Musculoskeletal Trauma PDF

Core Concepts Musculoskeletal System: Understanding the bones, muscles, and other components is crucial for identifying and treating injuries. Emergency Care Guidelines: General guidelines include assessing the injury, immobilizing the affected area, and preventing further damage. Splinting: The purpose of splinting is to immobilize the injured area to prevent further injury. General procedures involve selecting the appropriate splint, applying it correctly, and ensuring it is secure but not too tight. Upper Extremity Injuries: Specific injuries to the upper extremities (arms, wrists, hands) require careful assessment and appropriate splinting techniques to stabilize the injury. Lower Extremity Injuries: Injuries to the lower extremities (legs, ankles, feet) also need proper assessment and splinting to prevent further damage and facilitate healing. Outcomes Functions of the musculoskeletal system: Provides structure, support, and movement; protects internal organs; stores minerals; and produces blood cells. Anatomy of bone: Bones are living tissues that can grow, repair, and remodel. They consist of a hard outer layer (compact bone) and a spongy inner layer (trabecular bone). Nature of bones as living tissue: Bones' ability to heal and remodel has implications for skeletal injuries, such as the need for proper alignment and stabilization during healing. Function of joints: Joints connect bones and allow for movement and flexibility. They can be classified by their structure (fibrous, cartilaginous, synovial) and function (immovable, slightly movable, freely movable). Bones of the skeletal system: Includes major bones such as the skull, spine, ribs, pelvis, and limbs. Forces producing musculoskeletal injuries: Understanding the forces (compression, tension, shear) helps anticipate injury patterns and potential complications. Fractures with high potential for emergency complications: Includes open fractures, fractures of the femur, pelvis, and spine, which can lead to significant blood loss and damage to surrounding tissues. Anatomy and physiology of muscles, cartilages, ligaments, and tendons: Muscles generate movement, cartilages cushion joints, ligaments connect bones, and tendons attach muscles to bones. Potential for underlying organ injury: Musculoskeletal injuries can be associated with damage to nearby organs, such as rib fractures leading to lung injury. Types of musculoskeletal injuries: Includes fractures, dislocations, sprains, and strains, each with specific characteristics and treatment needs. Complications of musculoskeletal injury: Injuries can lead to complications like infection, nerve damage, and impaired blood flow. Management decisions for musculoskeletal injuries: Involves assessing the injury, stabilizing the patient, and preventing further harm. General assessment findings: Includes pain, swelling, deformity, and loss of function. Serial checks of distal circulation, sensation, and motor function (CSM): Important for monitoring extremity injuries to ensure adequate blood flow and nerve function. Prioritizing care steps: Focus on life-threatening conditions first, then stabilize the musculoskeletal injury. Use of traction: Traction can be used to align bones and reduce pain in certain fractures, such as femur fractures. Signs of compartment syndrome: Includes severe pain, swelling, and decreased sensation or movement, requiring immediate medical attention. Role of splinting: Splinting immobilizes the injury, reduces pain, and prevents further damage. Principles of splinting: Ensure the splint is secure but not too tight, immobilize the joints above and below the injury, and check CSM before and after splinting. Types of splints: Includes rigid splints, soft splints, and traction splints, each suited for different types of injuries. Transport decisions: Consider the overall condition of the patient and the severity of the musculoskeletal injury when deciding on transport. Musculoskeletal System The musculoskeletal system includes bones, joints, muscles, cartilage, tendons, and ligaments. The skeleton is divided into two major parts: the axial skeleton and the appendicular skeleton. Axial skeleton: Comprises the skull (cranium and face), sternum, ribs, and spine (cervical, thoracic, and lumbar vertebrae, sacrum, and coccyx). Appendicular skeleton: Includes the extremities. Upper extremities: Clavicles, scapulae, arms, wrists, and hands. Lower extremities: Pelvis, thighs, legs, ankles, and feet. Anatomy of Bone Bones are composed of dense connective tissue and form the body's framework. They provide support and protection for internal organs and need to be strong yet flexible to withstand stress. Bones store salts and metabolic materials and are sites for red blood cell production. Bones are highly vascular, meaning they have a rich blood supply and can bleed when fractured. Significant blood loss from bone fractures, such as in the pelvis, hip, or femur, can lead to shock. Joints are where bones meet and are essential for movement. Bones are classified by appearance into four types: Long bones: Found in the arms and thighs. Short bones: Located in the hands and feet. Flat bones: Include the sternum, shoulder blades, and ribs. Irregular bones: Examples include the vertebrae of the spinal column. Figure 32-5 Bones are classified by shape. Long bones are complex structures, not uniform throughout. Bones contain calcium for hardness and protein fibers for flexibility. The combination of hardness and flexibility gives bones their strength. Aging reduces protein formation and calcium storage in bones, making 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. The periosteum becomes visible when bone is exposed due to injury. Do not remove objects piercing the periosteum as they may be firmly held and could be impaled in bone, blood vessels, or nerves. Each bone has a unique curvature, and bones involved 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. Self-Healing Nature of Bone The most common bone injury is a fracture. 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. Figure 32-6 (A) Open fracture and dislocation of the ankle. (B) X-ray of the same injury. Interruption of blood supply at a fracture site causes cell death at the injury location. Cells near the fracture site remain intact and begin to divide rapidly within hours. These cells form a mass of tissue that surrounds the fracture site, from which new bone is generated. The healing process can take weeks or months, depending on the bone, fracture type, and patient’s health and age. Immobilization of the broken bone is crucial for proper healing to prevent further soft tissue damage and ensure correct bone regeneration. Mishandling the fracture early can lead to more soft tissue damage, longer healing times, and potential permanent disability. In children, fractures near the growth plate can affect bone growth, potentially resulting in one limb being shorter if not properly treated. Muscles, Cartilage, Ligaments, and Tendons The musculoskeletal system includes muscles, cartilage, ligaments, and tendons. Muscles are tissues or fibers that cause movement of body parts or organs. There are three types of muscles: Smooth (involuntary) muscles: Found in the walls of organs and digestive structures, they move food through the digestive system and perform other functions. Cardiac (myocardial) muscle: Found in the walls of the heart. Skeletal (voluntary) muscles: Control all conscious or deliberate motions and include muscles connected to bones, as well as muscles in the tongue, pharynx, and upper esophagus. Figure 32-7 (A) The muscular system. (B) Three types of muscle.. Cartilage is a connective tissue that covers the outside of the bone end (epiphysis) and allows for smooth movement at joints. Cartilage is less rigid than bone and forms or helps to form flexible structures such as: The septum of the nose (wall between the nostrils) The external ear The trachea Connections between the ribs and sternum (breastbone) Tendons are bands of connective tissue that bind muscles to bones, enabling the power of movement across the joints. Figure 32-8 Meat grinder injury to soft tissue, tendons, ligaments, and bone in a child. Ligaments are connective tissues that support joints by attaching bone ends. They allow for a stable range of motion. Mnemonics to distinguish connective functions: MTB: muscle–tendon–bone BLB: bone–ligament–bone Mechanisms of Musculoskeletal Injury Three types of mechanisms cause musculoskeletal injuries: direct force, twisting force, and indirect force. Direct force: Example includes being struck by an automobile, leading to crushed tissue and fractures. Twisting or rotational forces: These can stretch or tear muscles and ligaments and break bones, such as when a ski digs into the snow while the skier’s body rotates. Indirect force: Often occurs when falling from heights and landing on feet, causing injuries to feet and ankles (direct) and knees, femurs, pelvis, and spinal column (indirect). Common causes of musculoskeletal injuries: Sporting activities (football, basketball, soccer, in-line skating, skiing, snowboarding, wrestling) and motor-vehicle collisions. Upper extremity injuries: Frequently caused by forces applied to an outstretched arm during a fall, leading to broken radius, ulna, or clavicle, or dislocated shoulder. Injury to Bones and Connective Tissue A fracture is the breaking of a bone and can present with varying degrees of pain and deformity. It is often difficult to distinguish between a fracture, dislocation, sprain, or severe bruise without imaging. In the field, assume the worst and treat any painful, swollen, or deformed extremity as a fracture. Bones are living tissue and bleed when fractured, even in simple cases. Blood loss from fractures can be significant: Simple closed tibia–fibula fracture: approximately 500 cc (1 pint) of blood loss. Femur fracture: approximately 1,000 cc (2 pints) of blood loss. Pelvic fractures: approximately 1,500 to 2,000 cc (3 to 4 pints) of blood loss. Figure 32-10 Bones bleed. In fact, there may be considerable blood loss, even from an uncomplicated closed fracture. During World War I, the death rate from closed femur fractures was about 80% due to complications like blood loss. Surgeons observed that thigh muscle spasms caused the broken femoral ends to override each other, injuring blood vessels. They invented the traction splint, which applies constant pull along the leg to stabilize the bone and reduce muscle spasms. Early application of a traction splint reduced the mortality rate from femur fractures to less than 20%. Splinting an extremity with a suspected fracture can prevent additional blood loss, pain, and complications from nerve and blood vessel injury. There are four types of musculoskeletal injuries: Fracture: Any break in a bone, classified as open or closed. 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. Figure 32-13 (A) A closed angulated fracture. (B) An X-ray of the same fracture. A dislocation is the disruption or coming apart of a joint. It occurs when the soft tissue of the joint capsule and ligaments are stretched beyond their normal range of motion and torn. Figure 32-14 A right shoulder dislocation. 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. Closed extremity injuries occur when the skin is not broken. Open extremity injuries involve broken or torn skin, either from the inside by the injured bone or from the outside by a penetrating wound. Open injuries are more serious due to the higher risk of contamination and infection. Closed injuries can often be treated in a hospital emergency department, while open fractures usually require surgery. Proper splinting and prehospital care are crucial to prevent closed injuries from becoming open ones. Figure 32-14 A right shoulder dislocation. 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. Closed extremity injuries occur when the skin is not broken. Open extremity injuries involve broken or torn skin, either from the inside by the injured bone or from the outside by a penetrating wound. Open injuries are more serious due to the higher risk of contamination and infection. Closed injuries can often be treated in a hospital emergency department, while open fractures usually require surgery. Proper splinting and prehospital care are crucial to prevent closed injuries from becoming open ones. Assessment of Musculoskeletal Injuries Examination involves using your senses and the skills of inspection (looking), palpation (feeling), and auscultation (listening). It is challenging to perform a proper examination on fully clothed patients, but complete disrobing may not always be practical or advisable due to weather, modesty, or patient refusal. Clothing should be cut or removed based on the environment and the severity of the situation. In cases of severe extremity trauma, injuries may be very obvious, but the priority is to identify and treat life-threatening conditions first. Do not let a grotesque but minor extremity injury distract you from more serious conditions. Patients may be distracted by the pain or appearance of an extremity injury and may not notice other injuries or symptoms, such as abdominal pain from internal bleeding. Ensure a full assessment of the patient and ask appropriate questions to avoid missing other injuries. Focus on musculoskeletal injuries to the extremities only after ruling out life-threatening airway, breathing, or circulation problems and injuries to the head, spine, chest, and abdomen. Compartment Syndrome Compartment syndrome is a serious condition caused by severe swelling in an extremity, often due to a fracture or crush injury. The progression of compartment syndrome includes: Bleeding and swelling within the extremity. Increased pressure within the muscle compartment, preventing tissue perfusion. Cellular damage leading to further swelling. Loss of blood flow to the area, potentially resulting in limb loss if pressure is not relieved. Signs and symptoms include: Pain and swelling. Sensation of pressure. Hardness of the extremity on palpation compared to the uninjured side. Reduced or absent distal circulation, sensation, and motor function (CSM). Treatment involves: Cold application and elevation of the extremity, if safe after splinting. Prompt transport to an appropriate facility. Primary assessment: If the patient is unstable, managing extremity injuries is a low priority. Focus on A-B-Cs and use a long spine board for immobilization rather than individual splinting. Fasciotomy of arm Compartment syndrome is a serious condition caused by severe swelling in an extremity, often due to a fracture or crush injury. The progression of compartment syndrome includes: Bleeding and swelling within the extremity. Increased pressure within the muscle compartment, preventing tissue perfusion. Cellular damage leading to further swelling. Loss of blood flow to the area, potentially resulting in limb loss if pressure is not relieved. Signs and symptoms include: Pain and swelling. Sensation of pressure. Hardness of the extremity on palpation compared to the uninjured side. Reduced or absent distal circulation, sensation, and motor function (CSM). Treatment involves: Cold application and elevation of the extremity, if safe after splinting. Prompt transport to an appropriate facility. Primary assessment: If the patient is unstable, prioritize managing A-B-Cs and immobilize the entire body on a long spine board rather than individually splinting each injury. Splinting Emergency care for suspected extremity fractures begins with splinting. Effective splinting must immobilize adjacent joints and bone ends. Benefits of effective splinting: 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. In the case of spinal injuries, immobilization prevents spinal cord injury and permanent paralysis. Realignment of the Deformed Extremity 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). Not realigning can lead to ineffective splinting, increased pain, further injury, and compromised nerves, arteries, and veins. Distal circulation compromise can cause tissue death due to lack of oxygen. Pain during realignment is brief and reduced by effective splinting. Injured joints should be splinted as found unless the distal extremity is cyanotic or lacks pulses; in such cases, align to a neutral position using gentle traction if no resistance is felt. General guidelines for realigning an extremity: One EMT grasps the distal extremity while 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 resistance is felt or if bone ends threaten to break the skin; otherwise, maintain traction until alignment and splinting are achieved. Strategies for Splinting Effective splinting often requires improvisation using available materials. Soft splints can be made from pillows or rolled blankets. Rigid splints can be improvised using items like lumber, cardboard, rolled newspapers, umbrellas, canes, broom handles, or catcher’s shin guards. For finger injuries, a tongue depressor can be used as a splint. EMS units carry three basic types of splints: rigid splints, formable splints, and traction splints. Rigid splints: Require the limb to be moved to the anatomic position. Provide the greatest support. 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. Commonly used to immobilize joint injuries in the position found. Examples include pillow and blanket splints. Traction splints: Specifically used for femur fractures. Figure 32-17 Splints and accessories for musculoskeletal injuries. Care for life-threatening problems first: Prioritize stabilizing the patient if they are unstable before splinting. Expose the injury site: Control any bleeding before moving the injured extremity. Assess distal CSM: Check and record circulation, sensation, and motor function both before and after splinting to monitor for nerve and blood vessel injury. Align long-bone injuries to the anatomic position: Use gentle traction if there is severe deformity or compromised distal circulation. Do not push protruding bones back into place. Immobilize both the injury site and adjacent joints: Ensure the splint keeps the injury site and the joints above and below still. If a joint is injured, immobilize the joint and the adjacent bones. Choose a method of splinting based on patient priority: Splint each site individually (slowest but best). Secure the limb to the torso or an uninjured leg (faster but second choice). Secure the entire body to a spine board (fastest but least effective). Splint before moving the patient if possible: Minimize handling to reduce damage. If extrication is necessary, immobilize the extremity as best as possible, such as by securing it to the uninjured limb. Pad the voids: Use padding to fill spaces between the body part and the splint to ensure proper immobilization and increase patient comfort. Hazards of Splinting Prioritize life-threatening conditions: Always address airway, breathing, and circulation before splinting. Severity and transportation dictate splinting method: The approach to splinting depends on the patient's condition and the urgency of transport. Risks of improper splinting: Too tight: Can compress soft tissue, injuring nerves, blood vessels, and muscles. Too loose: Allows excessive movement, risking further soft-tissue injury or open fractures. Avoid splinting in a deformed position: Realign deformed injuries properly to prevent additional harm. Focus on preventing excessive movement: Proper splinting is crucial to avoid further injury. Hazards of Splinting Prioritize life-threatening conditions: Always address airway, breathing, and circulation before splinting. Transport priority: The method of splinting depends on the severity of the patient's condition and the need for rapid transportation. Risks of improper splinting: Too tight: Can compress soft tissue, injuring nerves, blood vessels, and muscles. Too loose: Allows excessive movement, risking further soft-tissue injury or open fractures. Avoid splinting in a deformed position: Realign deformed injuries properly to prevent additional harm. Challenge of splinting deformed long-bone injuries: It is difficult to prevent excessive movement, so proper technique is crucial. Splinting Long-Bone and Joint Injuries Select an appropriate splint based on the severity of the condition and transportation method. Have cravats, padding, and roller bandages ready before starting. Use formable splints to splint joints in the position found; align to the anatomic position if the distal extremity is pulseless or cyanotic using gentle traction. Follow these 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 and position it under or alongside the limb, maintaining stabilization or traction. Apply and secure the splint to immobilize adjacent joints and the injury site. Reassess CSM distal to the injury after splinting. Scan 32-2 Immobilizing a Joint Assess and prepare the extremity for splinting using the previous steps. Move the vacuum splint into position around the extremity. Leave the distal end (fingers or toes) exposed. Withdraw the air from the splint using the pump until it is firm. Secure the Velcro straps. Monitor the patient. Traction Splint Femur fractures: Major issue is muscle spasms in the thigh (quadriceps and hamstrings) causing bone ends to override, leading to pain and further soft-tissue injury. Traction splints: Used to counteract muscle spasms and reduce pain. Two types: 1. Bipolar splints: Cradle the leg between two metal rods (e.g., half-ring splint, Hare, Fernotrac). 2. Unipolar splints: Single metal rod placed alongside the leg (e.g., Sager, Kendrick traction devices). Application of traction: 1. For Sager unipolar splint, traction should be about 10% of the patient's body weight, not exceeding 15 pounds (6.8 kg). 2. For bipolar splints, apply firm traction to align the limb and maintain a firm pull to prevent bone override. Counter-traction: All field-applied traction splints exert counter-traction, pulling on an ankle hitch and anchoring against the pelvis. 1. Bipolar splints: Movement of the pelvis can cause shifting and loss of traction. 2. Unipolar splints: Anchored against the pubis, less likely to shift during patient movement. Indications for traction splint: Painful, swollen, deformed mid-thigh with no joint or lower leg injury. Contraindications: Pelvis, hip, or knee injury; avulsion or partial amputation; injury to the lower third of the leg. Application guidelines: 1. Take Standard Precautions and expose the area if possible. 2. Manually stabilize the leg and apply manual traction. 3. Assess CSM (circulation, sensation, movement) distal to the injury. 4. Adjust the splint to the proper length and position it under the injured leg. 5. Apply the proximal securing device (ischial strap). 6. Apply the distal securing device (ankle hitch). 7. Apply mechanical traction. 8. Position and secure support straps. 9. Reevaluate securing devices and reassess CSM distal to the injury. 10.Secure the patient’s torso and the traction splint to a long spine board to immobilize the hip and prevent movement of the splint. Upper-Extremity Injuries A dislocated shoulder can sometimes self-reduce, meaning the humerus head returns to its place on its own. After self-reduction, check the distal circulation, sensation, and movement (CSM). Apply a sling and swathe to immobilize the shoulder. Transport the patient to a medical facility. The shoulder joint remains at high risk of re-dislocation due to weakened or stretched ligaments. The patient needs to be evaluated by a physician. Lower-Extremity Injuries The pelvic wrap is used to treat pelvic injuries by reducing internal bleeding, pain, and providing stabilization. It is an alternative to the pneumatic anti-shock garment (PASG) and is used for suspected pelvic fractures. The pelvic wrap should be applied to patients with pelvic deformity or instability, regardless of shock signs. It may also be used based on the mechanism of injury, such as motorcycle crashes or auto-pedestrian collisions, even without obvious deformity. Commercial pelvic splints can be used, or a pelvic wrap can be improvised from a sheet. The wrap or splint can be placed on the backboard before moving the patient, to be secured if instability or shock develops. Always adhere to local protocols when applying a pelvic wrap. Figure 32-19 (A) A commercial pelvic splint. (B) To devise a pelvic wrap, lay a sheet, folded flat, approximately 10 inches (25 centimeters) wide onto the backboard. (C) Bring the sides of the sheet together. (D) Tie the sheet firmly without overcompression to complete the pelvic wrap. Determine if the patient needs pelvic stabilization due to an unstable pelvis, with or without signs of shock or mechanism of injury (MOI). Prepare a backboard with a sheet folded flat, approximately 10 inches (25 centimeters) wide, placed across the backboard where the hips will be positioned. Carefully roll the patient onto the backboard and center the sheet at the patient’s greater trochanter, positioning it lower than the iliac wings. Bring the sides of the sheet around to the front of the patient, causing compression and stabilization of the pelvis as you tie the sheet. Ensure the sheet is firm enough to maintain the pelvis in a normal position without overcompression. Secure the sheet using ties or clamps to maintain the compression. Scan 32-13 Two-Splint Method—Straight Knee Patella Dislocation vs. Knee Dislocation: A patella dislocation involves the kneecap being displaced and laterally palpable, often with the knee stuck in flexion. A knee dislocation involves the tibia being forced anteriorly or posteriorly relative to the distal femur. Distal Pulse Check: Always check for a distal pulse in cases of knee dislocation, as the popliteal artery may be compressed, stopping blood supply to the lower leg. Lack of pulse is an emergency. Emergency Response: If no pulse is detected, contact medical direction for permission to gently move the lower leg to restore the pulse and transport the patient immediately. Potential Hidden Damage: Even if the patella appears to have repositioned itself, other injuries such as fractures or combined fractures and dislocations may be present. Splinting and Monitoring: Always splint the injury and transport the patient, regardless of whether it is a fracture, dislocation, sprain, or strain. Monitor the patient for loss of distal circulation, sensation, and movement (CSM), and for signs of discoloration or coldness in the foot. Transport without delay if these symptoms occur and notify medical direction while en route. Chapter Review Bones bleed: Fractures cause blood loss from within the bone and surrounding tissue damage. Shock risk: Serious or multiple fractures can lead to shock. Splinting: Immobilize the bone ends and adjacent joints to protect from further injury, reduce pain, and control bleeding. Creativity in splinting: There are multiple correct ways to splint the same extremity. Pre-movement splinting: Splint injuries to bones and joints before moving the patient. Multiple trauma or shock: If the patient has multiple trauma or shock, prioritize placing the patient on a long spine board and securing the limbs. Splint individual fractures en route if possible. Chapter Glossary Angulated fracture: A fracture where the broken bone segments are at an angle to each other. Bones: Hard but flexible living structures that provide support for the body and protection to vital organs. Cartilage: Tough tissue that covers the joint ends of bones and helps form certain body parts, such as the ear. Closed extremity injury: An injury to an extremity with no associated opening in the skin. Comminuted fracture: A fracture where the bone is broken in several places. Compartment syndrome: Injury caused when tissues such as blood vessels and nerves are constricted within a space, often due to swelling or a tight dressing/cast. Crepitus: A grating sensation or sound made when fractured bone ends rub together. Dislocation: The disruption or separation of a joint. Extremities: Portions of the skeleton including the clavicles, scapulae, arms, wrists, hands (upper extremities), and pelvis, thighs, legs, ankles, feet (lower extremities). Fracture: Any break in a bone. Greenstick fracture: An incomplete fracture. Joints: Places where bones articulate or meet. Ligaments: Tissues that connect bone to bone. Manual traction: The process of applying tension to straighten and realign a fractured limb before splinting; also called tension. Muscles: Tissues or fibers that cause movement of body parts and organs. Open extremity injury: An extremity injury where the skin has been broken or torn through by an injured bone or an external penetrating object. Sprain: The stretching and tearing of ligaments. Strain: Muscle injury resulting from overstretching or over-exertion of the muscle. Tendons: Tissues that connect muscle to bone. Traction splint: A splint that applies constant pull along the length of a lower extremity to help stabilize the fractured bone and reduce muscle spasm, primarily used on femoral shaft fractures. Short Answer Basic anatomy of bone and its purposes: Bones provide structure, protect organs, anchor muscles, and store calcium. Signs and symptoms of musculoskeletal injury: Pain, swelling, deformity, bruising, inability to move the affected part, and sometimes a grating sensation. Basic emergency care for painful, swollen, or deformed extremities: Immobilize the injury, apply ice to reduce swelling, and elevate the extremity. Splinting is crucial to prevent further injury. General guidelines for splinting long bones and joints: Ensure the splint immobilizes the joint above and below the injury. Check for circulation, sensation, and movement before and after applying the splint. Realigning angulated deformed injuries to the anatomic position: This helps restore circulation and prevent further damage to nerves and blood vessels. Basic principles of splinting: Immobilize the injury, avoid unnecessary movement, and ensure the splint is secure but not too tight. Hazards of splinting: Improper splinting can cause further injury, restrict blood flow, or increase pain. Basic types of splints carried on ambulances: Rigid splints, soft splints, air splints, and traction splints. Thinking and Linking Blood loss and shock with fractures: Fractured tibia and fibula: Signs and symptoms of shock: Increased heart rate, pale and clammy skin, anxiety, and decreased blood pressure. Likely to compensate initially but may decompensate if blood loss is significant. Both tibias and fibulas fractured: Signs and symptoms of shock: More pronounced due to greater blood loss, including rapid pulse, confusion, and significant drop in blood pressure. Higher risk of decompensation due to the extent of injuries and blood loss. Femur fracture: Signs and symptoms of shock: Severe pain, swelling, and potential for significant blood loss leading to rapid heart rate, low blood pressure, and altered mental status. High likelihood of decompensation without prompt treatment. Pelvic fracture: Signs and symptoms of shock: Severe internal bleeding, instability, and signs of hypovolemic shock such as weak pulse, cold extremities, and unconsciousness. Very high risk of decompensation due to the potential for massive blood loss. Treatment and transportation for an ATV accident: Pain in thigh and hip: Use a traction splint for the femur fracture to reduce pain and prevent further injury. Use a backboard and cervical collar to immobilize the patient and prevent spinal injury. Call for additional assistance to safely extricate the patient from the woods, considering the terrain and distance to the nearest accessible point for an ambulance. Ensure proper scene size-up to identify any additional hazards and coordinate with rescue teams for efficient and safe patient transport. Critical Thinking Exercises Assessment findings for shock in musculoskeletal injury patients: Rapid, weak pulse Pale, clammy skin Altered mental status (confusion or unconsciousness) Differentiating rapid pulse and anxiety from pain versus shock: Pain-induced anxiety: Pulse rate may be elevated but strong Skin color and temperature remain normal Mental status is typically alert and oriented Shock-induced anxiety: Pulse rate is rapid and weak Skin is pale, cool, and clammy Mental status may be altered, with confusion or unconsciousness

Musculoskeletal Trauma PDF

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