5. musculoskeletal injuries

University of Tabuk Faculty of Applied Medical Sciences Department of Nursing First Aid and Emergency Nursing (Theory) (NUR 410) Level 8, Academic Year (AY) 1434—1435 H YOLANDA G. CABALTICA, RN, MAN Lecturer

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University of TabukFaculty of Applied Medical SciencesDepartment of Nursing

First Aid and Emergency Nursing (Theory) (NUR 410)Level 8, Academic Year (AY) 14341435 HYOLANDA G. CABALTICA, RN, MANLecturer

Musculoskeletal Injuries

Musculoskeletal injuries can occur from both blunt and penetrating trauma. Injuries may include: contusions fractures cramps spasms dislocations sprains/strains subluxationsEarly proper treatment of these injuries may prevent long term morbidity and disability.

Major injuries to the musculoskeletal system ( e.g., pelvic fractures and hip dislocations) may cause shock due to hemorrhage, injury to adjacent nerves and blood vessels and infection due to the presence of an open fracture. Fractures of the humerus, pelvis or femur take priority over other musculoskeletal injuries as do fractures or dislocations involving circulatory or neurologic deficits

ASSESSMENT / TREATMENT PRIORITIESMaintain appropriate body substance isolation precautions.Maintain an open airway and assist ventilations as needed. Assume Spinal injury when appropriate and treat accordingly.

Administer high oxygen concentration.Determine patient's hemodynamic stability and symptoms. If indicated, continually assess the Level of Consciousness, ABCs and Vital Signs.

ASSESSMENT / TREATMENT PRIORITIESAssess the neurovascular status (motor, sensory and circulation) distal to the injury before and after proper immobilization.

If no palpable, distal pulse is present, apply gentle traction along the axis of the extremity distal to the injury until the distal pulse is palpable and immobilize in place. Note: This does not apply to dislocations.

Immobilize all painful, swollen and/or deformed extremity injuries (e.g. fractures, sprains, strains and/or dislocations) involving joints, in the position found.

All jewelry should be removed from an injured extremity.


ASSESSMENT / TREATMENT PRIORITIESObtain appropriate S-A-M-P-L-E history related to event.

Prevent / treat for shock.

Monitor and record vital signs

FRACTURE is a partial or complete break in the continuity of the bone.

Fractures are usually caused by a fall, blow or other traumatic event.

Pathological fractures are those caused by disease that weakens the bones; they can occur with little or no trauma.

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TYPES OF FRACTURE:Open fracture (Also called compound fracture.)- the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.

Closed fracture (Also called simple fracture.)- the bone is broken, but the skin is intact.

Greenstick- incomplete fracture. The broken bone is not completely separated.


Transverse- the break is in a straight line across the bone.


COMMON TYPES OF FRACTURESSpiral- the break spirals around the bone; common in a twisting injury.

Oblique- diagonal break across the bone.


Compression- the bone is crushed, causing the broken bone to be wider or flatter in appearance.COMMON TYPES OF FRACTURES

Comminuted fracture results from a force that creates splintering or crushing of bone segments.COMMON TYPES OF FRACTURES

Signs and symptoms of a fracture include:Swelling or bruising over a bone.

Deformity of an arm or leg.Pain in the injured area that gets worse when the area is moved or pressure is applied.

Loss of function in the injured area.In compound fractures, bone is protruding from the skin.Grating or crepitus this is a sensation that can be felt when the broken ends of the bone rub together.

Always wear a seat belt in acar.Always wear the proper safetyequipment (helmets and other protective pads) for recreational activities, such as cycling or contact sports.Keep walkways and stairs free of objects you could trip over.If you have osteoporosis, take regular exercise to improve your strength and balance. This may help to reduce the risk of falls. Also, discuss with your doctor whether medication would be appropriate.To help prevent fractures, follow general safety precautions, including:

Goal of Treatment for Fracture: To regain and maintain correct position and alignment

To regain the function of the involved part

To return the patient to his usual activities in the shortest Time and at the least expense.

Process of Fracture Treatment:Reduction- setting the bone; refers to restoration of the fracture fragments into anatomic position and alignment

Immobilization maintains reduction until bone healing occurs

Rehabilitation regaining normal function of the affected part.

Control external bleeding and protect the wound

Ask the casualty not to move, make them comfortable

Avoid twisting of the neck or spine, maintain the alignment of the spine

Management of Fracture

Check for circulation into the limb beyond the fractureHandle gently, do not attempt to straighten fractured limbsImmobilize the fracture with pillows and blankets or use splints if necessary

Seek medical assistance for transportation of the casualtyManage shock.

Management of Fracture


the displacement of the bone ends at a joint so that the joint surface are no longer in contact.

A joint consists of opposing ends of bone, covered by cartilage which are held together by a joint capsule, ligaments and tendons.

The capsule and the ligaments help provide stability to the jointWhen there is a dislocation, the joint capsule is torn and one of the bone ends is dislodged from its normal position.A complete dislocation causes tearing of the ligaments.


Frequently Dislocated JointsShoulderElbowFingersHipAnkle

Causes:Department of Nursing 25Usually caused by a trauma like a fall/blowRheumatoidarthritisalso causes dislocation

A visibly deformed or out of place shoulder swelling discoloration (bruising)Pain on any attempted motion of the joint.Swollen, out of place, intense pain and immovable, the joint almost always swells significantly and feels painful when pressure is applied (point tenderness).numbness and/or tingling below the injury

Signs & Symptoms of Dislocation


Call medical help as soon as possibleDo not move the joint or try to place it backPlace ice to control swellingIf skin is cut, clean gently and bandage with sterile gauzeSling or splint the injury in its original positionIf injury is serious, check for breathingIf not breathing, provideCardio pulmonary resuscitation (CPR)Elevate the feet up to 12 inchesCover the patient with a blanket


Wear protective gear while sportingMake home environment safeTeach safe habits to childrenDo not stand on chairs or other unstable objectsExercise care while using bath oilsMake use of hand rails while using the stairs


is a partial tear of a ligament.caused by a sudden twisting or stretching of the joint beyond the normal range of motion.Two common areas of sprain are the ankle and kneesAnkle injury is usually caused by a sudden twisting of the foot being turned inward

A sprain is an injury to a ligament--a stretching or a tearing. One or more ligaments can be injured during a sprain. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved.

28Signs and Symptoms of SprainPain, swelling,bruising, and loss of the ability to move and use the joint (called functional ability).Department of Nursing 29

StrainAn injury to either a muscle or a tendon. Depending on the severity of the injury, a strain may be a simple overstretch of the muscle or tendon, or it can result in a partial or complete tear.

An acute strain is caused by trauma or an injury such as a blow to the body; it can also be caused by improperly lifting heavy objects or over-stressing the muscles. Chronic strains are usually the result of overuse--prolonged, repetitive movement of the muscles and tendons.

Signs and Symptoms of a Strain

Pain,muscle spasm, and muscle weakness.Localized swelling, cramping, or inflammationMinor or moderate strain, usually have some loss of muscle function. Patients typically have pain in the injured area and general weakness of the muscle when they attempt to move it. Severe strains that partially or completely tear the muscle or tendon are often very painful and disabling.

Treatment for Sprains and StrainsReduce Swelling and PainTreatment for sprains and strains is similar and can be thought of as having two stages. First Stage GOAL:Reduce swelling and pain. Advise patients to follow a formula of (RICE) Rest, Ice, Compression, and Elevationfor the first 24 to 48 hours after the injury. The doctor may also recommend anover-the-counteror prescriptionnonsteroidal anti-inflammatory drug, such asaspirinoribuprofen, to help decrease pain and inflammation.

Begin RehabilitationSecond Stage GOAL:Rehabilitation, whose overall goal is to improve the condition of the injured part and restore its function. The health care provider will prescribe anexerciseprogram designed to prevent stiffness, improve range of motion, and restore the joint's normal flexibility and strength. Some patients may need physical therapy during this stage.

Prevention of Sprains and Strains:

Maintain a healthy, well-balanced diet to keep muscles strong.Maintain ahealthy weight.Practice safety measures to help prevent falls Wear shoes that fit properly.Replaceathletic shoesas soon as the tread wears out or the heel wears down on one side.Do stretching exercises daily.

Be in proper physical condition to play a sport.Warm up and stretch before participating in any sports or exercise.Wear protective equipment when playing.Avoid exercising or playing sports when tired or in pain.Run on even surfaces.

http://www.webmd.boots.comhttp://wordnetweb.princeton.edu/perl/webwn?s=comminuted fractureReferences:Fracture-First Aid and Emergency Treatment Guide | Medindiahttp://www.medindia.net/patients/firstaid-fractureDislocation - First Aid and Emergency Treatment Guide Medindiahttp://www.medindia.net/patients/First aid-dislocation