Pathophysiology – Musculoskeletal system
An 11-year-old boy presents to the emergency room (ER) with a 4-inch laceration on his right arm. He was with his friends doing bicycle stunts when he fell off his bike and cut his arm on a rusty nail from the ramp. In addition, his wrist is swollen, bruised, tender to touch, and warm, with limited mobility. He will most likely need stitches to close the laceration and a splint for the sprain.
Explain the process of bone remodeling
Explain the physiological process that takes place during a sprain
After treatment, as he prepares to leave, you give him last-minute care instructions for laceration and sprain. What would be important for this boy to know to prevent further health concerns with his injuries?
The boy concernedly asks you, “My uncle lost his foot because he got gangrene in it. Am I going to lose my arm if I get an infection in this cut?” How would you respond?
Sample Answer
The Process of Bone Remodeling
Bone remodeling involves removing mature bone tissues from the skeletal for the formation of new bone tissue. Bone remodeling also controls the replacement and reshaping of bone following events such as fractures and micro-damage occurring during normal activities. The bone remodeling circle involves three consecutive phases, including the resorption phase, where osteoclasts digest the old bone. The second phase is known as reversal and involves the development and sprout of mononuclear cells on the bone surface. The third phase is the formation phase and involves osteoblast secreting a new bone to replace the resorbed bone. Bone remodeling prevents the accumulation of old bone and facilitates the maintenance of plasma calcium homeostasis. The process is both local and systematic. Systematic regulators involved in the process include growth hormones, thyroid hormones, parathyroid hormone, and calcitriol. Factors such as bone morphogenic proteins, insulin-like growth factors, tumor growth factor-beta, and prostaglandins are involved. A large number of cytokines and growth factors have been identified as crucial in bone remodeling (Siddiqui & Partridge, 2016).
The Physiological Process That Takes Place During a Sprain
A sprain refers to an injury due to stretching or tearing of ligaments. Ligaments refer to tough and inelastic fibers, which are made of collagen and connect two or more bones forming a joint. They are crucial for proprioception and joint stability. Sprains mostly occur at the ankle, wrist, or knee. A sprain occurs when the ligaments are stretched beyond their normal range due to sudden movement of a joint outside its usual range (May Jr, & Varacallo, 2020). A ligament rupture may occur at the junction between the ligament and the bone or the midsubstance of the ligament. During a sprain, an avulsion fracture may occur if the ligament pulls a bone with it during the stretch. A sprain ranges from mild to severe. A mild sprain involves a tear of few fibers, while a severe sprain involves complete rupturing of the ligament resulting in joint instability. A sprain is graded as grade 1, 2, and grade 3, depending on the severity. From the case study, the boy seems to have suffered a small tear since he only requires a splint. The injury was either caused by extreme twisting or overstretching.
Instructions for Laceration and Sprain
Instruction to be provided concerning the laceration and the sprain is for the bot to refrain from using his hand to prevent movement in the joint and keep his wound site clean and dry. Muscle contraction may result in improper healing. For the sprain, he should apply ice for 10 to 15 minutes for the first days to reduce swelling. The arm should stay elevated above the heart level. Limit the use of the limb and refrain from moving the injured area. He should not ride his bike until advised by a health care professional. The boy should monitor for signs of infection. The laceration should be cared for effectively to prevent complications. A laceration refers to a soft tissue injury due to the skin being torn. Although proper cleaning of the wound and immunization against C. tetani prevents infection, failure to keep the wound clean and dry may lead to reinfection. I would advise the boy against swimming to prevent contamination due to contact with contaminated surfaces as an infected wound can result in sepsis. Although the wound was irrigated and cleansed properly with antimicrobials, it was left open for prevention of anaerobic infection, increasing the risk of entry of microorganisms due to lack of skin, which acts as a protective barrier. The boy will be advised to be careful to prevent injuring the ligament again as it may result in failure to regain full strength at the wrist. Signs of infection to look for include fever, pus or blood draining, and increased pain (Newman & Mahdy, 2021). As long as the boy does not use a limb or get an infection, the injuries will affect health with no deformity or residual disability.
Whether the Boy Will Lose the Arm like the Uncle Lost the Foot Due to Gangrene
The reply that gangrene is caused by the insufficient blood supply and occurs in people with chronic health issues that affects blood circulation. Gas gangrene is mainly caused by a bacterium known as clostridium perfringens and thrives in areas with no oxygen with risk factors for gangrene, including long-term smoking and diabetes (Huang, et al 2018). The boy does have major risk factors, especially poor blood circulation. Despite this, the boy has the risk factor due to the recent injury, but the risk of contracting is slim since the laceration was irrigated, cleansed, and treated properly. He only at the risk of contracting infection associated with Staph, a skin surface opportunistic bacterium. The uncle’s foot was likely amputated to prevent the spreading of the infection. His uncle might have had other risk factors such as immobility, poor wound management, age, and chronic diseases such as diabetes. Emphasis would be to follow all the instructions provided to ensure that he does not become susceptible to infection.
