Orthopaedic Trauma

Fracture

A break in the continuity of the bone

Closed or open, displaced or nondisplaced

Signs: bruising, crepitus, false motion, exposed fragments, pain, locked joint

Determine whether overlying skin is damaged

Osteomyelitis

Infection of the bone

Happens when exposed through the sin

Greenstick fracture

Incomplete fracture that passes only partway through the shaft

Comminuted fracture

Fracture where the bone is broken into more than two fragments

Epiphyseal fracture

Fracture in the growth section of a child’s bone

Incomplete fracture

Fracture that doesn’t run completely through the bone

Oblique fracture

Fracture where the bone is broken at an angle across the bone

Pathologic fracture

Fracture of weakened/diseased bone

Dislocation

Disruption of a joint in which the bone ends are no longer in contact

Occasionally spontaneously reduce

Sprains

Occur when a joint is twisted or stretched beyond its normal range of motion

Ball/socket/hinge joints mainly

No severe deformity typically

Strain

Stretching or tearing of a muscle causing pain/swelling/bruising

Amputation

Injury in which an extremity is completely severed from the body

Can damage every aspect of the musculoskeletal system

Orthopaedic complications

Systemic changes/illnesses depend on strength of force, injury location, overall patient health

Contamination/infection

Golden hour

Critical for life/preserving limb viability

Open fractures/vascular injuries = critical emergencies

Splinting

Flexible or rigid device used to protect/maintain the position of an injured extremity

All fractures/dislocations/sprains before moving patient

Open wounds covered with dry/sterile dressing

Rigid splint

More firm material applied to all sides

Two EMTs required

Used with severe deformity or resistance/extreme paint when tractioning

Formable splint

Flexible

Structural aluminum/vacuum splints

Pelvic binder

Used to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain

Provides temporary stabilization

Transportation

Rapid not needed

Pulseless limbs take priority

Pelvic fracture

Result from heavy blows, suspect when lower discomfort occurs

Blood loss can be life threatening

Bone fragments can lacerate the rectum/vagina/bladder

Clavicle fracture

Most common, especially in children

Pain reported in the shoulder

Shoulder dislocation

Most common anterior dislocation

Painful: splint whatever feels best

Humerus fracture

Proximal, midshaft, or distally at elbow

Consider traction and splint

Elbow injury

Potentially serious

Assess distal neurovascular functions periodically, prompt transport if impaired

Proximal femur fracture

Break through the neck or across the proximal shaft

Characteristic deformity: externally rotated, shorter injured limb

Common in older people with osteoporosis

Femoral shaft feature

Occurs in any part of the shaft from hip to above the knee

Thigh muscles spasm

Significant blood loss

Cover wounds with dry/sterile dressing

Traction splint

Traction splint

Primarily secure femur fractures

Stabilize/align/avoid neurovascular compromise

Don’t use for upper extremity, close to the knee, pelvis, partial amputation, lower leg injury

Knee ligament injury

Swelling, ecchymosis, tenderness, joint effusion

Splint

Knee dislocation

May threaten the limb/nerves/joint, potentially damaged/torn ligaments
Check for distal pulse

Dislocation direction

Refers to the position of the tibia with respect to the femur

Posterior/medial

Above the knee fracture

May occur at the distal end of the femur, proximal end of the tibia, or in the patella

Adequate pulse/no deformity = splint the limb with straight knee

Contact medical control for absent lower pulse

NO traction splint

Patella dislocation

Most common in teen athletic activities

Usually displaces to the lateral side

Splint

Ankle injury

Dress open wounds, assess distal neurovascular function, correct gross deformities, apply splint

Foot injury

Force of injury transmitted up the legs

Associated w swelling but not deformity

RICES

Rest

Ice

Compression

Elevation

Splinting

Amputations

Occasionally can be reattach

Immobilize the part with bulky compression dressings

Wrap the body part in clean/sterile dressing and place in a plastic bag with ice surrounding

Compartment syndrome

Occurs with a fractured tibia/forearm 6-12 hours after an injury as a result of excessive bleeding/severely crushed extremity/rapid return of blood to ischemic limb

Signs: out of proportion pain, stretching muscles, pallor, decreased sensation/power

Treatment: splint at heart level, transport, reassess neurovascular status frequently