examined within 24 hours
• Application of ice
• Immobilization - knee brace/immobilizer first few days
• Weight bearing as tolerated with crutches

• Rest
• Ice
• NSAIDs
• Elevation
• Ambulation as tolerated with crutches
• If there is a tight, painful effusion, it may be aspirated
• Knee immobilizer or hinged knee brace for support of knee
  
• Physical Therapy

Inflammation of the bursa from repeated or excessive trauma or friction, gout, rheumatoid arthritis, or infection.

Note: Bursae are closed sacs that contain a small amount of synovial fluid and are located at sites of friction, such as between tendons and bones and near the joints.

• Warmth
• Pain
• Swelling
• Limited ROM in the affected part

True.

Note: may also use ice/NSAIDs to decrease pain/inflammation, compression dressing or splint to immoblize, corticosteroid injection, aspiration of bursal fluid, surgery if septic bursae or wall has become thickened

• Open/Compound - through skin/bone & soft tissue exposed
• Closed/Simple - not through skin/intact skin
• Complete - break is completely through bone
• Incomplete - bone in one piece/break across shaft
• Displaced - two ends of a broken bone are separated and out of their normal positions
• Nondisplaced - periosteum intact and bone still in alignment

• Edema and swelling
• Pain and tenderness
• Muscle spasm
• Deformity - may not be obvious
• Echymosis or contusion
• Loss of function
• Crepitation
• Patient guarding extremity

Bone Scan

(shows inflammatory process as well)

• Fracture Hematoma - bleeding creates a hematoma  within 72 hours
• Granulation Tissue - phagocytosis absorbs products of necrosis and produces basis for new bone (3-14 days)
• Callus Formation - forms initial bone matrix, made of cartilage, osteoblasts, calcium, phosphorous, magnesium (verified by x-ray)
• Ossification of callus - 3 weeks to 6 months (cast may be removed with limited mobility allowed)
• Consolidation - distance between bone fragments reduces as callus continues (up to 1 year)
• Remodeling - union is complete

Electrical stimulation and pulsed electromagnetic fields (PEMFs)

Note: used 10-12 hours/day usually when sleeping

• Age
• Displacement of fracture
• Site of fracture
• Blood supply to area
• Immoblization
• Implants
• Infection
• Hormones

Closed reduction is a nonsurgical, manual realignment of bone fragments to their previous anatomic position.

After reduction, traction, casting, external fixation, splints, or orthoses (braces) immobilize the injured part to maintain alignment until healing occurs.

15 minutes

(not strong enough for weight bearing until 24-72 hours)

• Sugar-tong splint - acute wrist injuries or injuries that result in swelling (wrapped with elastic or stockinette)
• Posterior splint - accommodates swelling
  
• Short arm cast - stable wrist or metacarpal fractures (immobilization with unrestricted elbow motion)
• Long arm cast - stable forearm or elbow fractures and unstable wrist fractures (restricts elbow and wrist movement)

• Ensure axillary area is well padded
• Make sure there is no undue pressure on posterior neck

Must assess for decreased bowel sounds, respiratory status, bowel and bladder function, and areas of pressure over the bony prominences, especially the iliac crest

Used for treatment of femoral fractures to immoblize trunk and extremity. It includes a body jacket cast and one long leg cast (goes from nipple line to base of foot).

Note: May include opposite extremity to area above knee (spica and a half) or both full extremities (double spica)

For the first 24 hours

Note:

It allows early mobilization

• Frequent position changes
• ROM exercises of unaffected joints (preferred activity)
• Deep-breathing exercises
• Isometric (resistance) exercises of uninvolved extremities
• Use of the trapeze bar (if permitted) to raise the body off the bed for linen changes and use of the bedpan

• Skin traction - uses light weights (5-10 lb), short term, tape boots or splints
• Skeletal traction - heavier weights (5-45 lb), used longer, pins or wires inserted into bone