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Orthopaedic Injuries Anatomy and Physiology of the Musculoskeletal System

Skeletal System Types of Musculoskeletal Injuries

FractureBroken bone

DislocationDisruption of a joint

SprainJoint injury with tearing of ligaments

StrainStretching or tearing of a muscle

Mechanism of InjuryForce may be applied in several ways:

Direct blowIndirect forceTwisting forceHigh-energy injury

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FracturesSigns of fractures (cont’d)

BruisingCrepitusFalse motionExposed fragmentsPainLocked joint

FracturesClosed fracture

A fracture that does not break the skin

Open fractureExternal wound associated with fracture

Nondisplaced fractureSimple crack of the bone

Displaced fractureFracture in which there is actual deformity.

Greenstick Fracture Comminuted Fracture

Pathologic Fracture Epiphyseal Fracture

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Signs and Symptoms of a FractureDeformity

Tenderness

Guarding

Swelling

Bruising

Crepitus

False motion

Exposed fragments

Pain

Locked joint

Signs and Symptoms of a Dislocation

Marked deformitySwellingPainTenderness on palpationVirtually complete loss of joint functionNumbness or impaired circulation to the limb and digit

Signs and Symptoms of a SprainPoint tenderness can be elicited over injured ligaments.

Swelling and ecchymosis appear at the point of injury to the ligaments.

Instability of the joint is indicated by increased motion.

Pain

Assessing Musculoskeletal InjuriesAssess mechanism of injuryInitial assessmentFocused physical examFollow BSI precautionsGive oxygen if neededDCAP-BTLSIf patient critically injured, transport immediatelyBe alert for compartment syndromeSplint injuryTransportCheck neurovascular status during transport

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Evaluating Neurovascular Function

Examination of the injured limb should include assessment of the following:

PulseCapillary refillSensationMotor function

Emergency Medical CareCompletely cover open wounds.

Apply the appropriate splint.

If swelling is present, apply ice or cold packs.

Prepare the patient for transport.

Always inform hospital personnel about wounds that have been dressed and splinted.

SplintingFlexible or rigid device used to protect extremityInjuries should be splinted prior to moving patient, unless the patient is critical.Splinting helps prevent further injury.Improvise splinting materials when needed.

General Principles of SplintingRemove clothing from the area.Note and record the patient’s neurovascular status.Cover all wounds with a dry, sterile dressing.Do not move the patient before splinting.Immobilize the joints above and below the injured joint.Pad all rigid splints.Maintain manual immobilization.Use constant, gentle, manual traction if needed.If you find resistance to limb alignment, splint the limb as is.

More General Principles of Splinting

Immobilize all suspected spinal injuries in a neutral in-line position.

If the patient has signs of shock, align limb in normal anatomic position and transport.

When in doubt, splint.

In-line Traction SplintingAct of exterting a pulling force on a bony structure in the direction of its normal alignment.Realigns fracture of the shaft of a long bone.Use the least amount of force necessary.If resistance is met or pain increases, splint in deformed position.

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Applying a Rigid SplintProvide gentle support and in-traction of the limb.

Another EMT-B places the rigid splint alongside or under the limb.

Place padding between the limb and splint as needed.

Secure the splint to the limb with bindings.

Assess and record distal neurovascular function.

Applying an Air SplintHold the injured limb, apply gentle traction and support the injury site.Partner should place splint around extremity.If splint has a zipper, zip the splint up. Inflate by pump or by mouth.Check and record distal neurovascular function.

Applying an Vacuum SplintStabilize and support the injury.Place the splint and wrap it around the limb.Draw the air out of the splint and seal the valve.Check and record distal neurovascular function.

Traction SplintsDo not use a traction splint under the following conditions:

Injuries close to or involving the kneePelvis and hip injuriesPartial amputation or avulsions with bone separationLower leg or ankle injuries

Applying a Traction Splint

Hare Traction SplintSager Traction Splint

Hazards of Improper SplintingCompression of nerves, tissues, and blood vesselsDelay in transport of a patient with a life-threatening conditionReduction of distal circulationAggravation of the injuryInjury to tissue, nerves, blood vessels, or muscle

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Clavicle and Scapula InjuriesClavicle is one of the most fractured bones in the body.Scapula is well protectedJoint between clavicle and scapula is the acromioclavicular (A/C) jointSplint with a sling and swathe.

Dislocation of the ShoulderMost commonly dislocated large jointUsually dislocates anteriorlyIs difficult to immobilize

Fractures of the HumerusOccurs either proximally, in the midshaft, or distally at the elbow.Consider applying traction to realign a severely angulated humerus, according to local protocols.Splint with sling and swathe, supplemented with a padded board splint.

Elbow InjuriesFractures and dislocations often occur around the elbow.Injuries to nerves and blood vessels common.Assess neurovascular function carefully

Realignment may be needed to improve circulation.

Fractures of the ForearmUsually involves both radius and ulnaUse a padded board, air, vacuum, or pillow splint.

Injuries to the Wrist and Hand

Follow BSI precautions.Cover all wounds.Form hand into the position of function.Place a roller bandage in palm of hand.Apply padded board splint.Secure entire length of splint.Apply a sling and swathe.

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Fractures of the PelvisMay involve life-threatening internal bleedingAssess pelvis for tenderness.Stable patients can be secured to a long backboard or scoop stretcher to immobilize isolated fractures of the pelvis.

Dislocation of the HipHip dislocation requires significant mechanism of injury.Posterior dislocations lie with hip joint flexed and thigh rotated inwardAnterior dislocations lie with leg extended straight out, and rotated, pointing away from midline.Splint in position of deformity and transport.

Fractures of the Proximal Femur

Presents with very characteristic deformityFractures from trauma injuries best managed with traction splint or PASG and a spine board.Isolated fracture in elderly can be managed with long spine board or a scoop stretcher.

Femoral Shaft FracturesMuscle spasms can cause deformity of the limbSignificant amount of blood loss will occur.Immobilize with traction splint.

Injuries of Knee LigamentsKnee is very vulnerable to injury.Patient will complain of pain in the joint and be unable to use the extremity normally.Splint from hip joint to foot.Monitor distal neurovascular function.

Dislocation of the KneeProduces significant deformityMore urgent injury is to the popliteal artery, which is often lacerated or compressed.Always check distal circulation.

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Fractures About the KneeIf there is adequate distal pulse and no significant deformity, splint the limb with the knee straight.If there is adequate distal pulse and significant deformity, splint the joint in the position of deformity.If pulse is absent below the level of the injury, contact medical control immediately.

Dislocation of the Patella

Usually dislocates to lateral side.Produces significant deformity.Splint in position found.Support with pillows.

Injuries to the Tibia and FibulaUsually, both bones fracture at the same time. Open fracture of tibia common.Immobilize with a padded rigid long leg splint or an air splint that extends from the foot to upper thigh.

Ankle InjuriesMost commonly injured jointDress all open wounds.Assess distal neurovascular function.Correct any gross deformity by applying gentle longitudinal traction to the heel.Before releasing traction, apply a splint.

Foot InjuriesUsually occur after a patient falls or jumps.Immobilize ankle joint and foot.Leave toes exposed to assess neurovascular function. Elevate foot 6”.Also consider possibility of spinal injury from a fall.

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Compartment Syndrome

Most often occurs with a fractured tibia or forearm of childrenTypically develops within 6 to 12 hours after injury, as a result of:

Excessive bleedingA severely crushed extremityThe rapid return of blood to an ischemic limb

Compartment SyndromePathophysiology

Signs and symptoms

•Early–Pain

–Paresthesias(tingling)

•Late–Pallor

–Pulselessness

–Paralysis

Compartment Syndrome

If you suspect the patient has compartment syndrome, splint the affected limb and transport immediately.

Reassess neurovascular status frequently during transport.

Compartment syndrome must be managed surgically.

Pneumatic Antishock Garments

Use as a splinting device if a patient has injuries to the lower extremities/pelvis.Do not use the PASG if any of the following conditions exist:

PregnancyPulmonary edemaAcute heart failure

Amputations

Surgeons can occasionally reattach amputated parts.Make sure to immobilize the part with bulky compression dressings.

Do not sever any partial amputations.Control any bleeding to the stump.If bleeding cannot be controlled, apply a tourniquet.

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Amputations

With a complete amputation, wrap the clean part in a sterile dressing and place it in a plastic bag.

Put the bag in a cool container filled with ice.The goal is to keep the part cool without allowing it to freeze or develop frostbite.

Questions?