EMT Chapter 32 Orthopaedic Injuries

acromioclavicular joint

A simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder.

amputation

An injury in which part of the body is completely severed.

articular cartilage

A pearly white Lair of specialized cartilage covering the articular surfaces( contact surfaces on the end) of bones in synovial joints

Calcaneus

heel bone

Closed fracture

Any break in a bone in which the overlying skin is not broken.

compartment syndrome

Swelling in a confined space that produces dangerous pressure; may cut off blood flow or damage sensitive tissue;pPainful swelling and increased pressure in a injured limb to the point that blood cannot supply muscles and nerves with oxygen and nutrients

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; produce a crackling sound or crinkly feeling.

Dislocation

Disruption of a joint in which ligaments are damaged and the bone ends are no longer in contact.

Displaced fracture

A fracture in which bone fragments are separated from one another and not in anatomic alignment. Produces deformity in the limb

Ecchymosis

Bruising or discoloration associated with bleeding within or under the skin.

False motion

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called free movement.

Fascia

The fiberlike connective tissue that covers arteries, veins, tendons, and ligaments.

Fibula

the outer and thinner of the two bones of the human leg between the knee and ankle

Fracture

a break in the continuity of a bone

Glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint.

Hematuria

blood in the urine

Joint

The place where two bones come into contact

Ligaments

bands of fibrous tissue that form joints by connecting one bone to another bone. Ligaments support and strengthen a joint

nondisplaced fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

Open fracture

Any break in a bone in which the overlying skin has been broken "compound"

Pelvic binder

A device to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain.

point tenderness

Tenderness that is sharply localized at the site of the injury, found by gently palpating along the bone with the tip of one finger.

Position of function

A hand position in which the wrist is slightly dorsiflexed and all finger joints are moderately flexed.

Reduce

To return a dislocated joint or fractured bone to its normal position; to set

retroperitoneal space

The space between the abdominal cavity and the posterior abdominal wall, containing the kidneys, certain large vessels, and parts of the gastrointestinal tract.

sciatic nerve

The major nerve To the lower extremities, controls much of muscle function in the leg and sensation and most of the leg and foot

Sling

A bandage or material that helps to support the weight of an injured upper extremity.

Splint

A flexible or rigid appliance used to protect and maintain the position of an injured extremity.

Sprain

occurs when a joint is twisted or stretched beyond its normal range of motion; seperation of the bone ends

Strain

Stretching or tearing of a muscle; muscle pull

Swathe

A bandage that passes around the chest to secure an injured arm to the chest.

Tibia

The shin bone, the larger of the two bones of the lower leg.

tourniquet

The bleeding control method Used when a wound continues to bleed despite the use of direct pressure, useful if a patient is bleeding severely from a partial or complete amputation

Traction

Longitudinal force applied to a structure; act of pulling on a body structure in the direction of its normal alignment

Zone of injury

The area of potentially damaged soft tissue, adjacent nerves, and blood vessels surrounding an injury to a bone or a joint.

The musculoskeletal system provides

Form, Upright posture, Movement

The musculoskeletal system protects

vital internal organs

are among the most common reasons why patients seek medical attention

Musculoskeletal injuries

Skull protects

brain

Thoracic (rib) cage protects

heart, lungs, and great vessels

Lower ribs protects

liver & spleen

Spinal column protects

spinal cord

The bones of the skeleton provide a

framework to which the muscles and tendons are attached

Tendons

Attach muscle to bone

Significant force is generally required to cause

fractures and dislocations

Treat any injury that breaks the skin as a possible

open fracture

Fractures are described by whether the bone

is moved from its normal position

Comminuted fracture

the bone is broken into more than two fragments

Epiphyseal fracture

the growth section of a child’s bone

Greenstick fracture

*typically seen in children due to their bones being softer; incomplete, that passes only partway through the shaft of a bone

Pathologic fracture

weakened or diseased bone

Oblique fracture

the bone is broken at an angle across the bone

Incomplete fracture

does not run completely through the bone

Spiral fracture

caused by a twisting force, causing an oblique fracture around and through the bone

Transverse fracture

occurs straight across the bone

Suspect a fracture if one or more of the following signs are present

Deformity, Tenderness, Guarding, Swelling, Bruising, Crepitus, Exposed fragments, Pain, Locked joint

RICES

Rest, Ice, Compression, Elevation, Splinting

Compartment Syndrome is characterized by

Pain that is out of proportion to the injury, Pain on passive stretching of muscles within the compartment, Pallor, Decreased sensation, Decreased power

If you suspect the patient has compartment syndrome

Splint the affected limb, keeping it at the level of the heart; Transport immediately; Reassess neurovascular status frequently during transport

__ is one of the most devastating consequences of an orthopaedic injury

Long-term disability

Severe injuries may compromise __, which could be limb threatening

neurovascular function

Assess neurovascular function by using the 6 P's of musculoskeletal assessment

parasthesia, pain, pressure, pallor (capillary refill < 3 sec), paralysis, pulses (distal to injured extremity)

PMS

pulse, motor, sensation

Splinting will help to prevent

Further damage to muscles, the spinal cord, peripheral nerves, and blood vessels; Laceration of the skin; Restriction of distal blood flow; Excessive bleeding of the tissues; Increased pain; Paralysis of extremities

Two situations in which you must splint the limb in the position of deformity

When the deformity is severe AND When you encounter resistance or extreme pain when applying gentle traction to the fracture of a shaft of a long bone

Very few musculoskeletal injuries justify the use of excessive speed during transport but a

patient with a pulseless limb must be given a higher priority

The is one of the most commonly fractured bones in the body

clavicle

Fractures of the ________ occur much less frequently because the bone is well protected by many large muscles

scapula

The humeral head most commonly dislocates

anteriorly

Dislocation of the elbow

The ulna and radius are most often displaced posteriorly

Fracture of olecranon process of ulna

Patient will be unable to extend the elbow

Fractures of the radial head

Attempts to rotate the elbow or wrist cause discomfort

Often results from direct compression in the form of a heavy blow

Fractures of the Pelvis (May be accompanied by life-threatening loss of blood)

Suspect a fracture of the pelvis in any patient who has sustained a high-velocity injury and complains of

discomfort in the lower back or abdomen

Bone fragments in a pelvis fracture can lacerate the

rectum, vagina, and bladder

Dislocation of the Hip

Dislocates only after significant injury; Most dislocations are posterior

Rotation and shortening: Anterior

Internal rotation

Rotation and shortening: Anterior

Outward rotation

Posterior dislocation is frequently complicated by injury to the

sciatic nerve

Do not use traction splints for any of these conditions

Injuries of the upper extremity; Open fracture of femur or lower leg; Injuries close to or involving the knee; Injuries of the pelvis and hip; Partial amputations or avulsions with bone separation; Lower leg, foot, or ankle injury

These are true emergencies that may threaten the limb.

Dislocation of the Knee (Limb-threatening popliteal artery disruption, Injuries to the nerves, Joint instability)

Usually, the dislocated patella displaces to the

lateral side and produces significant deformity

Skeletal muscle is also referred to as

striated muscle

You respond to a soccer game for a 16-year-old male with severe ankle pain. When you deliver him to the hospital, the physician tells you that he suspects a sprain. This means that

stretching or tearing of the ligaments with partial or temporary dislocation of the bone ends has occurred

A young male has a musculoskeletal injury and is unresponsive. You will NOT be able to assess

sensory and motor functions

The purpose of splinting a fracture is to

prevent motion of bony fragments

A motorcyclist crashed his bike and has closed deformities to both of his midshaft femurs. He is conscious, but restless; his skin is cool and clammy; and his radial pulses are rapid and weak. The MOST appropriate splinting technique for this patient involves

securing him to a long backboard

To effectively immobilize a fractured clavicle, you should apply a(n)

sling and swathe

A patient tripped, fell, and landed on her elbow. She is in severe pain and has obvious deformity to her elbow. You should

manually stabilize her injury

When treating an open extremity fracture, you should

dress the wound before applying a splint

Which of the following musculoskeletal injuries has the GREATEST risk for shock due to blood loss?

Pelvic fracture

A patient injured her knee while riding a bicycle. She is lying on the ground, has her left leg flexed, is in severe pain, and cannot move her leg. Your assessment reveals obvious deformity to her left knee. Distal pulses are present and strong. The MOST appropriate treatment for her injury involves

splinting the leg in the position in which it was found

A fracture is most accurately define as

break in the continuity of the bone

In moving joints, the ends of the bones are covered with

articular cartilage

In general, musculoskeletal injuries should be splinted before moving the patient unless

the patient is clinically unstable

Traction splints primarily immobilize and secure fractures of the

femur

A _______ is a musculoskeletal injury in which there is partial or temporary seperation of the bone ends as well as partial stretching or tearing of the supporting ligaments

sprain

Which of the following scenarios is an example of a direct injury?

a passenger fractures her patella after it strikes the dashboard

Which of the following types of muscle is under direct voluntary control of the brain?

skeletal

The most commonly fractured bone in the body is the

clavicle