Musculoskeletal Trauma

Question 1

Signs and symptoms of a lower limb fracture or dislocation:

Answer 1

anatomical deformity
pain
external haemorrhage
swelling
tenderness on palpation
crepitus
neurovascular compromise

Question 2

Three Complications of fractures?

Answer 2

Absent circulation
Acute compartment syndrome
Neurological Injury

Question 3

Acute compartment syndrome presenting conditions

Answer 3

Severe pain out of proportion to the injury
Pain on passive movement
Tense swelling

Late signs include:
Paraesthesia
Paresis
Pulseless

Question 4

Anterior Dislocation - diagnose and treat.

Answer 4

The athlete will generally cradle the arm to their side. Typically there is loss of the deltoid roundness, although in modern day athletes, the wearing of shoulder pads makes this almost impossible to see. It may be detected by palpation, although once again, this may be difficult due to the tight shirts and shoulder pads. Sometimes it is possible to palpate the humeral head as a fullness in the clavipectoral groove.

Attempting active shoulder movements, will be painful and severely limited. The athlete often knows their shoulder has dislocated. Check for, and document, the presence of a radial pulse. If possible, check the sensation over the “Regimental badge” area adjacent to the insertion of deltoid; this may be impractical due to clothing and padding. This is to assess and document if the axillary nerve is affected The integrity of the radial nerve can be assessed by assessing wrist and elbow function, and testing for reduced sensation over the dorsum of the hand.

Question 5

Posterior Dislocation - diagnose and treat.

Answer 5

The athlete may present with the arm adducted and internally rotated, or holding their arm in forward elevation with their opposite hand and complaining of increased pain if they try to lower it and attempting abduction or lateral rotation are painful.. A posterior bulge may be present palpated below the acromion; once again this may be difficult to identify due to clothing and padding. The same neurovascular checks need to be carried out as for an anterior dislocation.

Removal of athlete from field of play: If a dislocation is suspected the athlete will need to leave the field of play. Generally the athlete will be able to walk off the field, the limb may be supported by the athlete, the athlete’s shirt can be rolled up from below, over the arm to provide support, or a Polysling can be applied with a swathe around the chest.

Question 6

Elbow Dislocation - Sings and symptoms ?

Answer 6

Severe pain at the time of injury
Loss of elbow function
Visible deformity
Tenderness over the dislocation
Swelling and bruising around the elbow
Numbness or paralysis in the arm below the dislocation
Reduced or absent pulse at the wrist

Question 7

For each of the below, what is the correct splint type / types ?

Fractured neck of femur
Fractured shaft of femur
Fracture or fracture / dislocation of knee
Patella dislocation
Tibial shaft fracture
Ankle fracture
Foot fractures

Answer 7

Fractured neck of femur - Padding between legs Figure of 8 bandage around ankles Broad bandage: 2 above, 2 below the knee

Fractured shaft of femur - Traction splint

Fracture or fracture / dislocation of knee - Long leg box splint, Vacuum splint, Traction splint without the application of traction

Patella dislocation - Pre-reduction: Companion strapping, Support on pillow, Contoured vacuum splint, Post-reduction: Box splint

Tibial shaft fracture - Long leg box splint, Long vacuum splint, Traction splints: partially useful in the presence of ipsi lateral tibial and femoral diaphyseal fractures

Ankle fracture - Short leg box splint, Short vacuum splint

Foot fractures - Short box splint, Short vacuum splint