NCLEX Review Guide: Adult Health - Musculoskeletal Injuries

Types of Fractures

• Open (compound) fractures have bone protruding through skin, requiring immediate surgical intervention and IV antibiotics to prevent osteomyelitis.
• Closed fractures maintain skin integrity but may still cause internal bleeding and compartment syndrome.
• Comminuted fractures involve multiple bone fragments and typically require surgical fixation with plates or screws.

Recognition and Management

• Compartment syndrome occurs when increased pressure within muscle compartments compromises circulation and tissue function.
• Pain out of proportion to injury is the earliest and most reliable sign, especially pain with passive stretching.
• Late signs include pulselessness, paralysis, and paresthesia - tissue death may be irreversible at this point.

1. Immediately notify physician if compartment syndrome suspected
2. Remove all constrictive devices (casts, bandages)
3. Keep extremity at heart level (not elevated)
4. Prepare for emergency fasciotomy
5. Monitor vital signs and urine output

Cast Management

• Wet plaster casts take 24-48 hours to dry completely and should be handled with palms only to prevent indentations.
• Never use heat sources to dry casts as this can cause burns and skin breakdown.
• Elevate casted extremity above heart level for first 24-48 hours to reduce swelling.

• Always prioritize airway, breathing, circulation before addressing musculoskeletal injuries.
• Remember that pain is the patient's subjective experience - believe and treat accordingly.
• Neurovascular assessments should be performed every 15 minutes initially, then every 1-2 hours.