Musculoskeletal Trauma Flashcards
Components of Musculoskeletal System
- Bones
- Joints
- Muscles
- Cartilage
- Ligaments
- Tendons
Physiology of Musculoskeletal System
- Bones: framework
- Joints: bending
- Muscles: movement
- Cartilage: flexibility
- Ligaments: connect bone to bone
- Tendons: connect muscle to bone
Bones
• Formed of dense connective tissues
• Vascular and susceptible to
bleeding on injury
Shapes of Bones
- Irregular
- Long
- Short
- Flat
Self-Healing Nature of Bone
- Break causes soft tissue swelling and a blood clot in the fracture area
- Interruption of blood supply causes the bone section to die
- Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone
Muscles, Cartilage, Ligaments, & Tendons
Striated Muscle Cardiac Muscle Smooth Muscle Bone Tendon - muscle to bone Ligament bone to bone
Mechanisms of Musculoskeletal Injury
- Direct force
- Indirect force
- Twisting (rotational) force
Injury to Bones and Connective Tissue
• Fracture: any break in a bone (open or closed) – Comminuted—broken in several places – Greenstick—incomplete break – Angulated—bent at angle • Dislocation: “coming apart” of a joint
Injury to Bones and Connective Tissue
- Sprain: stretching and tearing of ligaments
* Strain: overstretching of muscle
Injury to Bones and Connective Tissue
• Not all injuries can be confirmed as a fracture in the field
• Splinting an extremity with a
suspected fracture helps prevent blood loss from bone tissues
Assessment: Musculoskeletal Injuries
- Rapidly identify and treat life-threatening conditions
- Be alert for injuries besides grotesque wound
- Pain and tenderness
- Deformity and angulation
Assessment: Musculoskeletal Injuries
- Grating (crepitus)
- Swelling
- Bruising
- Exposed bone ends
- Nerve/blood vessel compromise (decreased CMS)
- Compartment syndrome
Six P’s of Assessment
- Pain or tenderness
- Pallor (pale skin)
- Parasthesia (pins and needles)
- Pulses diminished or absent
- Paralysis
- Pressure
Think About It: Musculoskeletal
- Do my patient’s musculoskeletal injuries add up to serious multiple trauma?
- Does my patient have circulation, sensation, and motor function distal to the suspected fracture or dislocation?
Treatment: Musculoskeletal Injuries
- Take standard precautions
- Perform primary assessment
- Take spinal precautions
- Splint any suspected extremity fractures after treating life threatening conditions
- Cover open wounds with sterile dressings
Advantages of Splinting
- Minimizes movement of disrupted joints and broken bone ends
- Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)
- Decreases pain
- Minimizes blood loss
- Can prevent a closed fracture from becoming an open fracture
Principles of Splinting
- Care for life-threatening problems first
- Expose injury site
- Assess distal CSM
- Align long-bone injuries to anatomical position
- Do not push protruding bones back into place
- Immobilize both injury site and adjacent joints
- Choose splinting method based on severity of condition and priority decision
- Apply splint before moving patient to stretcher
- Pad voids
Realigning Deformed Extremity
• Assists in restoring effective circulation to extremity and to fit it to splint
• If not realigned, splint may be ineffective, causing increased
pain and possible further injury
• If not realigned, increased chance of nerves, arteries, and veins being compromised
• Increased pain is only momentary
Hazards of Splinting
- “Splinting patient to death”—splinting before life-threatening conditions addressed
- Not ensuring ABC’s
- Too tight—compresses soft tissues
- Too loose—allows too much movement
- Splinting in deformed position
Treatment: Splinting Long Bone and Joints
• Select splint appropriate to
injury
• Standard precautions
• Manually stabilize injury site
Treatment: Splinting Long Bone and Joints
• Assess circulation, sensation, and motor function
• Realign injury if deformed or if
distal extremity is cyanotic or pulseless
Treatment: Splinting Long Bone and Joints
• Measure or adjust splint; move it into position
• Apply and secure splint to immobilize injury site, adjacent
joints
• Reassess CSM distal to injury
Treatment Traction Splint
.
Shoulder Girdle Injuries
• Assessment
– Pain in shoulder
– Dropped shoulder
– Severe blow to back over scapula
Shoulder Girdle Injuries: Tx
• Treatment – Assess distal CSM – Use sling and swathe – Do not attempt to straighten or reduce – Reassess distal CSM
Forearm, Wrist, and Hand Injuries
• Signs
– Forearm: deformity and tenderness
– Wrist: deformity and tenderness
– Hand: deformity and pain; dislocated fingers
Splinting Forearm, Wrist, and Hand Injuries
• Padded rigid splint
– From elbow past fingertips
– Roll of bandage placed in hand
– Sling and swathe
Splinting Forearm, Wrist, and Hand Injuries
• Soft splint
– Roll of bandage placed in hand
– Tie forearm, wrist, and hand into fold of one pillow or between two pillows
– Tape finger to adjacent uninjured finger
Pelvic Injuries
• Assessment – Pain in pelvis, hips, or groin – Pain when pressure applied – Cannot lift legs – Lateral rotation of foot – Unexplained pressure in bladder
Pelvic Injuries
• Treatment – Move patient as little as possible – Determine CSM distal to injury – Straighten lower limbs to anatomical position – Stabilize lower limbs – Assume spinal injuries – Treat for shock
Hip Dislocation/Fracture: Assessment
• Assessment – Anterior hip dislocation – Posterior hip dislocation • Rotation of leg and foot – Pain and unable to stand
Hip Dislocation/Fracture: Tx
• Treatment – Assess distal CSM – Move patient onto spine board – Immobilize limb with pillows and blankets – Secure patient to spine board – Reassess distal CSM
