Ch. 6 - Fractures and Dislocations

Question 1

Open vs. Closed Fractures?

Answer 1

Open = bone sticks out 
Closed = broken but not piercing muscle or skin

Question 2

Signs and Symptoms of Fractures and Dislocations?

Answer 2

-Pain and point tenderness
-Crepitus (grating bone sound)
-Swelling/Discoloration
-Deformity
-Loss of function/range of motion at the joint (Dislocation)
-Loss of function/range of motion at a bone (Fracture)
-Altered CSMs
-

Question 3

How do we assess Fractures and dislocations?

Answer 3

1. Assess bone/joint
2. Expose/visualize injury
3. Look for deformity/swelling
4. Feel for tenderness, pain, swelling, deformity
5. Assess CSM

Question 4

What is Compartment Syndrome?

Answer 4

Increased pressure in a muscle compartment (group of muscles and other tissue surrounded by collagen rich membrane called a fascia).
Common in lower leg, forearm, but can also occur in foot, hand, thigh or upper arm.
Pain is out of proportion to the injury, stimulated by stretching or movement. If skin is pale or cyanotic. Distal pulse may diminish or be absent, muscle may feel tight or full.
Surgical emergency/ RAPID EVAC

Question 5

How do we treat Fractures and Dislocations?

Answer 5

1. Immobilize- Bones above and below dislocations
   Joint above and below fractures.
2. Clean and dress wounds - especially open fracture irrigate wound. If bones cannot be reduced, keep both ends of the bone moist with disinfected water soaked dressing .
3. Remove jewelry or tight clothing
4. Manage pain - RICE
5. Assess for other injuries
6. Splint for movement, always assess CSM after splinting
7. Treat for shock

Question 6

What should you do if you encounter angulated fractures or dislocations?

Answer 6

Apply gentle traction in line with the axis of the bone and realign the bone ends. If resistance or unbearable pain occurs, leave and splint in deformed position.
SCOPE only allows us to reduce anterior shoulder dislocation, patella, and fingers or toes.
NEVER attempt to reduce elbow, wrist, ankle, knee, and hip in the field. Immobilize and immediately evacuate.

Question 7

What are the qualities of a good splint?

Answer 7

1. Ridged, supports injury
2. Pads injury
3. Insulates from the cold
4. Lightweight
5. Offers access to distal pulse
6. Immobilize joint above and below fracture
7. Immobilizes the bones above and below a joint injury.

Question 8

How should the Hand be splinted?

Answer 8

In the Position of Function (the way the hand is when holding a glass of water).
Fingers get buddy taped to adjacent digits
If injury i sonly to fingers, no need to splint the wrist, but if injury involves the bones at the base of fingers, stabilize the wrist as well.

Question 9

Evacuation Guidelines for Musculoskeletal injuries?

Answer 9

Evacuate all musculoskeletal injuries showing loss of function (irreducible dislocations or first time dislocations).
RAPID EVAC all Open Fractures and any musculoskeletal injury with altered CSM.