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LESSON 18. INJURIES TO MUSCLES AND BONES. Introduction. Trauma patients often have considerable musculoskeletal injuries With significant mechanisms of injury, bones may fracture and joints may be injured Injuries may result in pain, disability and life-threatening bleeding.

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  • Trauma patients often have considerable musculoskeletal injuries
  • With significant mechanisms of injury, bones may fracture and joints may be injured
  • Injuries may result in pain, disability and life-threatening bleeding
musculoskeletal system review
Musculoskeletal System Review
  • Bones
  • Muscles
  • Tendons
  • Ligaments
primary functions of musculoskeletal system
Primary Functions of Musculoskeletal System
  • Provide shape and support for body
  • Muscles acting on bones allow movement
  • Bones protect vital internal organs
types of muscles
Skeletal muscles  voluntary

Smooth muscles  involuntary

Cardiac muscle  involuntary

All muscle activity controlledby nervous system

Types of Muscles
mechanisms of injury to musculoskeletal system
Mechanisms of Injury to Musculoskeletal System
  • Direct force: force applied directly to body
  • Indirect force: force transferred from original body site along an extremity to another point
  • Twisting forces: part of body forced to move in unnatural direction
factors involved in injuries
Factors Involved in Injuries
  • The greater the force:
    • The more likely the injury
    • Fracture/Joint dislocation severity more likely
  • Patient’s age and health status
types of musculoskeletal injuries
Types of Musculoskeletal Injuries
  • Fractures
  • Dislocations
  • Sprains
  • Muscle injuries

EMRs need not determine type of musculoskeletal injury:

Bone may be completely broken or only cracked

Closed fracture  skin not broken

Open fracture  open wound at site

dislocations continued
Dislocations (continued)
  • One or more bones at joint displaced from normal position
  • Ligaments holding bone are torn
  • Result from strong forces
  • Sometimes accompanied by bone fractures or other injuries
  • Can be very painful
dislocations continued1
Dislocations (continued)
  • Patient cannot use joint due to pain or structural damage
  • Serious bleeding may result
  • Nearby nerves may be injured
  • With severe dislocation, joint or limb will look deformed
  • Joint injury involving ligament stretching and tearing
  • Typically occur when joint is overextended
  • Can be mild or severe
  • Ankles, knees, wrists, fingers most common
  • Considerable swelling often occurs rapidly
muscle injuries
Muscle Injuries
  • Strains, contusions, cramps
  • Usually less serious than fractures and joint injuries
  • Many causes
recognizing musculoskeletal injury
Recognizing Musculoskeletal Injury
  • Sometimes injury type is obvious
  • Often you will recognize musculoskeletal injury if present
  • Emergency care is same regardless of injury type
  • Usually not life-threatening
  • May be serious and result in pain and disability
assessment of musculoskeletal injuries
Assessment ofMusculoskeletal Injuries
  • Perform standard assessment
  • Ask patient what happened and what was felt
  • If large forces involved, consider potential for spinal injury
  • Expose injury site carefully
  • Amount of pain and swelling not indicator of injury severity
  • Immediate medical treatment if no circulation or possible nerve damage
assess for circulation sensation and movement csm below the injury site
Check pulse below injury

Check skin color and temperature

Touch fingers or toes

Does patient feel touch, tingling sensation, numbness?

Have patient wiggle fingers or toes

Assess for Circulation, Sensation and Movement (CSM) Below the Injury Site
signs and symptoms of musculoskeletal injury continued
Signs and Symptoms of Musculoskeletal Injury(continued)
  • Pain and tenderness
  • Abnormal sensation (numbness, tingling)
  • Inability to move area
  • Joint locked into position
  • Impaired function or circulation
  • Difference in temperature from opposite extremity
preventing movement
Preventing Movement
  • Movement causes injury, pain, swelling
  • Bone movement further injures soft tissues
  • Movement generally increases blood flow - may increase internal bleeding and swelling
  • Manually stabilize or splint injured area
emergency care of musculoskeletal injuries
Emergency Care ofMusculoskeletal Injuries
  • Perform standard patient care
  • Control any life threats
  • Allow patient to be in position of comfort
  • Cover open wounds with sterile dressing
  • Apply cold pack with skin barrier
  • Don’t replace protruding bones
emergency care of musculoskeletal injuries continued
Emergency Care of Musculoskeletal Injuries (continued)
  • Stabilize injured extremity manually
  • Support above and below injury
  • If appropriate, splint extremity
  • Follow local protocol for oxygen
  • With traumatic amputation of a body part, care for amputated part after stabilizing patient
  • Movement may worsen musculoskeletal injury and cause more pain
  • Splint injured arm or leg if risk of area being moved (unless help expected quickly)
  • Always splint an extremity before patient is transported
splinting continued
Splinting (continued)
  • Helps prevent further injury
  • Reduces pain
  • Minimizes bleeding and swelling
types of splints
Types of Splints
  • Rigid splints
  • Soft splints
  • Air splints (inflatable splints)
  • Pneumatic splints
  • Anatomic splints
  • Improvised splints
rigid splint

Plastic or metal

Rolled newspaper or magazine

Thick cardboard

Rigid Splint
soft splint

Folded blanket or towel

Triangular bandage folded into sling

Soft Splint
securing splints
Securing Splints
  • Use bandages, strips of cloth, Velcro
  • Use knots that can be untied
  • Don’t secure with tape to skin
guidelines for all splints
Guidelines for All Splints
  • Dress open wounds
  • Splint only if it doesn’t cause more pain
  • Splint in position found
  • Immobilize entire area (joints above and below injury)
  • Pad between splint and skin
  • Assess CSM before and after splinting
  • Put splints on both sides of fracture if possible
  • Apply cold pack to injury around splint
guidelines for slings
Guidelines for Slings
  • Use sling to prevent movement and to elevate extremity
  • Splint injury first
  • If you splint injury in position found and this position makes use of sling difficult  do not use sling
guidelines for slings continued
Guidelines for Slings (continued)
  • Do not move arm into position for sling if it causes pain
  • A cold pack can be used inside sling
  • Do not cover fingers inside sling
shoulder injuries
Shoulder Injuries
  • Involve clavicle, scapula or joint structures
  • Clavicle is most frequently fractured bone
  • Scapula fractures are rare
  • Shoulder dislocations are common
splinting shoulder injuries
Splinting Shoulder Injuries
  • Goal is to stabilize area from trunk to upper arm
  • Use soft splint; do not move extremity
  • Assess for circulation, sensation and movement
splinting shoulder injuries continued
Splinting Shoulder Injuries (continued)
  • Pad hollow between body and arm
  • Apply sling and swathe to support and immobilize arm – if this causes pain use larger pillow
upper arm injuries
Upper Arm Injuries
  • Immobilize humerus fractures with rigid splint
  • Treat fractures near shoulder with soft splint
splinting upper arm injuries
Splinting Upper Arm Injuries
  • Stabilize bone between shoulder and elbow
  • Assess circulation, sensation, movement in hand and fingers
  • Apply rigid splint along outside of arm
splinting upper arm injuries continued
Splinting Upper Arm Injuries (continued)
  • Tie splint above injury and at elbow
  • Support wrist with sling and wide swathe
  • If it causes pain to raise wrist for a sling, use long rigid splint
elbow injuries
Elbow Injuries
  • Sprains and dislocations are common
  • Fractures occur above or below elbow
  • Patient unable to move joint
splinting elbow injuries
Splinting Elbow Injuries
  • If elbow bent, apply rigid splint from upper arm to wrist
  • If more support needed, use sling at wrist and swathe around chest
splinting elbow injuries continued
Splinting Elbow Injuries(continued)
  • If elbow straight, apply rigid splint from upper arm to hand
  • If more support needed, use swathes around chest and upper arm and lower arm and waist

Secure splint

Put splinted arm in sling and swathe

wrist injuries
Wrist Injuries
  • Sprains
  • Fractures
splinting wrist injuries
Splinting Wrist Injuries
  • Goal is to stabilize from forearm to hand
  • Soft splint and sling often sufficient
  • Rigid splint provides more support
  • Assess circulation, sensation, movement in hand and fingers
splinting wrist injuries continued
Splinting Wrist Injuries (continued)
  • Apply rigid splint on palm side of arm from forearm past fingertips
  • Tie above and below wrist
  • Leave fingers uncovered
  • Support forearm and wrist with sling and apply binder around upper arm and chest
hand injuries
Hand Injuries
  • May be injured by direct blow
  • Fractures occur when patient punches something with closed fist
splinting hand injuries
Splinting Hand Injuries
  • Goal is immobilization of hand – use soft or rigid splint
  • Place roll of gauze in palm
  • Bandage entire hand leave fingers exposed if possible to check CSM
  • Place rigid splint on palm side of hand; pad between hand and splint
  • Support further with sling and swathe
finger injuries
Finger Injuries
  • Fractures and dislocations
  • Often a splint is not required
  • Use rigid splint or anatomic splint
splinting finger injuries
Splinting Finger Injuries
  • Use soft splint if finger cannot be straightened without pain
  • Don’t manipulate finger into normal position
  • Use rigid splint, secured with tape or anatomic splint by taping finger to adjoining finger with gauze in between
lower extremity injuries
Lower Extremity Injuries
  • Larger forces are typically involved – forces may also cause spinal injury
  • Assess patient without moving extremity
  • Femur fracture can damage femoral artery and cause life-threatening bleeding
hip and pelvis injuries
Hip and Pelvis Injuries
  • Fractures and dislocations
  • Hip fracture: fracture of top part of femur
  • Fractures more common in elderly due to osteoporosis
  • Bleeding and pain may be severe
  • Dislocations can occur at any age:
    • Falls
    • Vehicular crashes
    • Blows to body
splinting hip and pelvis injuries
Splinting Hip and Pelvis Injuries
  • Do not move patient
  • Immobilize leg and hip in position found
  • Pad between legs and bandage together (unless this causes more pain)
  • Treat for shock but do not elevate legs
upper leg injuries
Upper Leg Injuries
  • Femur fractures are serious
  • Severe pain and shock may occur
  • Keep patient from moving
  • Rigid splint unnecessary if patient is lying down with leg supported by ground
  • Use folded blankets or coats to immobilize leg in position found
splinting upper leg injuries
Splinting Upper Leg Injuries
  • Anatomic splint
  • Rigid splints
splinting upper leg injuries continued
Splinting Upper Leg Injuries(continued)
  • Check circulation and sensation in foot and toes
  • Put rigid splint on each side of leg
    • Pad body areas and voids
    • Inside splint should extend from groin past foot
    • Outside splint should extend from armpit past foot
anatomic splinting of leg injuries
Anatomic Splinting of Leg Injuries
  • Gently slide 4 or 5 bandages under both legs  but not over injury
  • Put padding between legs
  • Do not move injured leg
  • Gently slide uninjured leg next to injured leg
  • Tie bandages
  • Check circulation again
traction splint for femur fractures
Traction Splintfor Femur Fractures
  • Traction splint maintains continual pull on femur to keep bone ends in normal position
  • EMRs may assist other EMS personnel
knee injuries
Knee Injuries
  • Sprains
  • Dislocations
  • Caused by:
    • Sports injuries
    • Motor vehicle crashes
    • Falls
  • Femur, tibia or fibula fractures are indistinguishable from knee injuries
splinting knee injuries
Splinting Knee Injuries
  • Splint in position found
  • Apply soft splint by rolling blanket or placing pillow around knee
  • If knee straight, make anatomical splint
splinting knee injuries continued
Splinting Knee Injuries (continued)
  • If possible, put rigid splint on both sides of leg
  • Pad body areas and voids
  • Check circulation and sensation in foot and toes first and periodically after splinting
splinting knee injuries continued1
Splinting Knee Injuries (continued)
  • If knee is straight, apply 2 splints along both sides of knee
  • If knee is bent, splint in position found
  • Tie splints with cravats or bandages
lower leg injuries
Lower Leg Injuries
  • Commonly caused by:
    • Sports
    • Motor vehicle crashes
    • Falls
  • Either or both bones of lower leg can be fractured

Check circulation

Gently slide 4 to 5 strips of bandages under both legs

ankle injuries
Ankle Injuries
  • Sprain may occur when foot is forcefully twisted to one side
  • Fractures or dislocations
  • Often involve torn ligaments and nerve or blood vessel damage
splinting ankle injuries
Splinting Ankle Injuries
  • Soft splint usually best
  • Gently remove the shoe to assess circulation, sensation, movement in toes
  • Tie pillow around foot and lower leg
  • For minor ankle injury not requiring splinting, elastic roller bandage may be used for compression
applying a figure 8 bandage to the ankle
Applying a Figure-8Bandage to the Ankle
  • Anchor starting end of bandage
  • Turn bandage diagonally across top of foot and around ankle, and bring bandage around in a figure-8
  • Continue with overlapping figure-8 turns
  • Fasten end of bandage with clips, tape or safety pins
foot injuries
Foot Injuries
  • Commonly caused by:
    • Direct blows
    • Falls
  • Involve almost any bone or ligament of foot
  • Treat same as ankle injuries
  • Toe fractures can be very painful
splinting foot injuries
Splinting Foot Injuries
  • Usually no splinting required
  • Use pillow splint as for ankle injury if:
    • Toe is significantly bent
    • More than 1 toe involved
    • Foot is very painful
rib fractures
Rib Fractures
  • Typically caused by blunt trauma to chest
  • More common in lower ribs and along side
  • Cause severe pain, discoloration, swelling
  • Pain often sharper upon breathing in
  • Patient may breathe shallowly and hold or support area
splinting rib injuries
Splinting Rib Injuries
  • Goal is primarily supportive
  • Have patient sit or stand in position for easy breathing
  • Support ribs with pillow or soft padding loosely bandaged over area and under arm
  • Immobilize arm with sling and swathe
  • Monitor breathing