UNIT 10 Nursing management of patients with musculoskeletal problems
The musculoskeletal system is the body’s framework that provides support, movement, protection, and mineral storage. It is made up of:
🔹 Bones
🔹 Joints
🔹 Muscles
🔹 Tendons
🔹 Ligaments
🔹 Cartilage
🧩 This system is a functional integration of two systems:
➡️ Skeletal System (🦴) – Rigid framework
➡️ Muscular System (💪) – Generates movement
| Shape | Description | Examples |
|---|---|---|
| 🟥 Long Bones | Longer than wide, support weight & movement | Femur, Tibia |
| 🟨 Short Bones | Cube-shaped, stability & movement | Carpals, Tarsals |
| ⬜ Flat Bones | Protect internal organs | Skull, Ribs |
| 🟪 Irregular Bones | Complex shapes | Vertebrae, Mandible |
| ⚪ Sesamoid Bones | Embedded in tendons | Patella |
✅ Support – Frame for the body
✅ Protection – Skull 🧠, Ribs ❤️, Vertebrae 🧬
✅ Movement – Acts as levers for muscles
✅ Mineral Storage – 🧂 Calcium & 🧪 Phosphate
✅ Blood Cell Formation – In red bone marrow (🔴⚪ platelets)
✅ Fat Storage – Yellow marrow stores lipids (⚠️ Energy reserve)
🔹 Diaphysis – Shaft, compact bone
🔹 Epiphysis – Ends, spongy bone with red marrow
🔹 Metaphysis – Between shaft & end (includes growth plate)
🔹 Medullary cavity – Hollow center, contains yellow marrow
🔹 Periosteum – Outer fibrous membrane
🔹 Endosteum – Inner lining of medullary cavity
Joints = Connections between bones 🧩
They allow mobility and provide stability.
| Type | Examples | Movement |
|---|---|---|
| 🔵 Fibrous | Skull sutures | Immovable |
| 🟠 Cartilaginous | Vertebrae, Pubic symphysis | Slight movement |
| 🟢 Synovial | Knee, Shoulder | Freely movable |
💡 Synovial Joints have:
➡️ Articular cartilage
➡️ Synovial cavity with fluid
➡️ Joint capsule
➡️ Ligaments
| Muscle Type | Characteristics | Location | Control |
|---|---|---|---|
| 💪 Skeletal | Striated, multinucleated | Attached to bones | Voluntary |
| 💓 Cardiac | Striated, branched, intercalated discs | Heart only | Involuntary |
| 🫁 Smooth | Non-striated, spindle-shaped | Walls of hollow organs | Involuntary |
✅ Movement – via tendon attachments
✅ Posture Maintenance
✅ Joint Stability
✅ Heat Production – 85% of body heat 🥵
✅ Circulation (Cardiac) & Peristalsis (Smooth)
💥 Sliding Filament Theory (in skeletal muscles):
🟢 Actin (thin) + 🔴 Myosin (thick) filaments slide over each other → contraction
Steps:
| Structure | Function |
|---|---|
| 🔩 Tendons | Connect muscle to bone |
| 🔗 Ligaments | Connect bone to bone |
| 🧊 Cartilage | Smooth, cushioning surface in joints |
🎯 Example:
👉 To flex the elbow:
🔸 Loss of bone density (osteopenia/osteoporosis)
🔸 Muscle mass decreases (sarcopenia)
🔸 Joint stiffness, ↓ flexibility
🔸 ↑ Risk of fractures & falls
The musculoskeletal system is essential for posture, protection, locomotion, and daily functioning. A healthy diet, physical activity, and proper ergonomics help maintain its strength and integrity across the lifespan.
✅ Identify musculoskeletal dysfunctions
✅ Determine severity and impact on daily life
✅ Establish baseline data
✅ Guide nursing care planning and evaluation
✅ Monitor for complications (e.g., immobility, fractures, infections)
Ask the patient about:
| Aspect | Key Questions |
|---|---|
| 🧬 Chief complaint | “What brings you in today?” |
| 🤕 Pain | Location, intensity, quality (aching, burning, sharp), duration, what aggravates or relieves it |
| ⚠️ Injury/Trauma | Any falls, fractures, sports/work injuries |
| 🏃 Mobility Issues | Difficulty walking, stiffness, limping, gait changes |
| 🧱 Deformities | Any visible bone or joint deformities |
| 😫 Weakness or Fatigue | In limbs, muscles, reduced endurance |
| 📜 Medical history | Arthritis, osteoporosis, muscular dystrophy, past surgeries |
| 🧬 Family history | Hereditary conditions (RA, SLE, osteoporosis) |
| 💊 Medications | Steroids, calcium/vitamin D supplements, NSAIDs |
| 🧠 Psychosocial Impact | Effects on work, ADLs, mood, social life |
🛏️ Ensure patient comfort and proper lighting before proceeding.
Look for:
Use fingertips and hands to assess:
Assess active and passive ROM:
📝 Note any limitations, pain, or asymmetry
| Grade | Description |
|---|---|
| 0️⃣ | No contraction |
| 1️⃣ | Flicker, no movement |
| 2️⃣ | Movement only with gravity eliminated |
| 3️⃣ | Movement against gravity |
| 4️⃣ | Movement against some resistance |
| 5️⃣ | Full strength, normal |
Be aware of results that support musculoskeletal assessment:
| Test | What It Shows |
|---|---|
| 🩸 Serum Calcium & Phosphate | Bone metabolism |
| 🧪 Alkaline Phosphatase (ALP) | Bone formation activity |
| 🩸 Rheumatoid Factor (RF), ANA, CRP, ESR | Autoimmune & inflammatory markers |
| 🩻 X-rays | Bone fractures, arthritis, deformities |
| 📊 DEXA scan | Bone mineral density (osteoporosis screening) |
| 🧲 MRI/CT scan | Soft tissues, ligaments, tendons |
| 🔬 Joint aspiration | Rule out infection or gout |
⚠️ Sudden loss of movement
⚠️ Severe unrelieved pain
⚠️ Cold or pale limb (↓ circulation)
⚠️ Numbness or tingling (nerve damage)
⚠️ Signs of infection in joint (fever, warmth, redness, swelling)
📝 Record:
✅ Compare both sides (bilateral limbs)
✅ Use anatomical terms (e.g., proximal, distal)
✅ Involve the patient actively (e.g., “Can you lift your leg?”)
✅ Assess impact on ADLs (bathing, dressing, walking)
✅ Be alert for compensatory movements or guarding
Nursing assessment of the musculoskeletal system involves: 👉 Comprehensive history
👉 Thorough physical exam
👉 Functional evaluation
👉 Monitoring diagnostic results
👉 Prompt recognition of complications
🧠 Remember: Early detection = Better outcome
A thorough musculoskeletal history helps identify the nature, onset, and impact of the problem. Use open-ended questions, pain scales, and ADL-based queries.
🗣️ Ask:
“What brought you here today?”
“What are you experiencing?”
➡️ Common complaints include:
✅ Joint or muscle pain
✅ Swelling, stiffness
✅ Weakness
✅ Deformity
✅ Limited range of motion
✅ Numbness or tingling
| Factor | Question |
|---|---|
| P – Provocation | What triggers it? (Movement, rest?) |
| Q – Quality | Dull, sharp, aching, burning? |
| R – Region/Radiation | Where is it? Does it spread? |
| S – Severity | Pain scale 0–10 |
| T – Timing | Constant, intermittent, duration? |
Ask about the patient’s ability to perform activities of daily living (ADLs):
🧼 Bathing
👗 Dressing
🚶 Walking
🍽️ Eating
🪑 Sitting or getting up
🛏️ Sleeping position & comfort
✅ Previous fractures, dislocations, arthritis, osteoporosis
✅ Orthopedic surgeries (joint replacement, spine surgery)
✅ Use of orthopedic devices (braces, walkers, canes)
✅ Medications: NSAIDs, corticosteroids, calcium/vitamin D
✅ History of falls or trauma
🧬 Hereditary musculoskeletal disorders:
✅ Job type (physical labor vs. sedentary)
✅ Exercise routine or lack thereof
✅ Sports involvement or overuse injuries
✅ Nutrition, calcium/vitamin D intake
✅ Smoking/alcohol (affect bone health)
Observe:
Feel for:
💡 Movements to assess:
🦵 Flexion ↘️ | Extension ↗️
➡️ Abduction | ⬅️ Adduction
🔄 Rotation | Circumduction
🧠 Use Muscle Strength Grading Scale (0–5)
| Grade | Description |
|---|---|
| 0️⃣ | No muscle contraction |
| 1️⃣ | Flicker only |
| 2️⃣ | Movement without gravity |
| 3️⃣ | Movement against gravity |
| 4️⃣ | Movement against some resistance |
| 5️⃣ | Full strength |
Observe the patient walking:
Assess posture and curvature:
🔬 Test results often used to confirm findings:
⚠️ Sudden muscle weakness
⚠️ Severe, unrelieved pain
⚠️ Numbness, tingling, or cold extremities
⚠️ Swelling with warmth and redness
⚠️ Loss of mobility or joint locking
Include: ✅ Pain scale and description
✅ Joint and muscle condition
✅ ROM findings
✅ Functional ability and gait
✅ Diagnostic results and trends
✅ Patient’s verbal reports and emotional status
Nursing history and physical assessment of the musculoskeletal system provide crucial data for:
🩺 Diagnosis
📅 Planning
🧠 Monitoring
🤝 Patient-centered care
🎯 A thorough and empathetic approach leads to early detection, effective treatment, and better quality of life for patients with musculoskeletal problems.
Laboratory investigations help detect inflammation, autoimmune disorders, bone metabolism, or infection.
| 🔬 Test | 💡 Purpose | ⬆️⬇️ Interpretation |
|---|---|---|
| Erythrocyte Sedimentation Rate (ESR) | Detects inflammation | ↑ in arthritis, infections |
| C-Reactive Protein (CRP) | More sensitive than ESR for inflammation | ↑ in RA, osteomyelitis |
| Rheumatoid Factor (RF) | Autoantibody for rheumatoid arthritis | ↑ in RA, SLE |
| Anti-Nuclear Antibody (ANA) | Detects autoimmune disease | ↑ in SLE, RA |
| Serum Calcium | Bone strength marker | ↑ in bone destruction; ↓ in osteoporosis |
| Serum Phosphorus | Works with calcium in bone | ↑ or ↓ in bone disease |
| Alkaline Phosphatase (ALP) | Indicates bone formation activity | ↑ in Paget’s disease, fractures |
| Creatine Kinase (CK-MM) | Muscle damage indicator | ↑ in muscle injury, myopathies |
| Uric Acid | Evaluates gout | ↑ in gout or renal failure |
| HLA-B27 | Genetic marker | Positive in ankylosing spondylitis |
✅ First-line test
✅ Detects:
✅ Cross-sectional view of bones & soft tissues
✅ Better than X-ray for:
✅ Best for soft tissues
✅ Shows:
✅ Injects radioactive isotope
✅ Detects:
✅ Measures Bone Mineral Density (BMD)
✅ Gold standard for osteoporosis diagnosis
✅ T-score interpretation:
✅ Non-invasive & radiation-free
✅ Best for:
✅ Aspiration of synovial fluid
✅ Used for:
✅ Assesses muscle & nerve function
✅ Used in:
✅ Removal of tissue sample
✅ Used to diagnose:
✅ Minimally invasive scope into joint
✅ Direct visualization of joint surfaces
✅ Can diagnose and treat:
🧑⚕️ Before the Test:
🧑⚕️ After the Test:
| Category | Tests | Use |
|---|---|---|
| Blood Tests | ESR, CRP, RF, CK, Calcium, ALP | Inflammation, autoimmune disease, bone metabolism |
| Imaging | X-ray, CT, MRI, Bone Scan, DEXA | Structure, density, soft tissue, tumors |
| Procedures | Arthrocentesis, Biopsy, EMG, Arthroscopy | Diagnosis of joint, muscle, nerve disorders |
📌 These tests are essential tools in identifying, monitoring, and planning treatment for musculoskeletal problems. Nurses play a key role in preparation, education, and post-test care to ensure patient safety and accurate results.
🧠 A dislocation is the complete displacement or separation of the articular surfaces of a joint, causing loss of joint alignment and function.
In simpler terms:
Dislocation = Bone out of joint place 💥
🆘 It is often accompanied by ligament tearing, pain, swelling, and restricted movement.
Dislocations usually result from trauma, but other factors may contribute as well:
Dislocations can be classified based on several factors:
| Type | Description |
|---|---|
| Acute Dislocation ⚠️ | Sudden and recent; usually due to trauma |
| Chronic Dislocation 🕰️ | Long-standing; may go unnoticed or untreated |
| Recurrent Dislocation 🔁 | Occurs repeatedly at the same joint (e.g., shoulder) |
| Type | Description |
|---|---|
| Complete Dislocation ❌ | Total loss of contact between joint surfaces |
| Subluxation (Partial) ✅ | Partial or incomplete dislocation – joint surfaces still partially in contact |
| Joint | Common Name | Notes |
|---|---|---|
| Shoulder | Glenohumeral dislocation | Most common dislocation 💪 |
| Hip | Hip dislocation | Often due to high-impact trauma or in newborns |
| Knee | Patellar or tibiofemoral | Less common but serious |
| Elbow | Elbow dislocation | Seen in falls or sports |
| Fingers/Toes | Phalangeal dislocation | Due to twisting injuries |
| Jaw (TMJ) | Temporomandibular dislocation | Can occur during yawning, trauma, or dental work |
🟥 Dislocations = Ortho Emergencies
🟨 Untreated = Risk of nerve damage, vascular injury, or joint deformity
🟩 Reduction (manual or surgical) is necessary to reposition the joint
🧊 Apply cold compress, immobilize, and monitor neurovascular status before treatment
Dislocation involves displacement of bones at a joint, leading to loss of articulation and structural disruption. Here’s how it happens:
📌 In subluxation, partial contact between articular surfaces is still retained.
Dislocation presents with obvious and immediate symptoms, especially after trauma.
| Symptom | Description |
|---|---|
| 🔺 Severe Pain | Sudden, sharp, localized to joint |
| 🔻 Swelling | Due to inflammation and fluid accumulation |
| 🚫 Immobility | Inability to move the joint normally |
| 🦴 Deformity | Abnormal joint shape or contour; joint may appear “out of place” |
| ✋ Tenderness | On palpation over the joint |
| 🩸 Bruising or Redness | Overlying skin may change color due to internal bleeding |
| ⚡ Numbness or Tingling | If nerves are compressed or stretched |
| ❄️ Cold or Pale Extremity | Sign of vascular compromise (serious complication) |
| 🧊 Muscle Spasm | Due to protective reflex and irritation |
| Test | Purpose |
|---|---|
| 🩻 X-ray | Confirms bone displacement, rules out fractures |
| 🧲 MRI | Evaluates soft tissue damage (ligaments, cartilage, tendons) |
| 🧠 CT Scan | Detailed bone view, especially in complex joints |
| 🎯 Ultrasound | Useful in shoulder dislocations or infants (e.g., developmental dysplasia of hip) |
| Aspect | Key Points |
|---|---|
| Pathophysiology | Trauma → ligament tear → joint misalignment → pain & immobility |
| Symptoms | Pain, swelling, deformity, loss of motion, numbness |
| Diagnosis | X-ray, MRI, CT scan, physical exam, special tests |
The primary goals are to relieve pain, realign the joint, and restore function while preventing complications.
🆘 At the scene or in the ER:
| Drug | Purpose |
|---|---|
| 💊 Analgesics (e.g., Paracetamol) | Relieve pain |
| 💉 NSAIDs (e.g., Ibuprofen, Diclofenac) | Reduce inflammation and pain |
| 💤 Muscle Relaxants (e.g., Diazepam) | Reduce muscle spasms before or after reduction |
| 💊 Sedation/Anesthesia (IV midazolam or propofol) | Used during joint reduction |
| 💉 Local/Regional Anesthetic | For pain control during manual manipulation |
| 💊 Antibiotics | If open dislocation or infection risk present |
| 💊 Tetanus prophylaxis | For open injuries or wounds |
➡️ Performed by an orthopedic specialist
➡️ Uses gentle traction and manipulation
➡️ Often done under sedation or local anesthesia
➡️ Followed by immobilization with:
✅ Duration: 2–6 weeks depending on joint and severity
✅ Purpose: Allow ligaments and joint capsule to heal
Begins after immobilization phase to regain:
Surgery is indicated when:
🚫 Closed reduction fails
🔁 Recurrent dislocations occur
🦴 Accompanying fractures or ligament tears
🧬 Congenital dislocation (e.g., hip in infants)
💥 Vascular or nerve damage present
| Surgery Type | Description |
|---|---|
| 🛠️ Open Reduction | Surgical realignment of the joint when manual (closed) reduction fails |
| 🪛 Internal Fixation | Screws, plates, or pins used to stabilize bones (if fracture involved) |
| ⚙️ Ligament Repair or Reconstruction | Repair torn ligaments to prevent future dislocations (e.g., ACL repair) |
| 🦴 Joint Capsule Tightening | Tightens loose joint structures (common in recurrent shoulder dislocations) |
| 🦿 Arthroplasty | Joint replacement, typically in chronic or degenerative dislocations |
| 📹 Arthroscopy | Minimally invasive procedure to inspect/repair joint structures |
🧑⚕️ Nursing & Rehab care includes:
| Management Type | Includes |
|---|---|
| Medical | Analgesics, NSAIDs, muscle relaxants, closed reduction, immobilization, physiotherapy |
| Surgical | Open reduction, internal fixation, ligament repair, joint capsule repair, arthroplasty |
(Complete joint displacement)
✅ Relieve pain and discomfort
✅ Prevent complications (e.g., nerve damage, stiffness)
✅ Promote joint healing
✅ Restore joint mobility and function
✅ Educate the patient for rehabilitation and prevention
| Parameter | Assessment |
|---|---|
| 🔺 Pain | Use pain scale (0–10), location, quality |
| 🔄 ROM | Limited, painful, or absent movement |
| 🧊 Swelling | Localized edema and inflammation |
| 🧠 Neurovascular Status | Color, warmth, sensation, pulses, capillary refill, movement distal to injury |
| ⚙️ Deformity | Obvious joint displacement, abnormal shape |
| 🧾 History | Trauma, injury mechanism, past dislocations, comorbidities |
Some common nursing diagnoses for a patient with dislocation:
✅ Pain is managed (patient verbalizes relief)
✅ Joint function is gradually restored
✅ Neurovascular status remains intact
✅ No signs of infection or complications
✅ Patient demonstrates understanding of care and prevention
| Nursing Action | Rationale |
|---|---|
| Pain relief | Promote comfort and rest |
| Immobilization | Support healing and prevent further injury |
| Neurovascular checks | Detect early complications like ischemia |
| Physiotherapy | Restore strength and mobility |
| Education | Prevent recurrence and enhance self-care |
If not treated promptly and properly, dislocation can lead to several acute and long-term complications:
📝 Use these as a quick revision list or nursing highlights:
✅ Dislocation = complete displacement of joint surfaces
✅ Most common joints: shoulder, finger, hip, knee
✅ Immediate management = Immobilize ➕ Cold compress ➕ Pain control ➕ Hospital referral
✅ Closed reduction is the first line of treatment
✅ Post-reduction care includes immobilization and physical therapy
✅ Perform neurovascular assessments regularly
✅ Monitor for swelling, numbness, or deformity
✅ Patient education is crucial to prevent recurrence
✅ Early rehab = better outcomes and restored mobility
✅ Complications include nerve injury, AVN, recurrence, arthritis
(Definition & Causes)
A fracture is a break in the continuity of a bone due to trauma, stress, or a pathological process.
In simpler terms:
💥 Fracture = Cracked or broken bone
🧠 It may involve a complete or incomplete break and can affect bone shape, alignment, and function.
Fractures can result from external trauma or internal weakening of the bone.
🛑 Direct or Indirect Force applied to the bone
🦴 Bone breaks due to disease even with minor stress
🔁 Repeated stress over time causes tiny cracks in the bone
🧬 Bone deformities from birth or inherited diseases
🛠️ Bone fracture caused during surgical procedures, manipulations, or by incorrect use of orthopedic devices.
| Cause Type | Examples |
|---|---|
| Traumatic | Falls, RTA, sports injuries |
| Pathological | Osteoporosis, bone cancer, osteomyelitis |
| Stress/Fatigue | Repeated strain in athletes |
| Congenital/Genetic | Osteogenesis imperfecta, Rickets |
| Iatrogenic | Surgical error, medical mishandling |
(Based on pattern, skin, bone condition, and mechanism)
🦴 Break is horizontal across the bone shaft
📌 Caused by direct force
🦴 Break is angled across the bone
🔁 Caused by twisting with force
🦴 Break spirals around the bone
⚠️ Often due to rotational or twisting injury
🧠 May raise suspicion in child abuse
🦴 Bone is broken into 3 or more fragments
💥 High-impact trauma (e.g., crush injury)
🦴 Multiple fractures in the same bone with separate segments
🦴 Bone ends are driven into each other
⚠️ Common in falls from height (e.g., hip fracture)
🦴 Incomplete break where one side bends and the other breaks
🧒 Seen only in children (softer bones)
🦴 Bone is crushed or compressed
🔻 Common in vertebrae of osteoporotic patients
🦴 A tendon or ligament pulls off a piece of bone
🏃 Seen in athletes (e.g., ankle, knee)
🦴 Tiny, thin cracks due to repetitive strain
😣 Often missed on early X-rays
🎯 Common in tibia, metatarsals
| Fracture Type | Common Location |
|---|---|
| Colles’ fracture | Distal radius (wrist) – fall on outstretched hand |
| Smith’s fracture | Reverse of Colles’ – fall on flexed wrist |
| Pott’s fracture | Ankle fracture – malleoli of tibia/fibula |
| Supracondylar fracture | Above elbow – common in children |
| Intertrochanteric fracture | Between femoral trochanters – elderly falls |
| Femoral neck fracture | High-risk in osteoporosis – leads to hip replacement |
| Type | Description |
|---|---|
| Stable Fracture | Bone ends remain aligned – minimal displacement |
| Unstable Fracture | Bone ends are misaligned or displaced – higher risk of complications |
| Classification | Type | Example |
|---|---|---|
| By Skin | Closed / Open | Simple vs. Compound |
| By Pattern | Transverse, Oblique, Spiral, Comminuted | Direction of break |
| By Completeness | Complete / Incomplete | Greenstick (incomplete) |
| By Bone Condition | Pathological / Stress | Osteoporosis, athletes |
| By Special Site | Colles’, Pott’s, Femoral neck | Location-specific |
| By Mechanism | Impacted, Avulsion, Compression | Trauma-type |
Regardless of the type, all fractures follow a similar pathophysiological process after the break:
| Fracture Type | Key Pathophysiology |
|---|---|
| Transverse | Direct blow → clean horizontal break |
| Oblique | Angled force → diagonal fracture line |
| Spiral | Twisting force → spiral fracture, risk of soft tissue injury |
| Comminuted | High energy trauma → multiple fragments |
| Greenstick | Pediatric bending → incomplete break |
| Compression | Axial load crushes vertebrae |
| Avulsion | Tendon/ligament force → bone fragment pulled |
| Stress | Microtrauma over time → small crack |
| Open | Bone exposed through skin → infection risk |
| Pathological | Weak bone structure breaks with minimal trauma |
Fracture symptoms vary by location and severity but typically include pain, deformity, and loss of function.
| Symptom | Description |
|---|---|
| 🔺 Pain | Sudden, sharp, localized at the site of fracture; worsens with movement or pressure |
| 🔻 Swelling | Due to inflammation and bleeding in surrounding tissues |
| 🩸 Bruising (Ecchymosis) | Discoloration due to subcutaneous bleeding |
| 🦴 Deformity | Limb appears crooked, shortened, or misaligned |
| ✋ Tenderness | On palpation over the fractured area |
| ⚠️ Crepitus | Grating sound or sensation when bone ends rub together |
| 🚫 Loss of Function | Inability to move or bear weight on the affected part |
| ❄️ Coolness or Pallor | Sign of vascular compromise in severe fractures |
| ⚡ Numbness or Tingling | If nerve injury is associated with the fracture |
| 💢 Muscle Spasms | Reflex spasm around broken bone causing more pain |
⚠️ Open fractures will also have external wound and possible bone protrusion.
Proper diagnosis is essential for confirming the type, location, and extent of the fracture.
| Test | Purpose |
|---|---|
| 🩻 X-ray | ✅ First-line test |
| 🔍 Shows fracture line, displacement, alignment | |
| 🧲 MRI | ✅ Detailed soft tissue view |
| 📍 Detects occult/stress fractures, ligament injury | |
| 🧠 CT Scan | ✅ 3D view |
| 📐 Used for complex fractures (e.g., pelvis, spine, joints) | |
| 📊 Bone Scan | ✅ Detects hidden stress fractures or AVN |
| ☢️ Uses radioactive tracer | |
| 🔬 Ultrasound (Pediatrics) | ✅ Detects subtle fractures in children, especially around the hip or wrist |
Used when fracture is associated with disease or complication:
| Test | Indication |
|---|---|
| 🩸 CBC (Complete Blood Count) | Detects blood loss or infection |
| 🧪 ESR / CRP | Elevated in infection or inflammation (e.g., open fracture, osteomyelitis) |
| 🧬 Calcium, Phosphorus, ALP | Bone metabolism in pathological fractures |
| 💊 Vitamin D level | Checked in recurrent or spontaneous fractures |
| 🔍 Culture & Sensitivity | From open wound or pus if infection is suspected |
| Category | Findings |
|---|---|
| Signs & Symptoms | Pain, swelling, bruising, deformity, crepitus, loss of function |
| Emergency Signs | Absent pulses, numbness, cold limb, open wound |
| Diagnosis | X-ray (first-line), MRI/CT (for complex), bone scan (occult), labs (if infection/pathology suspected) |
✅ Relieve pain
✅ Restore bone alignment
✅ Promote bone healing
✅ Preserve joint function
✅ Prevent complications (infection, deformity, neurovascular compromise)
Medical (non-surgical) management is preferred when fractures are:
At the site of injury or ER:
| Action | Purpose |
|---|---|
| 🧊 Immobilize the affected part | Prevent further damage |
| 🩸 Control bleeding (if open fracture) | Minimize blood loss |
| ❌ Do NOT attempt realignment | Could damage nerves/vessels |
| 🚑 Transport carefully | To avoid worsening the injury |
| Medication | Purpose |
|---|---|
| 💊 Analgesics (e.g., Paracetamol) | Relieve mild to moderate pain |
| 💉 NSAIDs (e.g., Ibuprofen, Diclofenac) | Control inflammation and pain |
| 💊 Muscle Relaxants (e.g., Diazepam) | Reduce muscle spasms |
| 💊 Antibiotics | Prevent/treat infection in open fractures |
| 💉 Tetanus Toxoid | If wound is open or contaminated |
Used to maintain alignment and stability during healing.
| Method | Description |
|---|---|
| 🪢 Splints | Temporary immobilization (acute phase) |
| 🦵 Casts | Plaster or fiberglass to hold bone in place |
| 🛏️ Traction | Weights & pulleys to align bone gradually |
| 🧯 Braces/Slings | Support during recovery |
| 📏 Functional Cast Bracing | Allows partial movement during healing |
After healing or immobilization:
Surgery is needed when:
| Procedure | Purpose |
|---|---|
| 🧲 Open Reduction & Internal Fixation (ORIF) | Open surgical exposure of fracture and alignment using plates, screws, or rods |
| 📍 External Fixation | Pins placed through skin & bone connected by external frame – ideal for open or infected fractures |
| 🔩 Intramedullary Nailing | Metal rod inserted into medullary cavity of long bones (e.g., femur, tibia) |
| 🧱 Bone Grafting | Used when there’s bone loss or non-union |
| 🧼 Debridement & Wound Closure | For open fractures to remove debris and prevent infection |
| 🦿 Arthroplasty | Joint replacement in case of fracture with joint destruction (e.g., hip replacement in elderly femoral neck fracture) |
| Management Type | Key Interventions |
|---|---|
| Medical | Immobilization, medications, closed reduction, rest, rehab |
| Surgical | ORIF, external fixation, bone grafting, arthroplasty |
| Rehab | ROM, strengthening, assistive device training |
✅ Relieve pain
✅ Promote bone healing
✅ Prevent complications (e.g., infection, DVT, contractures)
✅ Restore mobility and function
✅ Provide patient education for recovery and self-care
Perform comprehensive initial and ongoing assessments:
| Component | What to Assess |
|---|---|
| 🩹 Pain | Location, intensity, duration, nature (sharp, dull) |
| 🦴 Deformity or Swelling | Compare both sides |
| ✋ Tenderness & Crepitus | On palpation |
| 🚫 ROM | Limited or absent due to pain |
| 🧠 Neurovascular Status | 6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pulselessness, Poikilothermia |
| 💉 Wound Site (if open fracture) | Signs of infection, drainage, wound care status |
| Goal | Expected Outcome |
|---|---|
| ✅ Pain relief | Patient reports decreased pain |
| ✅ Neurovascular integrity | Normal pulses, sensation, and movement maintained |
| ✅ Infection prevention | Wound heals without signs of infection |
| ✅ Mobility improvement | Patient performs ROM and ambulates with/without aid |
| ✅ Knowledge gained | Patient verbalizes cast care and follow-up instructions |
Fractures can lead to local and systemic complications, especially if not managed properly or timely.
| Complication | Description |
|---|---|
| ⚠️ Neurovascular Injury | Damage to surrounding nerves or blood vessels → numbness, tingling, pulseless limb |
| 💥 Compartment Syndrome | Increased pressure within muscle compartments → severe pain, pallor, paralysis (surgical emergency!) |
| 🩸 Hemorrhage/Shock | Excessive bleeding (especially in long bone fractures like femur or pelvis) |
| 🧫 Infection | Especially in open or compound fractures → may lead to osteomyelitis |
| ❌ Fat Embolism Syndrome | Fat globules enter bloodstream (common in femur fracture) → respiratory distress, petechiae, altered sensorium |
| 🧊 Venous Thromboembolism (VTE) | DVT or pulmonary embolism due to immobility |
| Complication | Description |
|---|---|
| 🦴 Delayed Union/Non-union | Fracture heals very slowly or not at all |
| 🔀 Malunion | Bone heals in wrong position causing deformity |
| 🔁 Joint Stiffness & Loss of Function | Especially if immobilization is prolonged |
| 🔄 Post-traumatic Arthritis | Cartilage damage leads to chronic joint pain and stiffness |
| 🧬 Avascular Necrosis (AVN) | Bone dies due to loss of blood supply (e.g., femoral head) |
| 🪛 Hardware-related issues | Loosening, breakage, or infection from plates/screws |
📝 Use these as high-yield summary points for quick recall:
✅ Fracture = break in bone continuity
✅ Causes: trauma, osteoporosis, tumors, stress, pathology
✅ Classified by skin involvement, pattern, location, stability
✅ Common symptoms: pain, swelling, deformity, crepitus, loss of function
✅ X-ray is first-line diagnostic tool
✅ Management includes immobilization, pain relief, reduction (closed/open), surgery
✅ Watch for neurovascular compromise – do frequent 6 P’s check
✅ Start early physiotherapy to prevent stiffness & restore mobility
✅ Monitor for signs of compartment syndrome, fat embolism, infection
✅ Patient education is crucial for cast care, mobility, diet, and follow-up
A sprain is a stretching or tearing of ligaments, which are the tough bands of fibrous tissue connecting bones to one another in a joint.
🧠 Ligaments = Bone to bone
Sprain = Injury to ligament (not muscle or bone)
| Cause | Description |
|---|---|
| 🤸♀️ Sudden twisting movement | Common in sports, falls, or awkward landings |
| 🕳️ Stepping on uneven surfaces | Ankle sprains common in outdoor activity |
| 🚶♂️ Overstretching of joint | During sudden impact or excessive load |
| 🧍♀️ Poor footwear or posture | Adds strain to joints |
| 🛠️ Accidents or trauma | Slips, trips, falls, vehicle accidents |
| Grade | Description | Symptoms |
|---|---|---|
| Grade I (Mild) | Slight stretching, microscopic tears | Mild pain, swelling, no instability |
| Grade II (Moderate) | Partial tearing of ligament | Moderate pain, swelling, bruising, some joint looseness |
| Grade III (Severe) | Complete tear of the ligament | Severe pain, instability, inability to bear weight |
🦶 Most common site:
| Symptom | Description |
|---|---|
| 🔺 Pain | At affected joint, especially on movement or pressure |
| 💢 Swelling | Due to inflammation and fluid accumulation |
| 💜 Bruising | Discoloration from internal bleeding |
| ❄️ Tenderness | Over the ligament or joint line |
| ⚠️ Instability | Feeling of “giving way” in joint (in moderate/severe sprain) |
| 🚫 Limited ROM | Due to pain or swelling |
| 🌡️ Warmth & Redness | Localized inflammation (in acute phase) |
| Test | Purpose |
|---|---|
| 🧑⚕️ Physical Exam | Check swelling, tenderness, joint stability, ROM |
| 🩻 X-ray | To rule out fractures |
| 🧲 MRI | Best for viewing ligament tears |
| 📸 Ultrasound | Can assess soft tissue injury dynamically |
| 🧠 Stress Tests | (e.g., anterior drawer for ankle sprain) assess ligament laxity |
| Component | Action |
|---|---|
| 🅁 = Rest | Avoid weight-bearing on affected joint |
| 🅄 = Ice | Apply 15–20 mins every 2–3 hours to reduce swelling |
| 🄲 = Compression | Elastic bandage or support wrap |
| 🄴 = Elevation | Keep injured area above heart level |
| Drug | Purpose |
|---|---|
| NSAIDs (Ibuprofen, Diclofenac) | Reduce pain & inflammation |
| Topical analgesics | For localized pain relief |
| Muscle relaxants | If spasms are present |
| Vitamin C, Zinc | Aid tissue repair |
Usually not required for mild/moderate sprains. Indicated in:
✅ Grade III (complete ligament tear)
✅ Recurrent sprains with chronic instability
✅ Failure of conservative management
| Intervention | Rationale |
|---|---|
| Elevate limb | Reduces swelling |
| Apply cold packs | Decrease pain & inflammation |
| Administer analgesics | Relieves discomfort |
| Educate on RICE protocol | Promotes healing |
| Support with splint/bracing | Prevents further injury |
| Teach ROM exercises (after 48–72 hrs) | Prevents stiffness |
| Encourage safe ambulation | Prevent falls |
| Explain signs of complications | Empower early reporting |
| Complication | Description |
|---|---|
| 🔁 Chronic Joint Instability | From repeated or severe sprains |
| 🧊 Stiffness & Reduced ROM | Due to prolonged immobilization |
| 🧫 Ligamentous Calcification | Abnormal healing or poor blood supply |
| 😖 Persistent Pain or Swelling | From poor healing or unrecognized complete tear |
| ⚠️ Associated injuries | Meniscus tear (knee), tendon strain, fractures |
✅ Sprain = ligament injury (vs. strain = muscle/tendon injury)
✅ Common in ankle, wrist, knee
✅ Graded I–III based on severity
✅ RICE + NSAIDs = first-line treatment
✅ Severe cases may need surgery or prolonged rehab
✅ Always assess for fracture or neurovascular issues
✅ Teach joint protection and exercises post-recovery
A strain is the overstretching or tearing of a muscle or tendon (which connects muscle to bone), typically caused by excessive force, overuse, or improper movement.
🧠 Strain = Muscle or tendon injury
(Remember: Strain = Soft tissue like muscle)
| Cause | Description |
|---|---|
| 🏃♂️ Overuse | Repeated movement (e.g., lifting, sports, running) |
| ⚡ Sudden force or overstretching | Quick acceleration/deceleration |
| ❌ Improper lifting technique | Heavy weights without warm-up |
| 😣 Muscle fatigue | Weak or tired muscles are prone to injury |
| 🛠️ Trauma | Direct impact or fall |
| Grade | Description | Symptoms |
|---|---|---|
| Grade I (Mild) | Slight overstretching, small tears | Mild pain, tenderness, no weakness |
| Grade II (Moderate) | Partial muscle or tendon tear | Moderate pain, swelling, weakness |
| Grade III (Severe) | Complete tear of muscle/tendon | Severe pain, swelling, loss of function, visible deformity |
🧍 Common Sites:
| Symptom | Description |
|---|---|
| 🔺 Pain | At the injured muscle or tendon, especially during use |
| 💢 Swelling | Due to inflammation |
| 💜 Bruising | May appear if blood vessels are torn |
| 😖 Tenderness | On palpation |
| 🚫 Muscle weakness | Inability to contract muscle effectively |
| ⚠️ Muscle spasm or cramping | Protective response |
| 🤕 Limited motion | Due to pain and stiffness |
| 🧱 Visible deformity | If complete tear or large hematoma |
| Test | Purpose |
|---|---|
| 👨⚕️ Physical exam | Assess swelling, pain, ROM, strength |
| 🩻 X-ray | Rule out fracture (especially in severe cases) |
| 🧲 MRI | Best for viewing muscle/tendon tears |
| 📸 Ultrasound | Dynamic view of soft tissues |
| Drug | Purpose |
|---|---|
| NSAIDs | Reduce pain and inflammation |
| Topical analgesics | Temporary pain relief |
| Muscle relaxants | Reduce spasm and stiffness |
| Vitamin C, protein supplements | Aid tissue healing |
Surgery is rare, but may be required if:
🔧 Surgical Procedures:
| Intervention | Rationale |
|---|---|
| Apply ice packs | Reduce swelling and pain |
| Elevate limb | Promote venous return |
| Administer prescribed meds | Pain and inflammation relief |
| Encourage gentle ROM exercises (after acute phase) | Prevent stiffness |
| Educate on proper posture and lifting | Prevent recurrence |
| Provide assistive devices if needed | Ensure mobility and safety |
| Complication | Description |
|---|---|
| 🔁 Recurrent strain | Especially if not rested adequately |
| 🧱 Chronic muscle weakness or tightness | Due to improper healing |
| 🧬 Scar tissue formation | Reduces flexibility |
| ❌ Complete rupture | If strain is ignored or worsens |
| ⌛ Delayed healing | In diabetics, elderly, or athletes under pressure |
✅ Strain = muscle or tendon injury (vs sprain = ligament)
✅ Caused by overuse, sudden force, or poor technique
✅ Common in back, hamstring, calf
✅ Follows Grade I–III classification
✅ RICE + NSAIDs are the first line of care
✅ Strengthening & flexibility exercises prevent recurrence
✅ Warm-up before activity is essential
✅ Watch for signs of complete rupture or chronic strain
A contusion is a soft tissue injury caused by blunt force trauma that results in bleeding under the skin without breaking the skin’s surface. This leads to pain, swelling, and discoloration (bruise).
🧠 “Contusion” = internal bleeding within skin, muscle, or soft tissue
Also called a bruise
| Cause | Description |
|---|---|
| 🤕 Blunt trauma | Direct hit from object, punch, fall, sports injury |
| 🛠️ Accidental impact | Bumping into hard surfaces or equipment |
| 🏀 Sports injuries | Collisions in contact sports (football, boxing) |
| 🚗 Motor vehicle accidents | Seatbelt or steering wheel trauma |
| 💊 Bleeding disorders or anticoagulants | Increased risk of easy bruising and severe contusions |
| Type | Description |
|---|---|
| Skin contusion (superficial) | Bleeding under skin, commonly known as a bruise |
| Muscle contusion (deep tissue) | Injury to underlying muscle fibers; common in athletes |
| Bone contusion (bone bruise) | Micro-trauma to bone without fracture, seen on MRI |
| Organ contusion | Internal injury to organs like liver, kidney, or brain (e.g., cerebral contusion) – life-threatening |
| Symptom | Description |
|---|---|
| 🔴 Red or purplish skin discoloration | Early stage of bruise |
| 💜 Blue/black patch | Mid-stage contusion (2–4 days) |
| 💛 Yellow-green fading color | Healing stage |
| 💢 Pain or tenderness | At the site of impact |
| 💧 Swelling | Due to inflammation and tissue damage |
| ⚠️ Stiffness or limited movement | If near joint or muscle |
| 😖 Hematoma or lump | Large contusions may form a firm swelling of clotted blood |
| Test | Purpose |
|---|---|
| 👁️ Physical Examination | Observe skin color, swelling, tenderness |
| 🧲 MRI | Detect deep tissue or bone contusions |
| 🧫 CBC | Rule out bleeding disorders or anemia |
| 💉 Coagulation profile (PT, aPTT) | Especially if bruising is recurrent or unexplained |
| 📸 X-ray/CT | Rule out associated fractures or organ damage (in high-impact trauma) |
| R | Rest – Avoid using the injured part |
|---|---|
| I | Ice – 15–20 minutes every 2–3 hours |
| C | Compression – With elastic bandage |
| E | Elevation – To reduce swelling & bleeding |
| Drug | Purpose |
|---|---|
| NSAIDs (e.g., Ibuprofen) | Pain relief and anti-inflammatory |
| Topical analgesics | For minor contusions |
| Muscle relaxants | For associated spasms (muscle contusions) |
| Vitamin K or platelet therapy | In bleeding disorders |
| Antibiotics | If secondary infection develops (rare) |
Surgery is rarely needed, but may be indicated in:
| Condition | Surgical Option |
|---|---|
| Large hematoma | Incision & drainage |
| Organ contusion (e.g., liver, spleen) | Emergency surgery to stop internal bleeding |
| Cerebral contusion with edema | Craniotomy or decompression |
| Compartment syndrome | Fasciotomy (surgical decompression) |
| Intervention | Rationale |
|---|---|
| Apply ice packs (first 48 hrs) | Reduces inflammation and pain |
| Elevate affected limb | Promotes venous return and reduces edema |
| Administer NSAIDs as prescribed | Pain and inflammation control |
| Monitor skin color progression | To evaluate healing |
| Educate on avoiding further trauma | Prevent recurrence |
| Encourage gentle ROM exercises | Restore function in affected limb |
| Report unexplained or frequent bruising | May indicate systemic disorder |
| Complication | Description |
|---|---|
| 🩸 Large hematoma | Can cause pressure, pain, and deformity |
| 💥 Compartment syndrome | Increased pressure in muscle compartments, cutting off circulation |
| 🧠 Cerebral edema | In head contusions – may lead to brain herniation |
| 🧫 Secondary infection | Rare, but can occur in deep or untreated contusions |
| 🧬 Tissue fibrosis | From chronic or improperly healed contusions |
✅ Contusion = soft tissue bruise due to blunt trauma
✅ Types include skin, muscle, bone, and organ contusions
✅ Follows RICE + NSAIDs for most cases
✅ Monitor for hematoma, neurovascular changes, or compartment syndrome
✅ Color change in bruise = normal healing process
✅ Deep contusions may mimic more serious injuries → always assess properly
✅ Prevention: protective gear, safe movement, fall prevention
Amputation is the surgical or traumatic removal of all or part of a limb, extremity, or body part such as an arm, leg, finger, toe, hand, or foot.
🧠 It may be performed to save life, prevent the spread of infection/gangrene, or remove a nonviable part.
Amputations may be surgical (planned) or traumatic (accidental).
| Cause | Description |
|---|---|
| ⚠️ Peripheral Vascular Disease (PVD) | Poor circulation leads to tissue death (esp. in diabetics) |
| 🤒 Diabetes Mellitus | Causes neuropathy and ischemia → foot ulcers → gangrene |
| 🧫 Infection | Chronic osteomyelitis or sepsis unresponsive to antibiotics |
| 🔥 Malignancy | Bone or soft tissue tumors (e.g., osteosarcoma) requiring radical excision |
| 🧬 Congenital Deformities | Nonfunctional or malformed limbs |
| Cause | Description |
|---|---|
| 🚗 Road traffic accidents | High-impact injuries with irreparable damage |
| 🛠️ Industrial or agricultural accidents | Machinery or heavy equipment trauma |
| 🔫 War or blast injuries | Landmines, gunshots, or explosions |
| 🐍 Severe animal or snake bites | Leading to necrosis or infection |
Amputations can be classified based on level, site, and urgency:
| Type | Description |
|---|---|
| 🦶 Toe/Finger Amputation | Common in diabetic foot or frostbite |
| 🦵 Below-Knee Amputation (BKA) | Retains knee joint; easier rehabilitation |
| 🦿 Above-Knee Amputation (AKA) | More disabling; prosthetic fitting is more complex |
| ✋ Below-Elbow Amputation (BEA) | Preserves elbow function |
| 💪 Above-Elbow Amputation (AEA) | Complete arm loss up to shoulder |
| 🧍♂️ Disarticulation | Amputation through a joint (e.g., hip or shoulder disarticulation) |
| 🦴 Hemipelvectomy | Removal of entire leg + part of pelvis |
| 💀 Facial/Organ Amputation | Rare, includes eye enucleation, breast mastectomy (sometimes categorized as amputations in extended sense) |
| Type | Description |
|---|---|
| ⏱️ Emergency Amputation | Performed to save life (e.g., gangrene, crush injury with infection) |
| 🗓️ Elective Amputation | Planned and scheduled; often for chronic conditions (e.g., cancer, PVD) |
| Method | Description |
|---|---|
| ✂️ Open (Guillotine) Amputation | Done rapidly without skin closure (infection or emergency); later followed by closure |
| 🧵 Closed (Flap) Amputation | Performed with skin flap creation and primary wound closure |
| Classification | Types |
|---|---|
| By site | Toe, foot, BKA, AKA, upper limb |
| By urgency | Emergency, Elective |
| By method | Open (Guillotine), Closed (Flap) |
| By cause | Surgical (disease/infection), Traumatic (accident/injury) |
Amputation is the removal of a part of the body, typically due to irreversible tissue damage, ischemia, trauma, or infection. Whether surgical or traumatic, the physiological process involves the following steps:
| Symptom | Cause |
|---|---|
| ❌ Non-healing wound or ulcer | Common in diabetics/PVD patients |
| 🖤 Gangrene or necrosis | Dead, blackened tissue |
| 😷 Severe infection (e.g., osteomyelitis) | Not responding to treatment |
| ⚠️ Uncontrolled pain | In ischemic limb |
| 💢 Loss of function or sensation | From irreversible nerve/muscle damage |
| 🧊 Cold, pulseless extremity | Poor circulation (ischemia) |
| Symptom | Description |
|---|---|
| 🔺 Postoperative pain | Due to surgical trauma and healing |
| 🧠 Phantom limb sensations | Feeling the presence of removed limb (normal, may or may not be painful) |
| 😖 Stump swelling, redness | Normal inflammatory response |
| 🩸 Drainage from surgical site | Should decrease over time |
| 🦿 Mobility limitations | Requires rehab and prosthetic fitting |
| 😔 Emotional disturbance | Body image issues, grief, anxiety, depression common |
Used to evaluate the need for amputation and plan surgical site.
| Test | Purpose |
|---|---|
| 🩸 CBC | Detects infection (↑WBC) or anemia |
| 💉 Blood glucose, HbA1c | Uncontrolled diabetes is a major risk factor |
| 🧪 Coagulation profile (PT, INR, aPTT) | Especially important before surgery |
| 🧫 Wound culture | Identifies infecting organisms in ulcers or gangrene |
| 🧪 Serum creatinine/urea | Kidney function if sepsis or diabetic nephropathy present |
| Imaging | Purpose |
|---|---|
| 🧲 Doppler Ultrasound | Assesses blood flow to the limb |
| 🧠 Arteriography/Angiography | Shows vascular occlusion or stenosis |
| 🧱 X-ray | Identifies bone destruction or gas gangrene |
| 🧠 MRI/CT Scan | Determines extent of soft tissue and bone involvement |
| 📸 Bone Scan | Detects osteomyelitis or bone death |
| Aspect | Key Points |
|---|---|
| Pathophysiology | Tissue necrosis due to ischemia/infection → removal prevents systemic spread |
| Pre-op Symptoms | Gangrene, non-healing ulcer, infection, loss of function |
| Post-op Symptoms | Pain, swelling, phantom limb sensation, mobility issues |
| Diagnosis | Labs for infection/metabolism, imaging for vascular & bone status |
(Pre-operative and Post-operative supportive care)
Medical management focuses on preparing the patient, treating the underlying condition, and supporting recovery post-amputation.
| Intervention | Purpose |
|---|---|
| 💉 Control of underlying disease | – Diabetes: insulin, oral hypoglycemics |
| Care Component | Description |
|---|---|
| 💊 Pain control | Opioids, NSAIDs, PCA pumps as needed |
| 🧠 Phantom limb pain management | Gabapentin, antidepressants, mirror therapy, TENS |
| 💧 Fluid and electrolyte balance | Monitor I&O, hydration |
| 🧫 Infection prevention | Continue IV/oral antibiotics as needed |
| 🩹 Wound care | Monitor for drainage, infection, and healing progress |
| 🍽️ Nutritional support | High-protein, vitamin C & zinc-rich diet for wound healing |
| 🧍 Rehabilitation referral | For physiotherapy and prosthetic planning |
Surgical management of amputation involves the removal of non-viable tissue and preparation of the stump for future prosthetic fitting or healing.
| Type | Description |
|---|---|
| ✂️ Open (Guillotine) Amputation | – Skin is left open |
| Procedure | Purpose |
|---|---|
| 🔩 Blood vessel ligation | Prevent bleeding |
| ✂️ Nerve retraction/trimming | Prevent painful neuroma formation |
| 🧵 Muscle shaping (myoplasty or myodesis) | Anchor muscles to allow mobility and shape |
| 🔧 Bone beveling | Smooth edges of the cut bone to prevent sharp edges or stump pain |
| 🧼 Drain placement | Prevent accumulation of fluid or hematoma |
| Procedure | Indication |
|---|---|
| 🦿 Below-Knee Amputation (BKA) | Most common; preserves knee for mobility |
| 🦵 Above-Knee Amputation (AKA) | Used when tissue damage extends above knee |
| 💪 Upper limb amputations | Less common; used in trauma, tumors |
| 🔄 Disarticulations | Through-joint removal (e.g., hip, shoulder) |
| 🦴 Hemipelvectomy / Forequarter amputation | Radical surgeries for malignancies |
| Management Type | Key Interventions |
|---|---|
| Medical (Pre-op) | Manage diabetes, infection, pain, nutrition, counseling |
| Medical (Post-op) | Pain control, wound care, fluid balance, rehab |
| Surgical (Open/Closed) | Remove diseased tissue, shape stump, prevent complications |
✅ Prevent infection and complications
✅ Promote wound healing
✅ Relieve pain, including phantom limb pain
✅ Restore mobility and independence
✅ Support psychological adjustment
✅ Educate for self-care and rehabilitation
Perform both pre-operative and post-operative assessments:
| Focus Area | Assessment |
|---|---|
| 🔢 Vitals | Monitor BP, HR, temperature (signs of infection or shock) |
| 🧫 Wound/infection status | Gangrene, ulcers, discharge, odor |
| 🔋 Nutritional status | Protein, vitamin levels, albumin |
| 🧠 Emotional response | Anxiety, denial, depression |
| 💊 Comorbidities | Diabetes, PVD, renal function, cardiovascular risk |
| Parameter | Description |
|---|---|
| 👁️ Stump | Inspect for bleeding, swelling, drainage, dressing condition |
| 🩸 Neurovascular check | Check circulation and sensation in remaining limb |
| 🧠 Phantom limb sensation/pain | Assess for burning, tingling, or pain in missing limb |
| 💢 Pain | Type, location, severity (surgical vs phantom) |
| 🧑🦯 Mobility | Ability to sit, stand, transfer, and use assistive devices |
| 🧠 Mental health | Grief reaction, body image disturbance, coping mechanisms |
| Goal | Expected Outcome |
|---|---|
| ✅ Pain Relief | Patient reports manageable or no pain |
| ✅ Wound Healing | Stump heals without signs of infection |
| ✅ Improved Mobility | Patient ambulates with assistive device or prosthesis |
| ✅ Body Image Acceptance | Patient participates in care, accepts self-image |
| ✅ Emotional Recovery | Patient expresses feelings and demonstrates coping |
| ✅ Independence | Performs ADLs with/without assistance |
✔️ Always perform neurovascular checks on the remaining limb
✔️ Early rehabilitation = better long-term outcomes
✔️ Phantom limb pain is real – validate and manage it
✔️ Holistic care includes emotional, physical, and educational support
✔️ Encourage positive reinforcement and patient empowerment
Complications can be physical, psychological, or prosthetic-related, and may occur early (acute) or late (chronic).
| Complication | Description |
|---|---|
| 🩸 Hemorrhage | Bleeding from surgical site or major vessel |
| 🧫 Infection | Common in open wounds or diabetic patients |
| 💥 Wound Dehiscence | Surgical site reopens due to poor healing or tension |
| 🔥 Hematoma | Accumulation of blood under the flap or stump |
| 🧠 Phantom Limb Pain (PLP) | Painful sensation in the missing limb; can be sharp, burning, or cramping |
| ⚠️ Stump Edema | Swelling due to inflammation or improper positioning |
| 💧 Shock | From blood loss or sepsis (especially in trauma cases) |
| Complication | Description |
|---|---|
| 🔁 Phantom Limb Sensation | Non-painful sensation of the missing limb (normal, not harmful) |
| ❌ Chronic Stump Pain | Due to neuroma formation or scar tissue |
| 🧬 Neuroma | Painful nerve-end growth at stump site |
| 💢 Contractures | Muscle shortening due to poor positioning or lack of mobility (e.g., hip/knee flexion contracture) |
| 🧼 Prosthetic Complications | Poor fit, skin irritation, breakdown, pressure sores |
| 😞 Psychological Issues | Depression, anxiety, PTSD, body image disturbance |
| ⚖️ Imbalance/Decreased Mobility | Leads to falls, pressure injuries, and deconditioning |
🧠 Use these high-yield points for clinical practice and quick exam revision:
✅ Amputation = removal of part or whole limb due to infection, trauma, ischemia, or malignancy
✅ Common indications: PVD, diabetes, osteomyelitis, trauma
✅ BKA (Below Knee Amputation) has better rehab outcomes than AKA (Above Knee)
✅ Open (guillotine) amputation is for infection/emergency; closed (flap) is planned/elective
✅ Monitor for phantom limb pain and neuroma – treat with meds, mirror therapy, or TENS
✅ Post-op care includes stump positioning, compression, ROM exercises, and wound inspection
✅ Start early rehabilitation with physiotherapy and prosthetic consultation
✅ Provide emotional support and counseling to address grief and altered body image
✅ Long-term success depends on nutritional support, infection control, education, and rehab
✅ Nurses play a vital role in promoting stump care, mobility, psychological support, and independence.
Musculoskeletal infections refer to infections involving the bones, joints, muscles, or surrounding soft tissues. These infections may be acute or chronic, and they can be localized or spread systemically.
🧠 Commonly affected areas: bones (osteomyelitis), joints (septic arthritis), muscles (pyomyositis), and soft tissues (cellulitis, abscesses).
| Type | Description |
|---|---|
| Osteomyelitis | Infection of the bone and bone marrow (acute or chronic) |
| Septic Arthritis | Infection of the synovial joint space, often rapid and destructive |
| Pyomyositis | Suppurative bacterial infection of skeletal muscles |
| Tenosynovitis | Inflammation of tendon sheath due to infection |
| Bursitis | Infected bursa (fluid-filled sacs near joints) |
| Necrotizing Fasciitis | Rapidly spreading infection of muscle fascia and soft tissue (life-threatening) |
| Organism | Example of Conditions |
|---|---|
| Bacteria (most common) | Staphylococcus aureus (most common), Streptococcus, Pseudomonas, Mycobacterium tuberculosis |
| Viruses | Hepatitis, HIV-related arthropathy |
| Fungi | Candida, Aspergillus (immunocompromised patients) |
| Mycobacteria | Tuberculous osteomyelitis or TB arthritis |
| Site | Symptoms |
|---|---|
| Bone (Osteomyelitis) | Deep, dull pain, tenderness, swelling, erythema, reduced ROM |
| Joint (Septic Arthritis) | Red, swollen, warm joint, intense pain, inability to move joint |
| Muscle (Pyomyositis) | Muscle tenderness, firm mass, warmth, difficulty in movement |
| Soft Tissue | Redness, warmth, swelling, sometimes pus or open wound |
| Test | Purpose |
|---|---|
| 🔬 CBC | ↑ WBC count (infection indicator) |
| 🧪 CRP, ESR | Elevated in inflammation |
| 🧫 Blood cultures | Identify causative organism |
| 💉 Joint aspiration / Wound culture | Direct sample of infected site |
| 🔬 Procalcitonin | Marker of bacterial infection |
| 🧪 TB test (Mantoux, GeneXpert) | If tubercular infection suspected |
| Test | Use |
|---|---|
| 🩻 X-ray | Bone destruction or sequestrum in chronic osteomyelitis |
| 🧲 MRI | Soft tissue, early infection, joint effusion |
| 🧠 CT Scan | Abscess location, bony involvement |
| 🧪 Bone Scan (Radionuclide) | Detects early osteomyelitis |
| 📸 Ultrasound | Joint effusion or soft tissue abscesses |
Common antibiotics used:
| Procedure | Indication |
|---|---|
| Surgical debridement | Removal of necrotic tissue or abscess |
| Incision & drainage | Large abscesses or purulent joints |
| Bone drilling / resection | In chronic osteomyelitis |
| Arthrotomy | Joint washout in septic arthritis |
| Amputation | Severe, life-threatening infection unresponsive to treatment |
| Implant removal | If prosthetic joint or hardware is infected |
| Complication | Description |
|---|---|
| 🦴 Chronic osteomyelitis | Persistent bone infection requiring surgery |
| 🛏️ Septicemia | Systemic infection (life-threatening) |
| 🔁 Joint destruction/deformity | In septic arthritis |
| 🧬 Pathological fracture | Weakened bone breaks |
| 🚑 Amputation | If severe or unmanageable |
| 😔 Functional disability | Limited mobility or joint function |
| 💊 Antibiotic resistance | Due to incomplete treatment or inappropriate use |
✅ Musculoskeletal infections can affect bones, joints, or muscles
✅ Most are bacterial, especially Staph aureus
✅ Early symptoms include pain, swelling, fever, limited movement
✅ Diagnosis via labs + imaging + cultures
✅ Management includes long-term antibiotics ± surgery
✅ Nurses play a key role in medication adherence, wound care, and rehabilitation
✅ Prompt diagnosis and aggressive treatment are critical to prevent permanent damage or systemic spread
Osteomyelitis is a serious infection of the bone and bone marrow, most commonly caused by bacteria (especially Staphylococcus aureus), but also by fungi or mycobacteria. It leads to inflammation, pus formation, bone destruction, and, if untreated, can cause permanent bone damage or systemic infection.
🧠 Osteo = bone, Myelo = marrow, Itis = inflammation
Osteomyelitis = infection and inflammation of bone + marrow
Osteomyelitis occurs when infectious organisms reach the bone through one of the following routes:
| Risk Factor | Mechanism |
|---|---|
| 😷 Diabetes mellitus | Poor wound healing, neuropathy, and increased infection risk |
| 🚬 Peripheral vascular disease (PVD) | Reduced blood flow to bone |
| 🔬 Immunosuppression (e.g., HIV, chemotherapy) | Decreased ability to fight infection |
| ⚙️ Presence of foreign body (e.g., joint prosthesis) | Surface for bacteria to colonize |
| 🧒 Sickle cell disease | Predisposes to Salmonella osteomyelitis |
| Type | Description |
|---|---|
| Acute Osteomyelitis | – Develops quickly (within 2 weeks of infection) |
| Type | Description |
|---|---|
| Hematogenous | Infection spread through blood — common in children |
| Contiguous-focus | Spread from nearby infected tissue (e.g., ulcers, trauma) — common in adults |
| Direct Inoculation | Post-surgical, penetrating injury, or open fracture |
| Type | Description |
|---|---|
| Vertebral Osteomyelitis | Common in adults; often hematogenous; causes back pain, fever |
| Diabetic Foot Osteomyelitis | Seen in long-standing diabetics with foot ulcers |
| Prosthetic Joint Infection | Infection around an implanted joint; may require removal of prosthesis |
| Tuberculous Osteomyelitis | Caused by Mycobacterium tuberculosis, often affects spine (Pott’s disease) |
| Classification | Examples |
|---|---|
| By duration | Acute, Chronic |
| By spread | Hematogenous, Contiguous, Direct inoculation |
| By site | Vertebrae, long bones, diabetic foot |
| By organism | Bacterial (Staph, Salmonella), TB, Fungal |