Musculoskeletal Injuries

• Understanding the bones, muscles, and other components of the Musculoskeletal System is crucial for identifying and treating injuries.
• General Emergency Care Guidelines include assessing the injury, immobilizing the affected area, and preventing further damage.
• Splint purpose is to immobilize the injured area to prevent further injury.
• General splinting procedures involve selecting the correct splint, applying it correctly, and ensuring it is secure but not too tight.
• Upper Extremity Injuries (arms, wrists, hands) require careful assessment and proper splinting techniques to stabilize.
• Lower Extremity Injuries (legs, ankles, feet) also need assessment and splinting to prevent further damage and facilitate healing.

Musculoskeletal System Functions

• Provides structure, support, and movement
• Protects internal organs
• Stores minerals
• Produces blood cells

Anatomy of Bone

• Bones are living tissues that can grow, repair, and remodel.
• Bones consist of a hard outer layer (compact bone) and a spongy inner layer (trabecular bone).

Bones as Living Tissue

• Bones' ability to heal and remodel has implications for skeletal injuries.
• Proper alignment and stabilization are necessary during healing. Joints connect bones and allow for movement and flexibility.
• Joints are classified by structure (fibrous, cartilaginous, synovial) and function (immovable, slightly movable, freely movable).
• Key bones in the skeletal system include the skull, spine, ribs, pelvis, and limbs.
• Understanding the forces that produce musculoskeletal injuries (compression, tension, shear) anticipates injury patterns and potential complications.
• Open fractures and femur, pelvis, and spine fractures can cause great blood loss and damage to tissues, potentially giving rise to emergency complications.
• Muscles generate movement, cartilages cushion joints, ligaments connect bones, and tendons attach muscles to bones.
• Musculoskeletal injuries can damage nearby organs.
• Fractured ribs can lead to lung damage.
• Musculoskeletal injuries include fractures, dislocations, sprains, and strains.
• Each of these injuries has specific characteristics and treatment needs.
• Musculoskeletal injuries can cause complications, such as infection, nerve damage, and impaired blood flow.
• Management decisions involve assessing the injury, stabilizing the patient, and preventing further harm.
• General assessment findings include pain, swelling, deformity, and loss of function.

Serial Checks of Distal Circulation, Sensation, and Motor Function (CSM)

• Important for monitoring adequate blood flow and nerve function for extremity injuries
• Care is prioritized by focusing on immediate life-threatening conditions first, then stabilizing the musculoskeletal injury.
• Traction can be used to align bones and reduce pain in femur fractures.
• Compartment syndrome includes severe pain, swelling, and decreased sensation or movement, requiring immediate medical attention.
• Splinting immobilizes the injury, reducing pain and preventing further damage.
• Key principles of splinting include ensuring the splint is secure but not too tight.
• Immobilize the joints above and below injury
• Check CSM before and after splinting.
• Types of splints include rigid, soft, and traction splints.
• Transport decisions require careful consideration of the patient's overall condition and musculoskeletal injury severity .

Musculoskeletal System Components

• Bones

• Joints

• Muscles

• Cartilage

• Tendons

• Ligaments

• The skeleton consists of the axial skeleton (skull, sternum, ribs, spine) and the appendicular skeleton (extremities).

• Upper extremities include the clavicles, scapulae, arms, wrists, and hands.

• Lower extremities include the pelvis, thighs, legs, ankles, and feet.

• Bones are made of dense connective tissue and provides the body framework.

• Bones support and protect internal organs.

• Bones are strong yet flexible to withstand stress.

• Bones store salts and metabolic materials which are red blood cell production sites.

• Bones are highly vascular, having a rich blood supply that can lead to bleeding during fractures.

• Major blood loss from fractures in the pelvis, hip, or femur can cause shock.

• Joints are where bones meet and are essential for movement.

• Long bones are located in the arms and thighs.

• Short bones are located in the hands and feet.

• Flat bones include the sternum, shoulder blades, and ribs.

• Irregular bones include the vertebrae of the spinal column.

• Long bones are constructed in a complex way.

• Bones contain calcium for hardness and protein fibers for flexibility.

• Combining hardness and flexibility gives bones their strength.

• Aging reduces protein formation and calcium storage in bones, which makes them brittle.

• Bones are covered by the periosteum, a strong, white, fibrous material.

• Blood vessels and nerves pass through the periosteum to enter and leave the bone.

• Periosteum can be seen when bone is exposed to injury.

• Piercing objects should not be removed from the periosteum because they may firmly hold nearby bone, blood vessels, or nerves in place.

• Each bone has a unique curvature.

• Bones used in ball-and-socket joints have rounded ends called heads.

• The head of the bone is connected to the shaft by the neck.

• Bone marrow, located in the center of bones, is responsible for red blood cell production.

• A fracture is the most common bone injury

• Initial effects of a bone injury include swelling of soft tissue and the formation of a blood clot.

• Swelling and clotting occur due to the destruction of blood vessels in the periosteum and the bone, as well as blood loss from nearby damaged vessels.

• Fracture site blood supply interruption causes cell death at the injury location.

• Cells close to the fracture site remain intact and divide rapidly within hours

• These cells form a mass of tissue that surrounds the fracture site, and new bone is generated in the process.

• Healing may take weeks or months, depending on the bone, fracture type, and patient's health and age.

• Immobilization of the broken bone properly prevents more soft tissue damage and ensures correct bone regeneration.

Complications With Fractures

• Early mishandling can lead to more soft tissue damage, longer healing times, and potential permanent disability.
• Fractures near growth plates can affect bone growth potentially resulting in one limb shorter if not properly treated (children).
• The musculoskeletal system includes muscles, cartilage, ligaments, and tendons as well.
• Muscles are tissues or fibers that cause movement of body parts or organs.

Types of Muscles

• Smooth (involuntary): In organ and digestive structure walls which move food though the digestive system.

• Cardiac (myocardial): In heart walls.

• Skeletal (voluntary): Control all conscious deliberate motions, including muscles connected to bones, in the tongue, pharynx, and upper esophagus.

• Cartilage is a connective tissue that covers the outside of the bone end (epiphysis) and allows for smooth movement at joints.

• Cartilage is crucial to less rigid flexible structures like the septum of the nose, the external ear, the trachea, and the connections between the ribs and sternum (breastbone).

• Tendons are bands of connective tissue that bind muscles to bones, allowing for movement.

• Ligaments are connective tissues that support joints by attaching bone ends, allowing for a stable range of motion.

Mnemonics to distinguish connective functions:

• MTB: muscle-tendon-bone
• BLB: bone-ligament-bone
• Mechanisms that cause musculoskeletal injuries involve direct force, twisting force, and indirect force.
• Direct force trauma includes crushed tissue and fractures, such as being struck by an automobile.
• Twisting or rotational forces can stretch or tear muscles and ligaments and break bones.
• Example is skiing where the ski digs into the snow while the body rotates.
• Indirect force injures feet and ankles when falling from height.
• Common musculoskeletal injuries include the knees, femurs, pelvis, and spinal column.
• Common causes include sporting activities (football, basketball, soccer, in-line skating, skiing, snowboarding, wrestling) and motor-vehicle collisions.
• Upper extremity injuries are frequently from forces applied to an outstretched arm during a fall, leading to broken radius, ulna, or clavicle, or dislocated shoulder.
• A fracture is the breaking of a bone and can present with varying degrees of pain and deformity.
• Distinguishing a fracture, dislocation, sprain, or severe bruise is difficult without imaging.
• In the field, treat all painful, swollen, or deformed extremities like a fracture.
• Bones are living tissue and bleed when fractured.
• Even simple cases can cause significant blood loss.

Blood Loss Examples

• Simple closed tibia–fibula fracture: approximately 500 cc (1 pint).

• Femur fracture: approximately 1,000 cc (2 pints).

• Pelvic fractures: approximately 1,500 to 2,000 cc (3 to 4 pints).

• During World War I, the death rate from closed femur fractures was about 80% due to complications.

• Tight muscle spasms caused the broken femoral ends to override, which injured blood vessels, reducing femoral fracture mortality from over 80% to less than 20%.

• Traction splints apply constant pull along the leg and reduces the mortality rate.

• Splinting an extremity with a suspected fracture can also prevent further blood loss, pain, and nerve and blood vessel injury.

• Types of musculoskeletal injuries include Fractures and breaks, classified as open or closed.

Fracture Types

• Comminuted fracture: Bone broken in several places.
• Greenstick fracture: Incomplete break, common in children due to more flexible bones.
• Angulated fracture Bone is bent at an angle.
• Dislocation is a disruption or coming apart of a joint because joint capsules and ligaments are stretched beyond their range of motion.
• A sprain is caused by the stretching and tearing of ligaments, typically associated with joint injuries.
• A strain is a muscle injury resulting from overstretching or overexertion of the muscle.
• In closed extremity injuries the skin is not broken.
• In open extremity injuries skin is broken or torn by the injured bone or by a penetrating wound.
• Open injuries are more serious due to the higher risk of contamination and infection.
• Closed injuries are often treated in a hospital, while open fractures usually require surgery.
• Proper splinting and prehospital care is crucial to keep closed injuries from opening.
• A complete exam involves using senses and the skills of inspection, palpation, and auscultation.
• Inspect (look)
• Palpate (feel)
• Ascultate (listen)
• Clothing should be cut or removed based on the environment and injury severity.

Priorities During Assessment

• In cases of severe extremity trauma, injuries are often obvious, but first confirm and treat life-threatening conditions.
• Do not let a grotesque but minor extremity injury distract from more serious conditions.
• Patients can be distracted between extremity injury, pain, or appearance and may not report other injuries or symptoms, such as abdominal pain caused by internal bleeding.
• Ensure a full assessment and avoid missing other injuries by asking questions.
• Focus on musculoskeletal injuries only after ruling out life-threatening airway, breathing, or circulation problems and injuries to the head, spine, chest, and abdomen.
• Compartment syndrome is a serious condition caused by severe swelling often from a fracture or crush injury.

Compartment Syndrome Progression

• Bleeding and swelling in the extremity.
• Increased pressure within the muscle compartment, preventing tissue perfusion.
• Cellular damage leading to more swelling.
• Loss of blood flow to the area, potentially resulting in limb loss if pressure is not relieved.

Symptoms of Compartment Syndrome

• Pain and swelling.
• Sensation of pressure.
• Hardness of the extremity on palpation.
• Reduced or absent distal circulation, sensation, and motor function.
• Treatments involve safely applying cold and elevating the extremity as well as prompt transport to an appropriate facility.
• Focus on A-B-Cs if patient is unstable.
• Use a long spine board for immobilization rather than individual splinting.
• Emergency splinting care for suspected extremity fractures begins with splinting
• Effective splinting must immobilize nearby joints and bone ends

Effective Splinting Benefits

• Minimizes movement of disrupted joints and broken bone ends.

• Decreases patient's pain.

• Prevents additional injury to soft tissues (nerves, arteries, veins, muscles).

• Prevents a closed fracture from becoming an open fracture.

• Minimizes blood loss.

• Realignment of a deformed extremity helps restore circulation and simplifies splinting.

• EMTs typically realign angulated shafts of long bones (humerus, ulna, radius, femur, tibia, fibula).

• Ineffective splinting, increased pain, further injury, and compromised nerves, arteries, and veins can result if extremity is not realigned.

• Distal circulation compromise can cause tissue death.

• Pain is typically brief during realignment.

• Reduced pain is reduced with effective splintine.

• Injured joints should generally be splinted as found, unless the distal extremity is cyanotic or lacks pulses.

• Align to a neutral position under gentle traction, as long as there no resistance is felt.

General guidelines for aligning an extremity:

• One EMT grasps the distal extremity.
• The partner places hands above and below the injury.
• The partner supports the site while the first EMT applies gentle manual traction along the long axis.
• Stop if the fracture is close to breaking skin.
• Otherwise, maintain alignment while splinting.
• Effective splinting can require using available materials as improvisation.
• Soft splints include pillows and rolled blankets.
• Firm or rigid splints can be improvised with lumber, cardboard, rolled newspapers, umbrellas, canes, broom handles, or shin guards.
• A tongue compress can be use for finger injuries.
• EMS units carry three basic types of splints comprising of rigid splints, formable splints, and traction splints.

Rigid Splints

• The limb must be moved to the anatomic position.
• These splints provide the greatest support and and are ideal for splinting long-bone injuries.
• Examples include cardboard, wood, Velcro, pneumatic splints (air splints, vacuum splints), and pneumatic anti-shock garments.

Formable Splints

• Can be molded to different angles.
• Allow for considerable movement.
• Immobilize joint injuries in the position found.
• Examples include pillow and blanket splints.

Traction Splints

• Specifically address and protect femur fractures
• Care for life-threatening problems first before addressing other injuries.
• Expose the injury site during treatment by controlling any bleeding before moving the injured extremity.
• CSM assesses circulation sensation, and movement that can monitor nerve and blood vesicle injuries.
• Use gentle traction if there is severe deformity or compromised circulation.
• Splint adjacent joints while insuring the site of injury remains still.
• Splint each injured site and secure it individually for each limb.
• Minimize how many times you handle the damaged area by securing the limb to the torso or another limb.
• Splint before moving the patient if possible. If extrication is necessary, fix the area with another limb.
• Use padding to fill void areas for proper immobilization.

Hazards of Splinting

• Address the airway before splinting any injury.
• Address all threatening conditions without concern for splinting.
• Splinting is contingent on the patients condition and the urgency of transport.
• Excessive or lack of compression during splinting can cause soft tissue injuries.
• Wounds must be realigned during splinting to avert additional trauma.
• Splinting can only be effective if excessive movement is avoided, otherwise additional damage and injury may occur.
• Select an appropiate splint based on all variables and conditions.
• Prepare all roller bandages, cravats, and pading as necessary.
• Use fromable splints for joints found in position.
• Use these guidelines when splinting long joints in positions where gentle traction can be applied when cyanotic.

Follow guidelines for splinting long-bone or joint injuries:

• Take Standard Precautions and expose the area if possible.
• Manually stabilize the injury site.
• Assess circulation, sensation, and motor function (CSM) by checking pulses, sensation, and movement distal to the injury.
• Realign the injury if deformed or if the distal extremity is cyanotic or pulseless.
• Measure or adjust the splint.
• Position it under or alongside the limb while maintaining stabilization or applying traction.
• Apply and secure the splint to immobilize adjacent joints and the injury site.
• Reassess CSM distal to the injury after splinting.
• A splint can be used under the vacuum conditions surrounding the extremity.
• Move a vacuum into place while leaving the distal end exposed.
• Compress air from within using a pumping method.
• Secure the velco straps and monitor.

Traction Splint

• Muscle spasming causes misalignment when fractures occur within the thigh area.
• Splints are used to counteract muscle spasms and reduce pain.

Types of Traction Splints

1. Bipolar splints: Cradle the leg using metal rods
2. Unipolar splints: Place a metal rod allong the leg

• Unipolar split traction should be 10% of bodyweight not exceeding 15 pounds
• Bipolar splits create firm pull against the limb to prevent override
• Field applied splints exert force against pelvis
• Bipolar movement can cause shifting and loss
• Unipolar are anchored towards the pelvis, less likely to shift
• Traction is split between swelling and deformities, as well as no lower point damages.
• An evaluation is required to asses the extent of damages along the extremity

Basic Actions to Take

1. Standard precautions and manual stabilize is first
2. Use CSM while accessing to the injury sites
3. Adjust the split and secure the proper ischal, ischal staps
4. Align straps and pull on the patients torso to prevent shifts
5. Reasses to ensure minimal problems
6. Check distal pulses

• Shoulders can self reduce allowing the humurous to reset in place.
• A check of distal movement is needed and a sling to mobilize.
• Shoulder injuries are prone to weakining as a result of the injury
• Physician evaluation is necessary

Lower Extremity Injuries

• Pelvic wraps are used to treat pelvic injuries due to stabilization and internal complications.
• Injuries for alternative anti shock garmets that are pelvic related.
• Pelvic injuries are due to shock symptoms.
• These accidents can occur from car crashes without any damages
• Split injuries may or may not indicate stability

Assess Patients In The Following Way

1. Support should provided and placed across the back of the hips
2. Center it in tangent with the greater iliac
3. Stabalize and apply pressure until there is a proper support.
4. Ensure clamps are in place along the compression zones

• Patella dislocation involves the kneecap or tibia being displaced.
• A distal pulse helps assess.
• An emergency response may be needed to perform leg movement.
• Fractures are often hidden due to a variety of injuries.

Splittering And Monitoring

• Always perform and transport any injuries
• Assess CSM symptoms
• Discoloration or coldness are immediate indicators of symptoms and leg damages
• Bones bleed during multiple injuries, so bleeding control is essential.
• Fractures may be an indication of shock.
• Splint by mobilizing joints in the area and assess the amount that it can be reduced by.
• Multiple patients can cause trauma when splittering areas.

Injuries Are

• An angled fractures which can affect the broken section
• Bones that are flexible structure to provide supports
• Cartilage to cover the body such as ears
• An opening of the skin in areas is a closed injury
• Injuries resulting in blood vessels can result in compartment shock

Short Answers

• Bones have multiple purposes such as structure, muscles, organs and calcium
• The signs and symptoms of fracture are the bruising and the unability to move with pressure applied
• Swelling and ice compression are ideal treatments for fracture injures.
• Check circulation and sensations for long injuries especially.

This lesson covers musculoskeletal injuries, their causes, and immediate care guidelines. It emphasizes understanding anatomy for assessment, proper splinting techniques, and potential complications like blood loss and organ protection. The content also addresses injury mechanisms and field management.