Orthopedics

Anatomy/Physiology:

  • 3 muscle types: cardiac, smooth, skeletal

  • Skeletal muscle attaches to the bones and usually crosses at least one join. Also called voluntary muscle

  • Smooth muscles are involuntary/automatic

  • Cardiac muscle are technically like smooth muscles, pumping the heart involuntarily

Fractures:

  • Comminuted

    • Bone broken into more than 2 fractures

  • Transverse

    • Straight across bone

  • Spiral

    • Caused by twisting force, causing oblique fracture around and through the bone

  • Greenstick

    • Incomplete fracture that passes only partway through the shaft of the bone

  • Oblique

    • A fracture in which the bone is broken at an angle across the bone

  • Pathologic

    • A fracture of weakened or diseased bone (ex. Osteoporosis)

  • Incomplete

    • A fracture that does not run completely through the bone

  • Epiphyseal

    • A fracture in the growth section of a child’s bone

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

    • Deformity, contusions, abrasions, punctures/penetrations, (electrical) burns, tenderness/guarding, false motion, crepitus, exposed bone fragments, locked joint, pain

Dislocations:

  • Don’t pop anything back in place just splint, that’s doctor’s job.

  • S/S similar to fracture: marked deformity, numbness, impaired circulation, etc

Sprains:

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

Strains:

  • A stretching or tearing of the muscle

  • Causes pain, swelling, and bruising of the soft tissues in the area. Often no deformity is present only minor swelling is noted at the site of the injury

RICES = Rest, Ice, Compression, Elevation, Stabilization

Amputations:

  • An amputation is where extremity is severed from body.

  • Focus on bleeding prevention.

Assessing the Severity:

  • Golden Hour is critical for life and for preserving limb viability.

Assessment:

  • Prioritize XABCDS-TV then do splinting, life threats and such are priority over splinting broken bones.

Rigid Splint:

  • Made from a firm material, applied at sides or front.

Formable Splints:

  • Most likely to use structural aluminum (SAM) splints and vacuum splints.

  • Other splints: air splints, pillow splints, sling and swathe bandages, vacuum splints

Hazards of Improper Splinting:

  • Compressions of nerves, tissues, and blood vessels

  • Delay in transport of a patient with a life-threatening injury

  • Reduction of distal circulation

  • Aggravation of injury

  • Injury to tissue, nerves, blood vessels, or muscles

Traction Splints:

  • Used primarily to secure fractures of the femur

  • Goals of in-line traction:

    • To stabilize the fracture fragments, align limb sufficiently, avoid potential neurovascular compromise

  • Only femur fracture in isolation, don’t use in others. Fracture has to be in middle third of femur. Can’t have other injuries by it.

Compartment Syndrome:

  • Typically develops within 6 - 12 hours after injury, as a result of: excessive bleeding, severely crushed extremity, rapid return of blood to an ischemic limb.

  • Splint affected limb keeping at level of the heart, transport immediately, reassess neurovascular status frequently during transport.