Musculoskeletal Injuries

Fracture

Partial or complete break or disruption in bone

• Also includes chips & cracks

• Can cause hypovolemic shock if associated w/ hemorrhage

Dislocation

Displacement or separation of a bone from its normal position at a joint

• Also in close proximity to vessels & nerves increasing risk

• First time dislocation → visit hospital

• DONT RELOCATE

Sprain

Partial or complete tearing of ligaments & other tissues @ joint

• Typically not associated w/ an emergency

• A complete ligament sprain involves tearing of ligaments & results when a joint is forced beyond normal ROMThis injury often leads to swelling, pain, and instability in the affected joint → ligaments. can’t heal themselves

Strain

Stretching/tearing of muscle or tendon fibers

• Typically not associated w/ an emergency

• Because tendons are stronger than muscles, tears usually occur in the muscle bellt rather than the tendon attachment

Closed Fracture

Skin is not disrupted @ fx site

Open Fracture

Skin is disrupted # fx site

Complete Fracture

Discontinuity b/w 2+ bone fragments

Incomplete Fracture

Partial discontinuity of bone

Complicated Fracture

Muscular, ligamentous, intra-articular, neurovascular & visceral issues

Uncomplicated Fracture

Minot soft tissue pathology

Occult Fracture

Fx is not visibly demonstrated, but is suspected based on clinical examination

5 Common S/S of MSK Injuries

1. Pain - irritation/damage to nerve endings, painful when touched/moved

2. Swelling - bleeding from damaged vessels; excessive fluid production from synovial capsule

3. Deformity - abnormal lumps, ridges, depressions, unusual bends/angles

4. Discolouration - hrs to days

5. Inability to use affected part

Fracture S/S

• Significant deformity

• Crepitus

• Snapping/poppoing sound @ time of injury

• MOI suggests severe trauma

• Mod. - severe swelling &/or discoloration

• Inability to move/use affected body part

Fracture S/S - Urgent Treatment

• Bone protruding from skin

• Loss of sensation/circulation in extremity - why PMS so important

• Cool to touch

• Long bones & pelvise - skull, spine, femur, tibia & humerus

Principlrs of Care

• Rest, ice, compression, elevation → trying to control inflammation

• Treat for shock

POLICE

Protection, Optimal Loading, Ice, Compression, Elevation

POLICE - Protection

Rest injured area for a couple daysPO

POLICE - Optimal Loading

Gradually reintroduce movement as tolerated to promote healing and strength

POLICE - Ice

Only if needed to decrease acute pain. Apply for max. 10min

POLICE - Compression

Helps the lymphatic system near injured area clear waste & increase blood circulation

POLICE - Elevation

Helps prevent excessive swelling that may impair ROM

Emergency Care for MSK Injuries

• Administer O2

• Control bleeding from open wounds

• Immobilize injuries in position found

• Elevate limb (unless doing so causes further injury)

• Apply ice from max. 20min (unless distal circulation impaired - ice contraindications b/c can’t feel it)

Immobilizing Injury for Transport

Purpose of immobilizing:

• Reduce pain

• Reduce risk of hemorrhaging

• Reduce potential loss of circulation to injured part

• Prevent further damage to soft tissues

• Prevent closed fx’s from becoming open

When to Call EMS w/ MSK Injuries

• Injury impairs walking/breating

• multiple major MSK injuries suspected

• Severe angulation w/ reduced or los of distal circulation &/or sensation

• Severe bleeding

• Injury involves trauma to spine or skull

Upper Extremity Injuries

• Most common injured area of the body

• MOI - FOOSH

• If patient holding their arm against body - don’t try & move it

• Injuries may also damage BVs, nerves & surrounding soft tissue

Scapular Fractures

MOI - Blow to shoulder (baseball to shoulder) → very hard to break flat bones & not common

Common locations of break - Body, neck, glenoid, acromion, scapular spine, coracoid

Clavicle Fracture

• Most common fx in the shoulder

• Can be emergency if fracture goes inwards

• Complaints of pain radiating down arm

• Since BVs & nerve under need to immobilize

• Most common fx site → middle 1/3

• Care - sling & swath or tubular sling

AC Separation

• 6 different categories

• More ligaments torn & clavicle displaced the higher the grade of separation

• When becomes too displaced causes problems

GH Subluxation/Dislocation

• First time dislocation - call EMS → treat as fracture & need imaging

• Anterior dislocation → feel humeral head in axilla

• Use sling to immobilize & ice to control pain & swelling

General Treatment - Shoulder Injuries

• Allow casualty to support their arm in comfortable position

• Fill any “hollows” b/w arm & chest (towels, pillow, etc.)

• Sling & swathe

• Check PMS before & after

• Apply ice

• Treat for shock

Humerus Fracture

• Very painful 

• May show considerable deformity & damage vessels & nerves if move it

• Care - control bleeding & immobilize arm from shoulder to wrist → check PMS before & after splinting

• Ice

• Treat for shock

Elbow Injuries

Since all nerves & BVs of forearm/hand pass through injuries to elbow can cause permanent disability. Injuries can become worse w/ movement

Elbow Dislocation

• Very rare

• Posterior olecranon dislocation due to force created by FOOSH

Elbow Injuries Treatment

• Don’t move elbow joint

• Ulnar artery & nerve particularly volunerable w/ elbow injuries

• Immobilize shoulder to hand in position found

• Control external bleeding w/ pressure

• Sling & swathe

• Check PMS before & after

• Treat for shock

• Ice to reduce swelling & pain

Forearm Fractures

Fractures are common in the radius & ulna & commonly together → a fracture of both bones are give arm S-shape (dinner fork deformity)

• Radial nerve & artery near these bones so fx can cause hemorrhage or loss of mvmt in wrist & hand

Treatment of Forearm, Wrist & Hand Injuries

• Control external bleeding w/ direct pressure & figure 8 bandage

• Immobilization - preseve hand fxn, rigid support under forearm, secure w/ cravats/tensor, sling & swathe

• Soft splint to immbolize hand or fingers → place something in hand to preserve hand position

• Buddy tape finger

• Check PS before & after

Lower Extremity Injuries

Because of size & strength of bones a significant force required to cause fx

• Femur is the largest bone in the body & during a fx there is a risk to femoral artery (life-threatening)

• Fractured leg may appear shorter from quad & hamstring contracture

Femur Fracture vs. Hip Dislocation

Fracture limb looks shorter vs. dislocation limb is internally rotated

Femoral Fracture Treatment

• Mid shaft fx - immobilze above & below

• Femoral fx w/ neurovascular compromise - traction splint

• Femoral fx can cause serious internal bleeding → assess shock, monitor BP, O2 as needed

• Check & re-check PS, apply ice

• If EMS enroute don’t splint → keep patient comfortable, treat for shock, control external bleeding

Splinting Bent Knee

Difficult! - get them to straighten, if not, keep in position found

Knee Injuries Treatment

• Control external bleeding - direct pressure & figure 8 bandage

• Knee is extended or can be extended without pain - splint

• Knee is flexed & painful to moce - splint in position found

• Apply ice, treat for shock, advanced medical care

Ottawa Ankle Rules

If bony pain over distal 6cm of lateral or medial malleolus, or base of 5th, or navicular and unable to WB (take 4 steps) then need x-ray to rule out ankle/foot fracture

Ankle & Foot Injuries Treatment

• Control external bleeding

• Immobilze

• Elevate

• Ice (max 20min)

• Treat for shock

General Care for MSK Injuries

• Control any bleeding

• Optimize rest accordingly

• Immobilize the injured area

• Ice

• Elevate area (if possible)

• Obtain more advanced medical care if necessary

Basic Splint Rules

• Ensure splint includes joint above & below

• Check PS before & after

• Follow manufacturer directions for commerical splints

Splinting - Rules of 1/3

Upper 3rd of tib/fib → joint above: hip, joint below: ankle

Middle 3rd of tib/fib → joint above: knee, joint below: ankle

Lower 3rd of tib/fib → joint above: knee, joint below: toes