Chapter 25

1. Chapter 25 Assessment and Care of Bone and Joint Injuries

2. Objectives (1 of 2) • List the assessment and emergency care for injuries of the upper extremities. • List the assessment and emergency care for injuries of the lower extremities. • Explain the rationale for stabilization of specific injuries to the upper extremities. • Explain the rationale for stabilization of specific injuries to the lower extremities.

3. Objectives (2 of 2) • Demonstrate the assessment and emergency care for injuries to the:

4. Upper Extremity Injuries • Causes: • Fall onto outstretched hand (FOOSH) • Can depend on age, position, forces, equipment, and surface • Position of limb has significant influence.

5. Clavicle and Scapula Injuries (1 of 2) • Clavicle is one of the most fractured bones in the body. • Usually occur due to FOOSH • Sometimes due to crush injuries • Pain, swelling, and deformity • Lies directly over arteries, veins, and nerves

6. Clavicle and Scapula Injuries (2 of 2) • Scapula is well protected. • Injury is associated with forceful direct impact • Watch for associated significant injuries • Joint between clavicle and scapula is the acromioclavicular (A/C) joint • “True dislocation” with point tenderness • Splint these injuries with a sling and swathe.

7. Dislocation of the Shoulder (1 of 2) • Most commonly dislocated large joint • Usually dislocates anteriorly • Extremely painful injury • Patients will self-splint the arm and shoulder. • Numbness and tingling can occur.

8. Dislocation of the Shoulder (2 of 2) • Difficult to immobilize • Sling and swathe • Blanket roll splint • Can be a recurrent injury • “Reduction” should occur in clinic or hospital

9. Fractures of the Humerus • Fracture occur either proximally, in midshaft, or distally at elbow. • Consider applying traction to realign a severely angulated humerus, according to local protocols. • Splint with sling and swathe, supplemented with a padded board splint or SAM splint.

10. Elbow Injuries • Fractures and dislocations often occur around the elbow. • Injuries to nerves and blood vessels are common. • Assess neurovascular function carefully. • Careful realignment may be needed to improve circulation.

11. Emergency Care of Elbow Injuries • Splint with padded rigid material or SAM splint, roller gauze, and a sling and swathe. • Always monitor distal CMS functions. • Rapid evacuation is essential in patients with poor distal circulation.

12. Fractures of the Forearm • Usually involves both radius and ulna • Common injury for snowboard riders • Known as “Colles” fractures and the appearance is called a “silver fork” deformity • Use a padded board, SAM splint, roller gauze, and sling and swathe. • Assess and reassess CMS functions.

13. Injuries to the Wrist and Hand • Common injury in all age groups, and especially riders and skiers • Many different injuries are possible. • “Skier’s” thumb is an ulnar collateral ligament sprain. • Due to potential complications, these injuries should be evaluated by a physician.

14. Emergency Care of Wrist and Hand Injuries • Form hand into position of function by placing a roller bandage in palm. • Apply padded board or SAM splint. • Secure splint with roller gauze. • Apply a sling and swathe. • Monitor CMS functions. • Find and send amputated parts with patient.

15. Lower Extremity Injuries • Includes: • Pelvis fractures • Hip dislocations • Femur fractures • Knee ligament sprains • Fractures and dislocations of the knee and patella • Tibia and fibula fractures • Ankle and foot sprains and fractures

16. Fractures of the Pelvis • Injuries are the result of a fall, collision or forceful compression. • May involve life-threatening internal bleeding • Organs within the pelvis can be injured. • Assess for pain in lower back, lower abdomen, or pelvic area. • Patients may lie in a fetal position or with knees partially flexed.

17. Emergency Care of a Pelvic Fracture • Palpate pelvis for tenderness: lateral sides, then pelvic rock, then lower anterior aspects • Anticipate shock, give high-flow oxygen. • Stable patients can be secured to a long backboard or scoop stretcher to immobilize isolated fractures of pelvis.

18. Dislocation of the Hip (1 of 2) • Hip dislocation requires significant MOI. • Patients with posterior dislocations lie with hip joint flexed and thigh rotated inward (most common). • Patients with anterior dislocations lie with leg extended straight out, and rotated, pointing away from midline.

19. Dislocation of the Hip (2 of 2) • Monitor CMS functions. • Splint in position of deformity on long backboard and transport.

20. Fractures of the Proximal Femur • Also known as a hip fracture • Displaced fractures present with characteristic deformity. • Apply high-flow oxygen, monitor CMS functions. • Fractures from trauma injuries best managed by splinting to uninjured leg and long backboard or scoop stretcher. • Traction splinting is not usually indicated.

21. Femoral Shaft Fractures • Leg is externally rotated, shortened, with deformity (bulge) at the thigh • Muscle spasms can cause deformity of the limb. • Significant blood loss can occur. • Monitor distal CMS functions. • Immobilize with traction splint. • Traction should be maintained until hospitalization.

22. Anatomy of the Knee • Modified hinge joint • 4 main ligaments: medial and lateral “collateral,” anterior and posterior cruciate • Patella aids flexion and is a “sesamoid” bone.

23. Injuries of Knee Ligaments • Most common injury in skiing • Frequently a “pop” is heard or felt. • Definitive assessment is best done before knee becomes swollen and painful. • MOI can often help indicate type of injury. • Splint (quick splint) and transport. • Monitor distal CMS function. • Apply ice and advise patient to seek physician’s care.

24. Fractures About the Knee • Can occur at three locations: • Distal femur • Proximal tibia • Patella • Deformity, swelling, impaired CMS functions • Perform re-alignment once if CMS functions are impaired. • Apply rigid splint (quick splint).

25. Dislocation of the Knee • Produces significant deformity • More urgent injury is to popliteal artery, which is often lacerated or compressed. • Always monitor distal CMS functions. • Perform realignment once if CMS functions are impaired. • Apply a rigid splint (quick splint).

26. Dislocation of the Patella • Patella usually dislocates to lateral side • Injury produces significant deformity • Splint (quick splint) in position found. • Monitor distal CMS functions. • May reduce spontaneously during splinting

27. Injuries to the Tibia and Fibula • Usually, both bones fracture at the same time. • Skiers may suffer “boot-top” or spiral fractures. • Open fracture of tibia is common. • Realignment is frequently required. • Concurrent femur fracture produces a “floating knee.” • Immobilize with a padded quick splint that extends from foot to upper thigh.

28. Ankle Injuries (1 of 2) • The ankle is the most commonly injured joint. • MOI includes abruptly “turning the foot under” or “twisting the foot in.” • Apply cold packs or ice. • Assess distal CMS functions. • Fractures are difficult to distinguish from severe sprains. • Patient should seek physician’s care if symptoms do not diminish within a day or two.

29. Ankle Injuries (2 of 2) • Fractures usually involve the distal tibia and/or fibula (lateral and medial malleoli). • Snowboard riders suffer talus fractures that mimic ankle sprains. • Dislocations are associated with distal fractures. • Perform realignment/traction once if CMS functions are impaired. • Monitor CMS functions and splint (soft or well-padded rigid splint).

30. Foot Injuries • Usually occur after a patient falls or jumps. • Also consider possibility of spinal injury from a fall. Apply a long backboard if needed. • Stress fractures occur with “overuse.” • Immobilize ankle joint and foot in a soft splint. • Elevate foot to reduce swelling.