Sprains, Strains, Dislocations, & Fractures PDF

Sprains Strains Dislocations & Fractures  Sprains & Strains  What are sprains?  Stretch and/or tear of a ligament caused by a sudden pull  One or more ligaments can be injured at the same time  Most common: sprained ankle  What are strains?  A strain is an i...

Sprains Strains Dislocations & Fractures  Sprains & Strains  What are sprains?  Stretch and/or tear of a ligament caused by a sudden pull  One or more ligaments can be injured at the same time  Most common: sprained ankle  What are strains?  A strain is an injury to a muscle or tendon(thick,tough fibrous cord of tissue that connects a muscle to a bone)  Can be as simple as overstretching a muscle or tendon, or it can be a partial or complete tear Most common: strained back  How do they occur? Carrying, holding, or restraining items, people or animals Lifting, pushing, holding or pulling loads Working in a fixed position with the back bent, Sitting or standing continuously, or driving vehicles for long periods Repetitive tasks such as reaching to lift or lower Objects, or to grip tools continuously Working in awkward positions involving bending or Twisting your body to reach items Vibrations through the body like driving a truck or using a powered hand tool  Signs & Symptoms Sprains Strains Pain Pain Swelling Muscle spasm Bruising Muscle weakness Not be able to move the joint Swelling Cramping, trouble to move the muscle  First Aid for Sprains and Strains RICE Therapy Rest Ice Compression Elevation Rest Stop using injured part. Use splint for injuries of the arm Ice Keep damp or dry cloth between skin and ice pack Do not apply ice for longer than 15 to 2o minutes at a time Compression Use elasticized bandage, compression sleeve, or cloth Wrap injured part firmly Do not impair blood supply Too tight compression may cause more swelling Wrap over ice Loosen the bandage if it gets too tight Elevation Elevate injured part above heart level It decreases swelling and pain Use objects and pillows to props Dislocation What? A joint dislocation, also called luxation, occurs when there is an abnormal separation in the joint. Why? Dislocations can occur because of anatomical issues or blunt force trauma. Car accidents Falling off the roof when cleaning gutters Being punched in the face during a fight Collisions between two football players Types? Anterior Dislocation Posterior Dislocation Inferior Dislocation Symptoms A visibly deformed or out-of-place shoulder Swelling or bruising Intense pain Inability to move the joint 1st Aid Don't delay medical care. Get medical help immediately. Don't move the joint. Until you receive help, splint the affected joint into its fixed position. Don't try to move a dislocated joint or force it back into place. This can damage the joint and its surrounding muscles, ligaments, nerves or blood vessels. Put ice on the injured joint. This can help reduce swelling by controlling internal bleeding and the buildup of fluids in and around the injured joint.  Emergency Care There are 2 steps Manipulation Immobilization  Manipulation This is known as Reduction. Where Doctor reposition the dislocated joint to its normal position. Under Sedatives Local Anesthesia General Anesthesia Immobilization Your doctor may ask you to wear a sling, splint, or cast for several weeks. This will prevent the joint from moving and allow the area to fully heal. Medical Management Pain Relivers aspirin ibuprofen (Advil, Motrin IB,) naproxen sodium (Aleve) acetaminophen (Tylenol) Surgical Management According to the severity a surgery may be required to reposition the dislocated joint. There are 2 Types of Surgical Procedures. Arthrotomy An arthrotomy is the creation of an opening in a joint.  Arthroscopy Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Example - Knee Hip Shoulder Wrist FRACTURES What are fractures? Fracture is the breaking of the continuity of the bone due to an external force COMMON TYPES OF FRACTURES Greenstick - Incomplete fracture. The broken bone is not completely separated. Transverse - The break is in a straight line across the bone.  Spiral - The break spirals around the bone; common in a twisting injury. Oblique - Diagonal break across the bone.  Compression - The bone is crushed, causing the broken bone to be wider or flatter in appearance. Comminuted - The break is in three or more pieces and fragments are present at the fracture site.  Segmental - The same bone is fractured in two places, so there is a "floating" segment of bone.  Clinical Manifestations Swelling or bruising over a bone Deformity of an arm or leg Pain in the injured area that gets worse when the area is moved or pressure is applied An inability to bear weight on the affected foot, ankle, or leg Loss of function in the injured area In open fractures, bone protruding from the skin FRACTURES FIRST AIDS Stop any bleeding. Apply pressure to the wound with a sterile bandage, a clean cloth or a clean piece of clothing. Immobilize the injured area. Don't try to realign the bone or push a bone that's sticking out back in. If you've been trained in how to splint and professional help isn't readily available, apply a splint to the area above and below the fracture sites. Padding the splints can help reduce discomfort. Apply ice packs to limit swelling and help relieve pain.Don't apply ice directly to the skin. Wrap the ice in a towel, piece of cloth or some other material. Treat for shock. If the person feels faint or is breathing in short, rapid breaths, lay the person down with the head slightly lower than the trunk and, if possible, elevate the legs. FRACTURES Emergency Care Algorithm for emergency management of fracture Control bleeding Apply direct pressure with a sterile gauze or Using any clean cloth for 20 minutes Grade the injury using Gustilo Anderson classification This scale helps in deciding the antibiotic and the amount of normal Saline needed to irrigate the wound Gustilo Anderson classification Type 1 - wound < 1 cm; minimal contamination, comminution or soft tissue damage Type 2 - wound > 1 cm; moderate soft tissue damage, minimal periosteal stripping Type 3A - severe soft tissue damage and substantial contamination, soft tissue coverage adequate Type 3B - severe soft tissue damage and substantial contamination, soft tissue coverage inadequate Type 3C - open fracture with an associated arterial damage needing repair Early antibiotics and analgesia Tetanus toxoid Analgesics Gustilo type 1 and 2 - Cefazolin IV for 2 days Gustilo type 3 - Cloxacillin, gentamicin and metronidazole IV for 5 days or augmentin may be used as an alternative. Neurovascular assessment This is done to exclude Compartment syndrome. Irrigate and dress the wound Debris and contaminants from the wound are removed The wound is irrigated with a lot of normal saline The wound is covered with a sterile dressing that should not be removed till the patient reaches the theatre. Non Operative therapy Casting Traction 1. Casting - Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb. 2. Traction - Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction. Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in an apparatus that facilitates traction. This method is most commonly used for fractures of the thigh bone. Surgical Management of Fractures Open Reduction Internal Fixation This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails. External Fixation External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.