extremity trauma Flashcards
introduction to musculoskeletal injuries
-Millions of Americans experience annually
-Multiple MOI:
– Falls, crashes, violence, etc.
– Multi-system trauma
skeletal tissue and structure
- give the body its structural form
- protect vital organs
- promote efficient movement despite the forces of gravity
- store salts and other materials needed for metabolism
- produce RBCs
bone structures
- diaphysis
- epiphysis- end of a long bone
- metaphysis
- medullary canal
- periosteum
- cartilage
epiphysis
-end of long bone
metaphysis
- between epiphysis and diaphysis
- growth plate
medullary canal
-contains bone marrow
periosteum
-fibrous covering of diaphysis
cartilage
-connective tissue that provides a smooth articulation surface for other bones
joint types
- ball and socket joint
- condyloid joint
- gliding joint
- hinge joint
- pivot joint
- saddle joint
joint structure
- tendon
- bone
- bursa
- synovial membrane
- articular cartilage
- joint cavity
- joint capsule
- bone
skeletal organization
- 206 bones
- axial skeleton- head, thorax, and spine
- appendicula skeleton- upper and lower extremities
bone aging
- birth to adult (18-20)- transition from flexible to firm bone
- adult to elderly (40+):
- reduction in collagen matrix and calcium salts diminution of bone strength
- spinal curvature
types of muscle
- smooth
- striated
- cardiac
muscular tissue and structure
-600 muscle groups
pathophysiology of the musculoskeletal system
- muscular injury
- contusion
- compartment syndrome
- penetrating injury
- fatigue
- muscle cramp muscle spasm
- strain
joint injury
- sprain
- subluxation
- dislocation
bone injury
- open fracture
- closed fracture
- hairline fracture
- impacted fracture
- transverse
pediatric considerations
-flexible nature
geriatric considerations
-osteoporosis
pathological fractures
-pathological diseases
general considerations with musculoskeletal injuries
- neurological compromise
- decrease stability
- muscle spams
bone repair cycle
- osteocytes produce osteoblasts
- deposition of salts
- increasing strength of matrix
inflammatory and degenerative conditions
- bursitis
- tendonitis
- arthritis:
- osteoarthritis- degenerative
- rheumatoid arthritis- chronic, systemic, progressive, debilitating
- gout- inflammation of joints produced by accumulation of uric acid crystals
arthritis
- osteoarthritis- degenerative
- rheumatoid arthritis- chronic, systemic, progressive, debilitating
- gout- inflammation of joints produced by accumulation of uric acid crystals
scene size up
- clues to specific injuries
- pelvic fractures or bilateral femur fractures are “load and go”
- control major bleeding
- history may suggest other injuries
initial assessment
- categories of urgency:
- life and limb threatening injury
- life threatening injury and minor musculoskeletal injury
- non life threatening injuries but serious musculoskeletal injuries
- non life threatening injuries and only isolated minor musculoskeletal injuries
musculoskeletal injury assessment
- rapid trauma assessment -only press on pelvis if no clinical signs of injury are present such as pain
- focused H&P- 6 Ps: pain, pallor, paralysis, paresthesia, pressure, pulses
- detailed physical exam
- ongoing assessment
- sports injury considerations
detailed exam of extremities
- deformity
- contusions
- abrasions
- penetrations
- burns
- tenderness
- lacerations
- swelling
- also check PMS*
general principles of musculoskeletal injury management
- protecting open wounds
- positioning the limb
- immobilizing the injury
- checking neurovascular function
- pulse- palpate and utilize pulse oximetry
- motor
- sensation
splinting devices
- rigid splints
- formable splints- vacuum splints, air splints
- soft splints
- traction splints
- other splinting aids- cravats or velcro splints
musculoskeletal injury management
- splinting devices
- fracture care
- joint care
- muscular and connective tissue care
fracture management: pelvis
- scoop stretcher
- pelvic sling device
- fluid resuscitation
femur fracture management
- traction splints- contraindicated in hip/knee injuries
- high force injury
- high potential for shock
tibia fibula fracture management
- frequently open fractures
- cove bone ends with moist dressing
- depending on level of fracture, use:
- rigid splint
- air splint
- pillow
clavicle fracture management
- most frequently fractured bone in the body
- transmitted to 1st and 2nd rib
- alert lung injury
care for specific joint injuries
- hip
- knee
- ankle
- foot
- shoulder
- elbow
- wrist/hand
- finger
- be alert for neurological compromise
hip fractures
- common in the elderly
- may be able to support weight- ability to walk does not rule out fracture
- leg often externally rotated
- may refer pain to the knee
- use other leg for splint
- use vacuum mattress if available
hip dislocation
- orthopedic emergency
- posterior dislocation most common
- hip flexed and leg rotated internally
- severe pain on attempts to straighten
hip dislocation management
- splint in most comfortable position
- document sensation and pulse
- prompt transport
- be alert for associated knee injuries or fractures
knee fracture or dislocation
- orthopedic emergency
- frequently causes vascular injury
- dislocation associated with 50% rate of amputation of leg
knee fracture or dislocation management
- obvious dislocation without distal pulse -> apply gentle traction along the long axis of the joint
- if gentle traction does not restore the pulse -> splint in place
- prompt transport
foot or hand injury
- common industrial injury
- often disabling
- rarely life threatening
- splint foot with pillow
- splint hand in position of function
shoulder injury
- AC separation- sling and swathe
- shoulder dislocation- use pillow with sling and swathe
- fracture- use sling and swathe
elbow injury
- fracture or dislocation may because neurovascular injury
- splint in position found
- transport promptly
rigid splint
-keep hand in position of function
air splint
-may be hard to reassess circulation
forearm/wrist injury
use a pillow
soft and connective tissue injuries
- tendon
- ligament
- muscle
other injury considerations: musculoskeletal injury management
- pediatric musculoskeletal injury
- athletic musculoskeletal injury
- patient refusals and referral
- psychological support
tendon
-muscle to bone
ligament
-bone to bone
