NURSING MANAGEMENT OF

PERSONS WITH MUSCULO-SKELETAL

INJURIES
Prepared by Marjorie Ming MPH,
RN/M 2008

MUSCULO-SKELETAL INJURIES
Definition of Terms
1. Muscle: A type of tissue composed of contractile cells or
fibres that effects movement of an organ or part of the
body. Muscle tissue also has the ability to shorten or
contract, has properties of irritability, conductivity &
elasticity.
Three types: smooth, striated, cardiac based on
histological structure.
2. Muscular: Pertaining to muscles.

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MUSCULO-SKELETAL INJURIES
Definition of Terms
3. Musculo: Combining form pertaining to muscle

4. Skeletal (Skeleton): a) A dried up body

(Taber s Psychlopedic Med. Dictionary)
b) Hard framework of bones of animals;
c) supporting framework or structure of a thing.
(Little Oxford Dictionary)

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MUSCULO-SKELETAL INJURIES: Types

Fractures: the long bone is most commonly
involved. Composed of the shaft or diaphysis &
the flared end or metaphysis.
In children the two important segments are the
physis (growth region) epiphysis which is directly
adjacent to the joint.
The epiphysis fuses to the metaphysis at the
end of the growth period
Injury to long bones in childhood can result in
growth retardation or arrest in longitudinal
growth of limb.
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MUSCULO-SKELETAL INJURIES: Types

Classification of Fractures
a) according to type of injury to the bone or
surrounding tissue e.g. transverse (across the
bone); oblique (at an angle across the bone);
comminuted (displaced fragments of bone).
b) open or closed: in an open # the skin is broken
due to penetration of bone fragment or external
trauma
c) Soft tissue injury is also probable with fractures.
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MUSCULO-SKELETAL INJURIES
Types of Fractures
1. Greenstick: A crack; bending of bone with
incomplete fracture.
Only affects one side of the bone
Common in skull fractures & in young children
when bones are pliable.
2. Comminuted: Bone completely broken in spiral,
transverse or oblique direction (direction of
fracture in relation to the long axis of the bone).
Bone broken in several fragments.
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MUSCULO-SKELETAL INJURIES
Types of Fractures
3. Open or Compound: Bone exposed to the air
through a break in the skin
Can also be associated with soft tissue injury
Infection is a common complication (exposure)
4. Closed or Simple: Skin remains intact.
Chances for Infection are greatly decreased.
5. Compression: Frequently in vertebral fractures.
Fractured bone is compressed by other bones.
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MUSCULO-SKELETAL INJURIES
Types of Fractures
6. Complete: Bone broken
sides of the periosteum.

disruption of both

7. Impacted: One part of fractured bone is driven

into another.
8. Depressed: Usually in skull or facial injuries.
Bone or fragments of bone are driven inwards.
9. Pathological: Break caused by disease
process.
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MUSCULO-SKELETAL INJURIES
Treatment of Fractures
1.Simple Reduction: Manipulation to return bone
to normal anatomical position (Closed Fractures)
Casts are generally applied to maintain reduced
fracture in proper alignment.
2. Traction: Skin & Skeletal
used to maintain
alignment of reduced fracture
a)Skeletal Traction: More Reliable & Effective
(most commonly used
Russel s & Thomas
Splint with Pearson attachment)
b)Skin Traction: Many types, the oldest is Buck s Traction
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MUSCULO-SKELETAL INJURIES
Treatment of Fractures
b) Skin Traction (Buck s) cont d.: Applied for short
periods on young patients with knee injuries or
elderly patients prior to surgical repair of
fractured hip.
Bryant s traction is used primarily for children
under 3 years with fractured femur
Neck Halters & Pelvic Traction: are also types
of skin traction.
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MUSCULO-SKELETAL INJURIES
Immobilization for Spinal Injuries: - Halo
Traction; Jewett-Taylor Brace;
Stryker Frame: Most easily maintains Cervical
Traction; Skeletal traction may be necessary.
Halo Traction: Popular because it allows early
mobility of patient, often follows after surgery.
Jewett-Taylor Brace: Generally applied before
getting the patient out of bed (for stabilizing).
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MUSCULO-SKELETAL INJURIES
Other Treatment Modalities:
1.Special Beds:
The Nelson Bed
to prevent movements of
body parts & prevent complications.
CircOlectric Bed
Facilitates immobility &
frequent turning for optimal care.
2. Bandages:
3. Slings:
4. Splints:
5. Plaster Casts:
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MUSCULO-SKELETAL INJURIES
Clinical Manifestations: Depends on the location,
type, and nature of the causative injury.
Fractures: generally characterized by pain,
abnormal positioning, oedema, immobility or
decreased range of motion, ecchymosis, guarding,
and crepitus.
Childhood fractures involve clavicle, tibia, ulna &
femur; distal forearm # the most common type.
Fractures to the pelvis are usually associated with
motor vehicle crashes. Epiphyseal injuries are
common in children.
Exact location is determined by X-ray.

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MUSCULO-SKELETAL INJURIES
Clinical Management: Two basic types
1.Reduction to realign displaced or fragmented
bones.
2.Immobilization to facilitate healing.
Closed Reduction aligns the bone by manual
manipulation using conscious sedation or pain
management during the procedure.
Open Reduction requires surgical alignment
and fixation of the bone, using pins, plates, wires
or screws. For open fractures surgery is done
for debridement to remove dead tissue & clean
the wound.
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MUSCULO-SKELETAL INJURIES
Complications of Fracture Reductions

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COMPLICATIONS
CLINICAL THERAPY
Infection:
*Acute (in open fractures)
*Chronic (osteomyelitis)
Debridement, drainage,
culture, and antibiotic
treatment.
Neurovascular injury from
physical nerve damage
Nerve repair
Vascular injury
Vascular repair, amputation,
tendon lengthening.
Malunion or delayed union:
undesired healed bone length
Corrective osteotomy,
prolonged immobilization.
Nonunion
Surgical Internal Fixation
Leg Length Discrepancy
She lift.

MUSCULO-SKELETAL INJURIES
Nursing Considerations Involve:
Prevention of and Correction of alterations
in the musculoskeletal system
Enable patients to achieve and maintain
optimal mobility
Preventing Complications
Utilize Preventive, Restorative and
Rehabilitative methods.
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MUSCULO-SKELETAL INJURIES
Nursing Considerations Involve:
1. Preventive & Restorative measures include the
use of bandages, splints, tractions, & casts.
2. Rehabilitative measures include the use of
Special Beds & Halo Traction.
Bandages: apply pressure; immobilize a body
part; prevent or reduce oedema; correct
deformity, & secure splints in place.

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MUSCULO-SKELETAL INJURIES
Nursing Considerations Involve:
ICE: Immobilize; Cold treatment; Elevate
area.
Observe: casted extremities frequently
especially when cast is drying: for pulse,
warmth, pain, paresthesia.
Bandaged Extremities: in the 1st 20 mins.
then 2 hrly. after application for circulation.
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MUSCULO-SKELETAL INJURIES
Nursing Considerations Involve: Diagnoses
1.Pain, related to injury
2.Risk for impaired skin integrity, related to
treatment
3.Risk for infection related to open fracture or
trauma
4.Impaired physical mobility related to treatment
5.Health seeking behaviours related to lack of in
formation about treatment and expected
outcome.
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MUSCULO-SKELETAL INJURIES
Nursing Considerations
1.Plan and Implement Care
2.Maintain Proper Alignment
3.Monitor Neurovascular Status
4.Promote Mobility
5.Discharge Planning and Home Care Teaching.
6.Prevent Complications
7.Notify physician immediately of sign of
complications.
**Major complication is compartment syndrome or
compromise of circulation & tissue function.
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MUSCULO-SKELETAL INJURIES
Compartment Syndrome
Clinical Manifestations: begin about 30 after tissue
ischaemia starts. [* Late signs]

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Major Manifestations are:
Check Extremities for:
Paresthesia: tingling, burning, loss of 2point discrimination
Colour
Temperature
Pain: unrelieved by medication (child
crying)
Capillary refill
Pressure: skin is tense, cast appears tight
Peripheral pulse
Pallor*: pale, grey or white skin tone
Oedema
Paralysis*: weakness or inability to move
extremity
Sensation
Pulselessness*: weak or absent pulse
Motor ability; Pain

MUSCULO-SKELETAL INJURIES
Strains, Sprain and Dislocations

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Condition
Clinical
Manifestations
Clinical Therapy
Strain: Stretching or
tearing a muscle or
tendon
*Vary by type &
severity.
Pain is either acute or
chronic.
Rest & support of
injured part until it
heals & normal activity
recurs
Sprain: Stretching or
tearing of a ligament
Oedema, Joint
Immobility, Pain
First 24 hours: Rest,
Ice Compression,
Elevation. Gradually
increase mobility
Dislocation: Complete
displacement of an
articular joint surface

Pain, Tenderness,
Swelling & Instability of
joint

Open or Closed
Reduction &
Immobilization.
Dependent on site &
severity of injury.

MUSCULO-SKELETAL INJURIES
DISCUSSION

QUESTION S & ANSWERS

REFERENCES
Ball J. and Bindler R, 3rd. Ed. 2003,
Paediatric Nursing Caring for Children
Prentice Hall, New Jersey
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