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Chapter 8. Specific Bone and Joint Injuries. Lesson Objectives (1 of 3). Identify major bones of the skeletal system.

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chapter 8

Chapter 8

Specific Bone and Joint Injuries

lesson objectives 1 of 3
Lesson Objectives (1 of 3)
  • Identify major bones of the skeletal system.
  • Assess and manage upper extremity injuries, including shoulder injuries, upper arm injuries, elbow injuries, lower arm injuries, hand injuries, and finger dislocations and fractures.
lesson objectives 2 of 3
Lesson Objectives (2 of 3)
  • Assess and manage lower extremity injuries, including hip injuries, pelvic injuries, thigh injuries, knee injuries, lower leg injuries, ankle injuries, and foot and toe injuries.
  • Assess and treat spinal injuries.
  • Know how to move a victim with a spinal injury.
lesson objectives 3 of 3
Lesson Objectives (3 of 3)
  • Know when to remove spine immobilization.
  • Know the evacuation guidelines for musculoskeletal injuries.
upper extremity injuries 1 of 19
Upper Extremity Injuries (1 of 19)
  • Shoulder injury
    • Collarbone (clavicle) can by injured by a direct blow or fall.
    • Fractures of the upper humerus (arm bone) are treated as shoulder injuries.
upper extremity injuries 2 of 19
Upper Extremity Injuries (2 of 19)
  • Shoulder injury
    • What to look for:
      • Tenderness
      • Swelling
      • Deformity
      • Extreme pain
upper extremity injuries 3 of 19
Upper Extremity Injuries (3 of 19)
  • Shoulder injury
    • What to do:
      • Treat all shoulder injuries with a sling.
upper extremity injuries 5 of 19
Upper Extremity Injuries (5 of 19)
  • Shoulder dislocation
    • What to look for:
      • Upper arm is usually held away from the body.
      • Shoulder looks squared off rather than rounded.
      • Check circulation, sensation, movement.
upper extremity injuries 6 of 19
Upper Extremity Injuries (6 of 19)
  • Shoulder dislocation
    • What to do:
      • Apply traction to relocate.
upper extremity injuries 7 of 19
Upper Extremity Injuries (7 of 19)
  • Upper arm injury
    • Can be caused by a fall, twisting, or a direct blow.
    • Usually obvious.
upper extremity injuries 8 of 19
Upper Extremity Injuries (8 of 19)
  • Upper arm injury
    • What to look for:
      • Swelling and deformity
      • Severe pain
      • Grating sensation and abnormal motion
      • Check circulation, sensation, and movement.
upper extremity injuries 9 of 19
Upper Extremity Injuries (9 of 19)
  • Upper arm injury
    • What to do:
      • Remove rings.
      • Place a rigid splint on outside of the arm.
      • Place padding between the victim’s arm and chest.
      • Allow the arm to hang in the sling position.
upper extremity injuries 10 of 19
Upper Extremity Injuries (10 of 19)
  • Elbow injury
    • Can be caused by direct blow
    • Can happen indirectly from a fall on an outstretched hand.
upper extremity injuries 11 of 19
Upper Extremity Injuries (11 of 19)
  • Elbow injury
    • What to look for:
      • Deformity, severe pain, swelling, tenderness
      • Inability to move the elbow without severe pain
      • Impaired circulation, sensation, or movement below the elbow
upper extremity injuries 12 of 19
Upper Extremity Injuries (12 of 19)
  • Elbow injury
    • What to do:
      • Remove rings.
      • Immobilize the affected arm with a sling.
      • Keep the elbow in the position found.
      • If there is severe deformity or medical care will be delayed more than a few hours, attempt reduction.
upper extremity injuries 13 of 19
Upper Extremity Injuries (13 of 19)
  • Lower arm injury
    • What to look for:
      • Can be caused by a direct blow or a fall when the victim lands on the outstretched hand.
upper extremity injuries 14 of 19
Upper Extremity Injuries (14 of 19)
  • Lower arm injury
    • What to do:
      • Remove rings.
      • Attempt to straighten severe angulation of the forearm.
      • Apply a splint from the middle of the palm to just below the elbow.
      • Seek medical care.
upper extremity injuries 15 of 19
Upper Extremity Injuries (15 of 19)
  • Hand injury
    • What to look for:
      • Deformities, tenderness, swelling.
      • Fingers may be out of alignment.
      • Check circulation, sensation, and movement.
upper extremity injuries 16 of 19
Upper Extremity Injuries (16 of 19)
  • Hand injury
    • What to do:
      • Place hand in position of function.
      • Place a rolled pair of socks in the palm.
      • Gently realign displaced fingers and buddy tape.
      • Attach a rigid splint along the forearm and under the hand.
upper extremity injuries 17 of 19
Upper Extremity Injuries (17 of 19)
  • Finger dislocation and fractures
    • Fingers are easily injured.
    • Minor injury can cause dislocation.
    • Injuries include:
      • Fractures
      • Sprains
      • Dislocations
      • Tendon injuries
upper extremity injuries 18 of 19
Upper Extremity Injuries (18 of 19)
  • Finger dislocation and fractures
    • What to look for:
      • Deformity and inability to use or bend finger
      • Pain and swelling
      • Restricted movement
      • Bruising
      • Abnormal position of adjoining bones
upper extremity injuries 19 of 19
Upper Extremity Injuries (19 of 19)
  • Finger dislocation and fractures
    • What to do:
      • Reduce dislocations immediately following injury.
      • Tape finger to its neighbor after reducing.
      • Fashion a splint that includes the thumb and wrist.
lower extremity injuries 1 of 22
Lower Extremity Injuries (1 of 22)
  • Hip injury
    • Hip is a ball-and-socket joint.
    • Socket joint is in the pelvic bone.
    • Hip can be dislocated or fractured.
lower extremity injuries 2 of 22
Lower Extremity Injuries (2 of 22)
  • Hip injury: What to look for
    • Pain around the hip that increases with movement
    • Inability to bear weight
    • Foot rotated outward or inward
    • Injured limb appears shorter than uninjured limb
    • With dislocation, hip and knee are both held bent, with knee turned inward.
lower extremity injuries 3 of 22
Lower Extremity Injuries (3 of 22)
  • Hip injury: What to do
    • Carry victim out of the wilderness.
    • Realign the limb and rotate the foot into normal position.
    • Splint affected leg to uninjured leg and secure.
    • Pad between the legs and around injured leg.
    • Evacuate.
lower extremity injuries 4 of 22
Lower Extremity Injuries (4 of 22)
  • Pelvic injury
    • What to look for:
      • Pain when you press the affected area or squeeze the pelvis side to side or front to back
      • Inability to bear weight
      • Signs of shock
      • Blood in urine or inability to urinate
lower extremity injuries 5 of 22
Lower Extremity Injuries (5 of 22)
  • Pelvic injury
    • What to do:
      • Stabilize on a rigid backboard, litter, or sled.
      • Evacuate.
lower extremity injuries 6 of 22
Lower Extremity Injuries (6 of 22)
  • Thigh injury
    • Fractures of the femur require a large amount of energy.
    • Victim can lose up to 2 quarts of blood due to internal bleeding.
    • Stabilization can reduce bleeding be lifesaving.
lower extremity injuries 7 of 22
Lower Extremity Injuries (7 of 22)
  • Thigh injury
    • What to look for:
      • Severe pain
      • Inability to bear weight
      • Motion at fracture site
      • Swelling and deformity
      • Thigh or leg may appear shortened.
      • Foot rotated abnormally
lower extremity injuries 8 of 22
Lower Extremity Injuries (8 of 22)
  • Thigh injury
    • What to do:
      • Apply manual traction
      • If victim must be moved without traction, stabilize in position of comfort and splint the injured leg to the uninjured leg.
      • Monitor circulation beyond the injury.
lower extremity injuries 9 of 22
Lower Extremity Injuries (9 of 22)
  • Knee injury
    • Fractures
    • Dislocations
    • Sprains
lower extremity injuries 10 of 22
Lower Extremity Injuries (10 of 22)
  • Knee injury: What to look for
    • Pain when attempting to bend or straighten the knee
    • Gap or marked tenderness along the edges of the kneecap
    • Displaced patella
    • Major deformity
    • Swelling
    • Tenderness
lower extremity injuries 11 of 22
Lower Extremity Injuries (11 of 22)
  • Knee injury: What to do
    • Flex hip slightly to relax the thigh muscle.
    • Gently straighten the knee.
    • Wrap the leg in a cylinder splint or an elastic bandage.
lower extremity injuries 12 of 22
Lower Extremity Injuries (12 of 22)
  • Lower leg injury
    • What to look for:
      • Severe pain
      • Swelling
      • Instability
      • Deformity
      • Inability to bear weight
lower extremity injuries 13 of 22
Lower Extremity Injuries (13 of 22)
  • Lower leg injury
    • What to do:
      • Correct deformities with gentle traction.
      • Splint lower leg fractures to immobilize knee and ankle.
      • Evacuate.
lower extremity injuries 14 of 22
Lower Extremity Injuries (14 of 22)
  • Ankle injury
    • Most ankle injuries are sprains of the outside (lateral) ligaments.
    • Ligament injuries and fractures often occur together.
    • Dislocations are nearly always associated with multiple fractures.
lower extremity injuries 15 of 22
Lower Extremity Injuries (15 of 22)
  • Ankle injury
    • What to look for:
      • Swollen, tender, bruised ankle
      • Pain and marked tenderness over the bones
      • Difficulty putting weight on foot
lower extremity injuries 16 of 22
Lower Extremity Injuries (16 of 22)
  • Ankle injury
    • What to do:
      • Decide whether to remove footwear.
      • Check circulation, sensation, and movement in the foot.
      • Straighten deformities.
      • Apply RICE procedures.
      • Splint ankle fractures.
lower extremity injuries 17 of 22
Lower Extremity Injuries (17 of 22)
  • Foot injury
    • Fractures can occur from:
      • Direct blow
      • Sudden twisting injury
      • Stress of repetitive activity
lower extremity injuries 18 of 22
Lower Extremity Injuries (18 of 22)
  • Foot injury
    • What to look for:
      • Local tenderness and pain with walking
      • Swelling
      • Bruising
      • Tenderness
lower extremity injuries 19 of 22
Lower Extremity Injuries (19 of 22)
  • Foot injury
    • What to do:
      • Provide a stiff-sole boot and cane or crutch.
      • If pain increases with walking, evacuate.
lower extremity injuries 20 of 22
Lower Extremity Injuries (20 of 22)
  • Toe injury
    • Toes are usually fractured by a direct blow.
    • Usually painful
    • Not usually serious
lower extremity injuries 21 of 22
Lower Extremity Injuries (21 of 22)
  • Toe injury
    • What to look for:
      • Compare injured and uninjured sides.
      • Injured toe will likely be swollen and deformed.
lower extremity injuries 22 of 22
Lower Extremity Injuries (22 of 22)
  • Toe injury
    • What to do:
      • Apply traction.
      • Realign toes that are out of alignment.
      • Buddy tape with padding between toes.
spinal injuries 1 of 6
Spinal Injuries (1 of 6)
  • Assessing and treating spinal injuries
    • What to look for:
      • Numbness, tingling, weakness, or burning sensation in arms or legs
      • Loss of bowel or bladder control
      • Paralysis of arms and/or legs
      • Tenderness along the spine
      • Pain resembling electric shock when attempting to move hands and feet.
spinal injuries 2 of 6
Spinal Injuries (2 of 6)
  • Assessing and treating spinal injuries
    • What to do:
      • Check breathing.
      • Instruct victim to lie still.
      • Stabilize neck.
      • Improvise a short backboard.
spinal injuries 3 of 6
Spinal Injuries (3 of 6)
  • Assessing and treating spinal injuries
    • What to do (continued):
      • Place the board behind the head, neck, and chest with rolled clothing on either side of the head.
      • Secure the trunk securely to the board around the chest, below the arms, and around the forehead.
      • Fashion a neck collar.
spinal injuries 4 of 6
Spinal Injuries (4 of 6)
  • Moving a victim with a spinal injury
    • Extricate victim and place on the back with spine straight.
    • Straighten the head and neck of an unresponsive victim to maintain open airway.
    • Roll victim onto backboard by log-rolling.
spinal injuries 5 of 6
Spinal Injuries (5 of 6)
  • When to remove spine immobilization
    • Victim is calm, fully alert, cooperative, and not intoxicated
    • No numbness, tingling, burning sensation, or paralysis or weakness in extremities
    • No marked tenderness of spine
    • No marked muscle spasm
spinal injuries 6 of 6
Spinal Injuries (6 of 6)
  • When to remove spine immobilization
    • No severe midline spine pain with movement
    • No other painful injuries that would make evacuation difficult
guidelines for evacuation of musculoskeletal injuries
Guidelines for Evacuation of Musculoskeletal Injuries
  • Evacuate as rapidly as possible for
    • Open fractures
    • Injuries with nerve damage, serious blood loss, and suspected spinal cord injury
    • Major fractures and dislocations