ABNORMALITIES OF

BONES AND JOINTS

SURGERY – GROUP NINE
Group Members
General objective
• At the end of the lesson, learners should be able
to demonstrate an understanding in sprains and
dislocations.
Specific objectives
• At the end of the lecture, student nurses should be
able to;
1. Define a sprain and dislocation
2. Describe the causes and risk factors of sprains and
dislocations
3. State the diagnosis of sprains and dislocations
4. Describe the management of sprains and dislocations
SPRAINS
INTRODUCTION
• sprains can occur to anyone: athletes, dancers
etc. All it takes is one clumsy step, an unseen
hole in the ground or an awkward sideways
movement to have a sprain.
 DEFINITION
• A sprain is the stretching or tearing of a
ligament. Ligaments are the fibrous bands of
tissue that connect two or more bones at a
joint and prevent excessive movement of the
joint. The most common location for a sprain
is in ankle and knee.
 CAUSES
• A sprain occurs when you overextend or tear a
ligament while severely stressing a joint. Sprains
often occur in the following circumstances:
• Ankle — Walking or exercising on an uneven
surface, landing awkwardly from a jump
• Knee — Pivoting during an athletic activity
 CONT…
• Wrist — Landing on an outstretched hand during a fall
• Thumb — Skiing injury or overextension when playing
racquet sports, such as tennis
• Children have areas of softer tissue, called growth
plates, near the ends of their bones. The ligaments
around a joint are often stronger than these growth
plates, so children are more likely to experience a
fracture than a sprain.
 RISK FACTORS
•Factors contributing to sprains include:
•Environmental conditions. 
Slippery or uneven surfaces can make you more prone to
injury.
•Fatigue. 
Tired muscles are less likely to provide good support for
your joints. When you're tired, you're also more likely to
succumb to forces that could stress a joint.
 CONT…
• Poor equipment. 
Ill-fitting or poorly maintained footwear or other
sporting equipment can contribute to your risk of
a sprain.
 TYPES OF SPRAINS
• First degree: the ankle’s ligaments have
stretched too far but have not torn. Symptoms
might include:
• Mild pain and swelling
• Limited joint stiffness and instability
• Uncomfortable jogging or jumping
 CONT…
• Second degree: This is the most common type of
sprain and results in a partial tear of the ligament.
Symptoms can include:
• Lots of swelling and bruising
• Moderate pain
• Loss of motion or use of your ankle
• Difficulty walking
 CONT…
• Third degree: Is the most severe type of sprain,
the ligament has been completely torn.
Symptoms are:
• Severe swelling and pain
• Instability of the joint
• Extreme loss of motion
• Significant pain while walking
 INVESTIGATIONS
• medical history—including a review of the
symptoms and how the injury occurred.
• physical examination.
• In cases of more severe sprains, especially when
there is weakness or loss of function, an X-ray
may be taken to rule out a fracture as the cause
of pain.
 MANAGEMENT
• Medical treatment
• Non steroidal anti-inflammatory drugs (such as
ibuprofen) may be given to manage pain during
the healing process.
 CONT…
• Ice packs
• Ice packs can help minimize swelling around the
injury. To properly ice an injury, it's usually
recommended that the ice is applied for no
longer than 15 minutes, and no more frequently
than once per hour. Applying ice for too long, or
too often, may actually cause problems.
 CONT…
• Heating pad
• Heating pads may be helpful to help relax and
loosen tissues, and to stimulate blood flow to
the area.
 CONT…
• Wrist Support
• A wrist splint may help support an injured
wrist.
• Support braces can help people who have
either had a recent wrist sprain injury or
those who tend to injure their wrists easily.
 CONT…
• Wrist braces function by providing gentle
support for wrist movements. They will not
prevent severe injuries, but may help to perform
simple activities while rehabilitating from a wrist
sprain.
 CONT…
• Ankle Brace
• Ankle braces act in a similar manner to the wrist
supports mentioned above. it's important to
maintain an ankle exercise routine to prevent
dependence on the brace.
 CONT…
• Compression Bandages
• Applying compression is most helpful in the very
early stages to prevent excessive fluid
accumulation, but can also help to squeeze out
excess fluid accumulation in the soft-tissues. It's
important to make sure the compression
dressing is not to tight as to cut off circulation.
 CONT…
• In addition, compression dressings around the
knee should be fairly loose to reduce the risk of
developing blood clots, a sometimes very serious
complication.
 CONT…
• Rest and Elevation
• In addition to ice and compression, rest and elevation
is an important part of treating an acute sprain or
strain.
• Rest – to avoid movement of the injured area and
avoid participation in activities where you may be at
risk to re-injure yourself until after the wound had
had plenty of time to heal.
 CONT…
• Elevation – If possible raise the injured limb up
above the heart. Support the elevated limb in a
sling or under a pillow or folded blanket to help
prevent or limit swelling.
DISLOCATIONS
 DEFINITION
• Is an injury to a joint in which the normally
adjacent joint surfaces become completely
separated from one another.
• A dislocation occurs when extreme force is put on a
ligament, allowing the ends of 2 connected bones
to separate. Ligaments are flexible bands of fibrous
tissue that connect various bones and cartilage.
 CONT…
• A dislocation occurs when a bone slips out of a
joint. For example, the top of your arm bone fits
into a joint at your shoulder. When it slips or
pops out of that joint, you have a dislocated
shoulder.
 CAUSES
1. Direct force the joint
2. Fallings
3. RTA
4. Sports
 TYPES OF DISLOCATIONS
• shoulder dislocation
• Hip dislocation
• Knee dislocation
• elbow dislocation
• Ankle dislocation
• In the smaller joints such as fingers, thumbs and
toes.
 SIGNS AND SYMPTOMS
• The following are the most common symptoms
of a dislocation. However, each person may
experience symptoms differently. Symptoms may
include:
• Pain in the injured area
• Swelling in the injured area
 CONT…
• Difficulty using or moving the injured area in a
normal manner
• Deformity of the dislocated area
• Bruising or redness in the injured area
• Numbness or weakness in the injured area
• NB: The symptoms of a dislocation may resemble
other medical conditions.
 DIAGNOSIS
•History taking – it will reveal history of trauma to the
joint.
•Physical examination - which will reveal deformed
joint, swelling of the joint, pain at the joint.
•X-ray of the joint - which will reveal separation of
adjacent joint surfaces.
•Magnetic resonance imaging (MRI) - to produce
detailed images of organs and structures involved.
 TREATMENT
• Manipulation or repositioning
• Two main methods are;
1. Closed reduction - this is where the joint is returned
to normal anatomical alignment by manipulation and
manual traction.
2. Open reduction - This is where there is surgical
opening of the joint and then the dislocation is
reduced.
 NURSING CARE
• Aims
• Prevent further tissue injury.
• Alleviate pain.
• Prevent complications.
• Provide information about condition,
prognosis, and treatment needs.
 CONT…
• Immobilization
• with a sling, splint, or cast for several weeks.
This will prevent the joint from moving and allow
the area to fully heal.
• The length of time the joint needs to be
immobile will vary, depending on the joint and
severity of the injury.
 CONT…
• Medication
• Most pain should go away after the joint returns to its
proper place. However, a pain reliever (Panadol) or a
muscle relaxant may be given, if the patient is still
feeling pain.
• Would care
• to keep the wound clean and dressed to prevent
infection.
 INFORMATION, EDUCATION AND COMMUNICATION
(IEC).

Diet
• Stress the importance of a well mixed diet to promote
quick wound healing and energy for ambulation.
Review date and follow up
• Patient should keep a review dates and should seek
medical assistance promptly should there be any
problem.
 CONT…
Drugs
• Encourage patient to adhere to medication
instructions to avoid defaulting.