Class 5 MSK
- Physical assessment
- inspection, Palpation, motion, strength opposition, gait
- PTH, Ca levels, Phosphorus PO4, Vit D, Creatinine Kinase (CK)
- X-ray, and bone density scan
- Pain, Neurovascular compromise (edema, mm spasm, loss of peripheral pulses, cap refill, and neurologic sensitivity), Immobility
- loss of bone density over time.
- diagnosis when 25%-40% of bone calcium lost.
- x-ray or bone density scan
- manifests as: pathological fractures, may not present with s/s, bone pain,
- Drugs: fosamax (alledramate), keep the Ca in the bone and prevent absorption
- Omeprazole may (PPI’s) may decrease Ca absorption.
- Lifestyle changes: Weight bearing exercise, Ca and Vit D supplementation,
- avoid: alcohol smoking, and carbonated beverages
- Risk Factors: small thin women, inactive lifestyle, white/asian, ETOH, Chronic Steroid use, Postmenopausal (lower estrogen levels)
- reduction – realigning the bone
- closed reduction is “pulling traction” and the bone is realigned without
- ORIF -open reduction internal fixation (surgical procedure)
- Healing: hematoma, granulation tissue, callus formation, ossification, consolidation, remodeling.
- complications: NEUROVASCULAR IMPAIRMENT, Pain, DVT, Fat embolism, Osteomyelitis, Myoglobinuria (leads to acute renal failure because it is a protein that is hard on the kidneys)
Fat embolism – comes from the bone marrow often in long bone fractures.
- includes the micro vasculature, can go into ARDS (acute resp. distress syndrome), petechiae, neuro issues (change in LOC).
- the issues arise from the emboli getting stuck in the lungs, brain, or other microvasculature.
- Cannot really treat this once it is lodged.
- from MM trauma, the muscle swells and pressure increases
- 6 Ps: pain, paresthesia, pallor, pulseless, pressure, paralysis.
- treat with a fasciotomy to relieve the pressure
- pulling the bone to allow for realignment to occur correctly.
- Manual, Skin or Bucks, and skeletal(drill into bone)
- sheer, urine retention (from pain meds and positioning), DVT, constipation, psychological issues, and fat emboli.
- AWFUL: Atelectasis, Wasting bone, Functional MM loss, Urine retention, Lastly constipation
- adding screws or plates, to help the bone heal correctly
- stay in permanently
- drill into the bone to anchor, then a system outside the body holds those anchors until it is healed then they are taken out,
- Clean the Pins consistently, about TID
- There are many many types and can affect the whole body not just the joints.
- buildup of uric acid in blood, then the crystals collect (especially in the big toe)
- Med: NSAID’s, colchicine, ibuprofen
THA – total hip arthroplasty (Replacement)
TKA – total knee arthroplasty (replacement)