Orthopedic Injuries

What structures make up the musculoskeletal system?

Bones, muscles, tendons, ligaments, joints, and associated neurovascular structures.

What do bones provide?

Structural support and protection for internal organs.

What do muscles do?

Generate force for movement and stability.

What connects muscle to bone?

Tendons.

What connects bone to bone?

Ligaments.

What does DOTS stand for?

Deformity, Open injuries, Tenderness, and Swelling.

What should be assessed distal to every extremity injury?

Pulse, motor function, sensation, skin color, and temperature.

When should distal neurovascular status be checked?

Before and after immobilization or position changes.

Why might an EMT mark a pulse location with a marker?

To make repeated pulse checks faster and easier for subsequent providers.

What four major orthopedic injury categories are emphasized?

Fractures, dislocations, sprains, and strains.

What is a fracture?

A break in a bone.

What is a dislocation?

Complete separation of the bones forming a joint.

What is a sprain?

Ligament injury.

What is a strain?

Muscle or tendon injury.

Why is pain assessment useful in orthopedic trauma?

It helps locate injury, track change, guide treatment, and evaluate response to pain management.

Should EMTs change a patient's reported pain score because it seems exaggerated?

No. Document the patient's stated score and objectively describe observed findings.

Why should pain management be considered before moving some orthopedic patients?

Movement can worsen pain and make extrication more difficult.

What does neurovascular compromise mean?

Impaired blood flow, nerve function, or both distal to an injury.

Why is neurovascular compromise time-sensitive?

Ongoing ischemia or nerve compression can cause permanent tissue damage.

What position should an injured extremity generally be kept in?

The position of comfort or position found unless circulation is compromised or protocol directs otherwise.

Why should patient movement be planned carefully?

Improper movement can worsen injury, pain, bleeding, or neurovascular compromise.

What history detail is especially important in orthopedic trauma regarding bleeding risk?

Whether the patient takes anticoagulants or other blood thinners.

What is a closed fracture?

A fracture with intact overlying skin.

What is an open fracture?

A fracture associated with an open wound and increased contamination/infection risk.

What is a transverse fracture?

A break running roughly perpendicular to the long axis of the bone.

What is an oblique fracture?

A fracture line running at an angle across the bone.

What is a comminuted fracture?

A fracture in which the bone is broken into multiple fragments.

What is a subluxation?

Partial separation of a joint that may sometimes reduce spontaneously.

Why can joint injuries be just as serious or painful as fractures?

They may involve ligaments, cartilage, nerves, vessels, and major instability.

Can swelling be absent immediately after an orthopedic injury?

Yes. Swelling may develop over time.

What is compartment syndrome?

Dangerous pressure buildup within a muscle compartment that compromises blood flow and nerve function.

What injuries commonly precede compartment syndrome?

Trauma, crush injury, and high-energy extremity injury.

What classic findings are associated with compartment syndrome?

Pain out of proportion, pallor, paresthesia, pulselessness, and paralysis.

Which compartment syndrome finding is especially important early?

Severe pain, especially pain with passive stretch.

Should EMTs wait for all classic compartment syndrome signs to appear?

No. Late signs such as pulselessness or paralysis may mean severe damage has already occurred.

Why is frequent reassessment important for compartment syndrome?

It can develop progressively over hours after the initial injury.

What is the goal of splinting?

Reduce pain, prevent further injury, maintain alignment, and protect neurovascular structures.

What joints should generally be immobilized with a long-bone fracture?

The joints above and below the fracture.

What kinds of splints are emphasized?

Soft, rigid/hard, air, traction, sling-and-swath, and improvised splints.

Why should bony prominences be padded during splinting?

To reduce pressure injury and improve comfort.

What should splinting do to patient pain?

Usually reduce it rather than worsen it.

What must be reassessed after splint placement?

Distal pulse, motor function, sensation, and circulation.

When can improvised splints be useful?

When standard devices are unavailable or in resource-limited situations.

What are general priorities for orthopedic treatment?

Control bleeding, protect open wounds, manage pain, reduce swelling, immobilize, and reassess neurovascular status.

What can cold therapy help with?

Pain and swelling.

Why should open fractures be covered?

To reduce contamination and infection risk.

Should life-threatening injuries take priority over splinting?

Yes. Orthopedic care is delayed when airway, breathing, circulation, or other life threats require attention.

What is the most common shoulder dislocation direction?

Anterior.

What appearance may an anterior shoulder dislocation produce?

A squared-off shoulder contour.

What mechanism commonly causes clavicle fracture?

Direct impact or falling onto an outstretched hand.

What is an AC separation?

Injury to the acromioclavicular joint causing deformity and instability.

What nerve distribution is emphasized in shoulder injury assessment?

Axillary nerve distribution.

Why are humeral fractures concerning for neurovascular injury?

The brachial artery and major nerves run close to the humerus.

What nerve is at risk with a proximal humerus fracture near the surgical neck?

Axillary nerve.

What nerve is at risk with a mid-shaft humerus fracture?

Radial nerve.

What pulse should be checked carefully with humeral injury?

Radial pulse.

What joints should be immobilized with a humerus fracture?

The shoulder and elbow.

How should most elbow injuries be immobilized?

In the position found unless distal circulation is compromised.

Why can elbow injuries be dangerous to neurovascular status?

Dislocation or swelling can compress nearby nerves and vessels.

Why are both-bone forearm fractures unstable?

Both radius and ulna are disrupted, eliminating normal structural support.

What additional motion must forearm splinting control?

Rotation.

What important complication should be monitored after high-energy forearm injury?

Compartment syndrome.

Why are scaphoid fractures important despite subtle presentation?

They can be easily missed yet cause significant long-term wrist complications.

What function can metacarpal fractures impair?

Grip strength.

What should be checked in finger injuries?

Joint stability and flexor/extensor tendon function.

What does a sling do?

Supports the weight and position of an injured upper extremity.

What does a swath add to a sling?

Additional stabilization by securing the arm to the torso.

What hip fracture is common in older adults after minor trauma?

Femoral neck fracture.

What type of mechanism commonly causes hip dislocation?

High-energy trauma.

Why can hip injuries cause significant blood loss?

The region has rich vascular supply and deep tissue spaces.

How much blood loss can occur with a femur fracture according to this course?

Up to about 1500 mL.

Why are femur fractures especially painful and unstable?

Large surrounding muscles spasm and pull fracture fragments out of alignment.

What is the first immobilization step for a femur fracture in this course?

Manual stabilization and traction until a traction splint is applied when indicated.

What is a benefit of early immobilization in femur fracture?

It reduces pain, limits movement, and may reduce bleeding and tissue damage.

Why is the knee important in orthopedic assessment?

It contains multiple ligaments, bones, vessels, and joint structures that can be injured together.

Why should distal pulses be checked carefully after knee deformity or dislocation?

Vascular compromise can occur.

Why is the tibia prone to open fractures?

It lies close to the skin with little soft-tissue coverage.

What major complication should be watched for in lower-leg trauma?

Compartment syndrome.

What do multiple malleolar ankle injuries suggest?

Significant instability.

Why are calcaneal fractures concerning beyond the foot itself?

Falls causing calcaneal fractures may also cause spinal injury.

Why can foot injuries be deceptively significant?

Many are closed and not dramatic externally but can greatly impair mobility and function.

What should be assessed in toe distributions after foot injury?

Circulation and sensation.

What fracture patterns are especially common in children?

Greenstick and buckle fractures.

Why are pediatric growth plate injuries important?

They can affect future bone growth.

What communication strategy is emphasized for pediatric orthopedic patients?

Use age-appropriate honesty and involve caregivers when helpful.

Why can children appear stable until late in serious injury?

They compensate well physiologically until sudden deterioration.

Why are older adults at increased fracture risk?

Reduced bone density and osteoporosis.

Why should a fall in an older adult trigger a medical assessment too?

The fall may have been caused by an underlying medical problem rather than simple mechanical loss of balance.

Why do anticoagulants matter in geriatric orthopedic trauma?

They increase the risk of bleeding and hidden injury.

What is the priority in multi-trauma with orthopedic injuries?

Treat life-threatening injuries first.

When might orthopedic immobilization be delayed in multisystem trauma?

When more urgent airway, breathing, circulation, or hemorrhage problems require immediate care.

What should happen with football helmets when spinal trauma is possible?

Leave them in place unless they interfere with airway care or removal is specifically indicated.

Why are industrial machine injuries complex?

They may involve crush injury, entrapment, contamination, amputation, and multi-agency extrication.

What key principle applies before removing a trapped patient from industrial machinery?

Begin appropriate patient care before extrication whenever possible.

How should an amputated part be handled conceptually?

Preserve and transport it appropriately per protocol while treating the patient's life threats.

What is a fat embolism?

Fat droplets entering the circulation after major long-bone injury and causing systemic complications.

What clue may suggest fat embolism after a long-bone fracture?

New respiratory changes or deterioration hours after injury.

Why are open fractures at higher risk for infection?

The skin barrier is broken and deeper tissues are exposed to contamination.

Why is vascular compromise an emergency in orthopedic trauma?

Prolonged loss of blood flow can cause tissue death and limb loss.

A patient has a deformed ankle with numb toes. What is your priority assessment concern?

Distal neurovascular compromise.