NLE Musculoskeletal Nursing — Fractures, Trauma and Orthopedic InjuriesConcept Map

Concept

Fracture Classification

Sub Concepts

• Complete vs Incomplete
• Closed (Simple) vs Open (Compound)
• Comminuted
• Greenstick
• Spiral
• Transverse
• Oblique
• Impacted
• Displaced vs Nondisplaced
• Pathologic

Relationship To Central

Foundational understanding of types of bone breaks

Concept

Bone Healing Process

Sub Concepts

• Hematoma Formation (1-3 days)
• Fibrocartilage Soft Callus Formation (1 week)
• Bony Hard Callus Formation (2-6 weeks)
• Ossification
• Remodeling
• Delayed Union
• Nonunion
• Malunion

Relationship To Central

Sequential physiologic stages that guide nursing interventions

Concept

Emergency and Initial Management

Sub Concepts

• Immobilization at Position Found
• Splinting Above and Below Injury
• Airway, Breathing, Circulation Support
• Neurovascular Assessment
• Open Fracture Wound Care
• Hemorrhage Control

Relationship To Central

Critical first-aid and assessment interventions

Concept

Fracture Reduction and Fixation

Sub Concepts

• Closed Reduction
• Open Reduction and Internal Fixation (ORIF)
• External Fixation
• Plates and Screws
• Rods
• Traction

Relationship To Central

Methods to restore bone alignment

Concept

Casts and Traction

Sub Concepts

• Cast Application and Support
• Elevation Protocols
• Neurovascular Monitoring
• Cast Care Education
• Skeletal Traction
• Pin-Site Care
• Weight Management
• Countertraction Maintenance

Relationship To Central

Primary immobilization and stabilization devices

Concept

Fat Embolism Syndrome (FES)

Sub Concepts

• Pathophysiology
• Timing: 24-72 Hours Post-Injury
• Long-Bone and Pelvic Fractures
• Classic Triad: Hypoxemia, Neurologic Changes, Petechial Rash
• Clinical Manifestations
• Nursing Priority: Oxygen Administration
• Prevention Through Early Immobilization

Relationship To Central

Life-threatening complication requiring rapid recognition and intervention

Concept

Compartment Syndrome

Sub Concepts

• Pathophysiology and Risk Factors
• The 6 Ps Assessment
• Pain on Passive Stretch (Earliest Sign)
• Pallor
• Pulselessness (Late Sign)
• Paresthesia
• Paralysis (Late)
• Poikilothermia (Coolness)
• 4-6 Hour Window for Intervention
• Cast Bivalving
• Fasciotomy
• Positioning and Care Modifications

Relationship To Central

Surgical emergency with potential for permanent tissue damage

Concept

Other Fracture Complications

Sub Concepts

• Deep Vein Thrombosis (DVT)
• Pulmonary Embolism (PE)
• Osteomyelitis
• Hemorrhage and Hypovolemic Shock
• Avascular Necrosis
• Prevention Strategies

Relationship To Central

Secondary complications requiring monitoring and prevention

Concept

Soft Tissue Injuries

Sub Concepts

• Sprains: Ligament Injury
• Strains: Muscle or Tendon Injury
• RICE Protocol
• Rest
• Ice (First 24-48 Hours)
• Compression
• Elevation
• Heat Application (After 48 Hours)

Relationship To Central

Non-fracture trauma to musculoskeletal structures

Concept

Dislocations and Subluxations

Sub Concepts

• Dislocation: Complete Joint Displacement
• Subluxation: Partial Displacement
• Neurovascular Assessment
• Immobilization
• Never Force Reduction
• Provider-Ordered Reduction

Relationship To Central

Joint displacement requiring urgent intervention

Concept

Amputation

Sub Concepts

• Indications
• Hemorrhage Monitoring
• Tourniquet at Bedside
• Residual Limb (Stump) Care
• Elevation Protocols
• Prone Positioning
• Contracture Prevention
• Prosthesis Preparation

Relationship To Central

Surgical removal requiring specialized postoperative care

Concept

Phantom Limb Pain

Sub Concepts

• Pathophysiology
• Phantom Limb Sensation
• Acknowledgment and Validation
• Pharmacologic Management
• Gabapentin and Pregabalin
• Antidepressants
• Mirror Therapy
• TENS Therapy
• Relaxation Techniques

Relationship To Central

Real physiologic phenomenon post-amputation requiring validation and management

Concept

Psychosocial Care and Rehabilitation

Sub Concepts

• Body Image Alterations
• Grief and Loss
• Emotional Support
• Physical Therapy
• Prosthesis Training
• Support Resources
• Return to Function

Relationship To Central

Holistic patient-centered care addressing emotional and functional recovery

Concept

Patient Teaching and Health Education

Sub Concepts

• Cast and Wound Care
• Signs of Infection
• Neurovascular Compromise Indicators
• Safe Crutch and Walker Use
• Weight-Bearing Precautions
• Nutritional Support
• Smoking Cessation
• Warning Signs of Complications

Relationship To Central

Nursing responsibility per RA 9173 for patient empowerment and prevention

To

Emergency and Initial Management

From

Fracture Classification

Strength

strong

Relationship

Type of fracture (especially open vs. closed) determines specific initial care protocols and infection risk assessment

To

Fracture Reduction and Fixation

From

Emergency and Initial Management

Strength

strong

Relationship

Proper immobilization and assessment at scene guides later reduction decisions and method selection

To

Casts and Traction

From

Bone Healing Process

Strength

strong

Relationship

Understanding healing stages informs when to modify immobilization and when patient can progress to weight-bearing

To

Compartment Syndrome

From

Casts and Traction

Strength

strong

Relationship

Tight casts and dressings are a primary cause of compartment syndrome; monitoring and adjustment are prevention strategies

To

Other Fracture Complications

From

Compartment Syndrome

Strength

strong

Relationship

Compartment syndrome, if unrecognized, leads to osteomyelitis, tissue necrosis, and permanent disability

To

Emergency and Initial Management

From

Fat Embolism Syndrome

Strength

strong

Relationship

Early immobilization and gentle handling at scene prevent fat mobilization and reduce FES risk

To

Fat Embolism Syndrome

From

Fracture Classification

Strength

moderate

Relationship

Long-bone and pelvic fractures carry highest FES risk; comminuted fractures have greater tissue trauma

To

Emergency and Initial Management

From

Soft Tissue Injuries

Strength

moderate

Relationship

RICE protocol mirrors fracture care principles for initial swelling and pain control

To

Emergency and Initial Management

From

Dislocations and Subluxations

Strength

moderate

Relationship

Joint displacement requires similar immobilization and neurovascular assessment as fractures

To

Phantom Limb Pain

From

Amputation

Strength

strong

Relationship

Post-amputation phantom pain is an expected physiologic response requiring specific validation and management strategies

To

Psychosocial Care and Rehabilitation

From

Amputation

Strength

strong

Relationship

Body image loss and grief are inherent to amputation; holistic care addresses both physical and emotional recovery

To

Casts and Traction

From

Patient Teaching and Health Education

Strength

strong

Relationship

Patient compliance with cast care, weight-bearing precautions, and neurovascular symptom reporting directly impacts healing and complication prevention

To

Bone Healing Process

From

Patient Teaching and Health Education

Strength

strong

Relationship

Teaching nutrition (protein, calcium, vitamin D), smoking cessation, and activity guidelines directly supports optimal bone healing

To

Patient Teaching and Health Education

From

Other Fracture Complications

Strength

moderate

Relationship

Educating patients on DVT/PE signs, infection symptoms, and neurovascular changes enables early self-detection and provider notification

To

Casts and Traction

From

Fracture Reduction and Fixation

Strength

strong

Relationship

Reduction method chosen (closed, ORIF, external fixation) determines the type of immobilization device and monitoring protocols needed

To

Neurovascular Complications in Other Fracture Complications

From

Compartment Syndrome

Strength

strong

Relationship

Compartment syndrome is the leading cause of neurovascular compromise in orthopedic emergencies requiring different management than other complications

To

Delayed Union, Nonunion, Malunion

From

Bone Healing Process

Strength

strong

Relationship

Complications in bone healing represent deviations from normal healing trajectory requiring intervention to restore function

To

Fat Embolism Syndrome

From

Emergency and Initial Management

Strength

strong

Relationship

Early gentle handling and immobilization at scene reduces fat mobilization risk within the critical 24-72 hour window