EMS 32: Orthopedic (Musculoskeletal) Injuries

Musculoskeletal system

Provides body support, posture, movement, and protection of vital organs

Functions of the skeleton

Protects organs, supports the body, produces blood cells, and stores minerals and electrolytes

Skeletal muscle

Voluntary muscle attached to bones by tendons that produces body movement

Smooth muscle

Involuntary muscle that controls movement within hollow organs and blood vessels

Cardiac muscle

Specialized involuntary muscle found only in the heart

Bones in the adult skeleton

206

Thoracic cage

Protects the heart, lungs, and great vessels

Pectoral girdle

Two clavicles and two scapulae

Bones of the upper extremity

Humerus, radius, ulna, carpals, metacarpals, and phalanges

Bones of the pelvis

Ilium, ischium, and pubis

Bones of the lower extremity

Femur, patella, tibia, fibula, tarsals, metatarsals, and phalanges

Joint

Connection between bones enclosed in a fibrous capsule and lubricated by synovial fluid

Fracture

Break in the continuity of a bone

Closed fracture

Broken bone with intact overlying skin

Open fracture

Broken bone with an associated wound communicating with the fracture site

Nondisplaced fracture

Bone is cracked but remains in normal alignment

Displaced fracture

Broken bone ends are no longer in normal alignment

Comminuted fracture

Bone broken into more than two fragments

Epiphyseal fracture

Fracture involving the growth plate of a child's bone

Greenstick fracture

Incomplete fracture in which one side of the bone bends while the other side breaks

Incomplete fracture

Fracture that does not extend completely through the bone

Oblique fracture

Fracture occurring diagonally across the bone

Pathologic fracture

Fracture occurring in weakened or diseased bone

Spiral fracture

Fracture caused by a twisting force

Transverse fracture

Fracture running straight across the bone

Signs of a fracture

Deformity, tenderness, guarding, swelling, bruising, crepitus, false motion, exposed bone fragments, pain, or a locked joint

Dislocation

Displacement of bone ends so they are no longer in contact

Signs of a dislocation

Marked deformity, swelling, pain with movement, tenderness, loss of joint motion, numbness, or impaired circulation

Sprain

Stretching or tearing of ligaments around a joint

Signs of a sprain

Pain, swelling, ecchymosis, guarding, and joint instability

Strain

Stretching or tearing of a muscle or tendon

Complications of musculoskeletal injuries

Depend on the force of injury, injury location, and the patient's overall health

Management goals for open fractures

Prevent contamination, reduce infection risk, minimize pain, prevent further injury, and transport promptly

Primary assessment for musculoskeletal injuries

Assess airway, breathing, circulation, bleeding, perfusion, and associated injuries before focusing on fractures

Open fracture clue

A laceration over an injured extremity should raise suspicion for an open fracture

Neurovascular assessment

Assess distal pulse, motor function, and sensation (PMS)

Splint

Rigid or flexible device used to immobilize and protect an injured extremity

Indications for splinting

Splint fractures, dislocations, and sprains before moving the patient whenever possible

Benefits of splinting

Reduces pain, bleeding, muscle damage, neurovascular injury, and further tissue damage

Steps before splinting

Expose the injury, cover open wounds, assess PMS, pad rigid splints, manually stabilize the injury

Splinting a deformed extremity

Splint in the position found if severe deformity or resistance and severe pain occur during gentle traction

Rigid splint

Firm splint applied to one or more sides of an injured extremity

Formable splint

Moldable splint such as a SAM splint

Vacuum splint

Splint that molds around an extremity using suction

Pelvic binder

Device used to stabilize pelvic fractures and reduce internal bleeding

Complications of improper splinting

Reduced circulation, nerve compression, increased pain, worsening injury, and tissue damage

Highest-priority extremity injury

Pulseless limb

Clavicle fracture signs

Shoulder pain with the arm held across the chest

Scapula fracture

Usually results from a forceful blow to the back and is treated with a sling and swathe

Shoulder dislocation treatment

Splint the arm in the most comfortable position

Humerus fracture treatment

May require gentle traction before splinting with a sling and swathe

Elbow injury concern

Risk of injury to nearby nerves and blood vessels

Olecranon fracture

Patient is unable to actively extend the elbow

Radial head fracture

Often results from a fall onto an outstretched hand

Forearm fracture

Radius and ulna commonly fracture together

Forearm splints

Padded board, air, vacuum, or pillow splints

Pelvic fracture concerns

Major blood loss and injury to the bladder, urethra, rectum, or vagina

Signs of pelvic fracture

Lower back or abdominal pain, pelvic tenderness, hematuria, or blood at the urethra

Hip dislocation

Usually posterior and caused by significant trauma

Signs of hip dislocation

Severe hip pain, resistance to movement, and tenderness

Hip dislocation management

Do not reduce, splint in position found, support with pillows, secure to a backboard, and transport promptly

Proximal femur fracture

Fracture involving the femoral neck, intertrochanteric region, or proximal shaft

Femoral shaft fracture

Fracture of the shaft of the femur with severe muscle spasm and risk of neurovascular injury

Best splint for femoral shaft fracture

Traction splint

Traction splint

Used only for isolated femoral shaft fractures

Do not use a traction splint for

Knee, lower leg, ankle, foot, pelvic, or hip injuries

Ligament injury signs

Swelling, ecchymosis, point tenderness, and joint effusion

Knee dislocation complications

Popliteal artery injury, nerve injury, and joint instability

Knee fracture with deformity and pulse present

Splint in the position found

Knee fracture with absent distal pulse

Contact medical control before attempting realignment

Patella dislocation treatment

Splint in the position found

Tibia and fibula fracture treatment

Apply a padded rigid long-leg splint or air splint

Ankle injury evaluation

Pain, swelling, tenderness, or inability to bear weight requires physician evaluation

Foot injury concern

Force may be transmitted up the leg to the spine

Foot splints

Rigid padded board, air splint, or pillow splint

RICES

Rest, Ice, Compression, Elevation, Splinting

Care of an amputated part

Wrap in sterile dressing, place in a sealed plastic bag, then place the bag on ice without direct contact

Compartment syndrome

Increased pressure within a closed muscle compartment causing impaired circulation and tissue damage

Common sites of compartment syndrome

Tibia fractures and forearm fractures, especially in children

Causes of compartment syndrome

Excessive bleeding, crush injury, or reperfusion after ischemia

Signs of compartment syndrome

Pain out of proportion, pain with passive stretching, pallor, decreased sensation, and decreased strength

Management of compartment syndrome

Splint the limb at heart level and frequently reassess distal neurovascular status