Injuries of the skeletal system

Injuries of the skeletal systemThe most common afflictions of the skeletal system are those induced by injury. In modern times injuries are encountered at an ever-increas­ing rate. Many councils and organizations direct their purpose at the prevention of injuries and have had remarkable success toward this goal. Still injuries are all too prevalent.

In many instances injuries of the skeletal sys­tem are multiple and associated with injuries of other systems. For the purpose of this post, injuries of this system may be divided into frac­tures, dislocations, and sprains.

Dislocations

Dislocation is a displacement of a bone from its normal relationship at a joint. With injury a bone is pulled or twisted out of its socket or other attachment to another bone. Dislocations are classified as closed or simple when the joint is not penetrated or open to the surface. The compound dislocation is one in which the joint is exposed to the surface by a break in the sur­rounding soft tissues. Dislocations are referred to as complete when there is total displacement of the gliding surfaces of the two opposed bones. Incomplete or partial dislocation is one wherein there still remains some contact of the bones’ joint ends.

The characteristics of a dislocation are also designated by the abnormal position the dis­placed bone takes in relationship to the joint, such as anterior (in front of) and posterior (be­hind) dislocation, etc. Dislocations which have fractures associated are termed fracture-dislo- cation. Dislocations which occur of the same joint on repeated occasions due to weakened joint ligaments are known as recurrent dislo­cations.

Diagnosis of dislocation may be quite appar­ent by the obvious external deformed contour of the region. In other instances, examination by feeling of the area may suggest dislocation. In all, however, the diagnosis must be ascer­tained by x-ray picture to determine whether there is associated fracture. An x-ray picture is also taken after reduction of dislocations to assure total replacement of the dislodged bone.

In general, the treatment of dislocations rests with reduction of the joint back into its normal position and immobilizing the joint for sufficient time for the ligaments around it to heal. Vary­ing times of immobilization are necessary for different joints. The joints are held in their posi­tion of optimal function. Maintenance of the joint in its corrected normal position is accom­plished by many different methods. Adhesive tape, strapping, splints, slings and harnesses, and bandages are employed. In some instances, plas­ter of paris casts are necessary. Bed rest is re­quired for some.

Open operation for dislocations is not com­monly indicated. In certain recurrent disloca­tions, however, such as at the outer end of the clavicle, closed methods may not be successful in restoring a stable joint. In such instances, re­pair of the ligaments and/or wiring of a joint may be necessary. In severe disabling recurrent dislocations of an important joint (the knee, for example), operation for joint fusion may be indicated.

Sprains

A sprain is a minor tear in the ligaments about a joint, caused by forceful movement of the joint beyond its normal range of motion so that the fibers of the ligaments are stretched and torn. Sprain may occur to any joint. Most com­mon is sprain of the finger joints; sprained ankle is the next in frequency; knee sprains are not uncommon. Treatment entails supporting the joint at rest, preferably with the joint bent toward the side of the injured ligaments. Ad­hesive tape, splints, slings and harnesses, and bandages are used. Casts sometimes are needed. Physical therapy may be indicated. Open opera­tion may be required in severe tearing of im­portant ligaments for their repair. In a few in­stances of “chronic sprain” where the ligaments are loosened, with an unstable joint, open sur­gery may benefit. The sacro-iliac joint, in the low back region where the spine joins the pelvis, is prone to instability, especially after it has once been injured. Treatment is most often by medical and physical therapy methods, but on occasion open operation to fuse this joint may be beneficial for stabilizing it.

Open Wounds

Open wounds of joints may be caused by lacerations, penetrating objects, or blunt forces. When a joint is open to the surface, the likeli­hood of infection in the joint is great. Treatment is by debridement of all the contaminated and dead tissue from the wound and its surgical re­construction. This should be done as soon as possible and all measures taken to prevent in­fection.

Hemarthrosis

Hemarthrosis (blood-joint) is a condition of blood within a joint. It may be from injury or following surgery of a joint. In some instances the blood must be withdrawn.

 

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