musculoskletal injuries

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Limmer et al., Emergency Care, 10th Edition

© 2005 by Pearson Education, Inc. Upper Saddle River, NJ

CHAPTER 28

Musculoskeletal

Injuries





MusculoskeletalMusculoskeletal

SystemSystem





Anatomy & Physiology

Bones provide framework.

Joints allow for bending.

Muscles allow for movement.

Cartilage provides flexibility.

Tendons connect muscle to bone.

Ligaments connect bone to bone.





TorsoTorso





Pelvis andPelvis and

Lower Lower

ExtremitiesExtremities







Ball-and-Socket JointBall-and-Socket Joint Hinge JointHinge Joint





Types of Muscle

• Smooth (involuntary)

• Found in organ walls & digestive

system

• Cardiac (myocardium)

• Found in walls of the heart

•

Skeletal (voluntary)





Voluntary (Skeletal) Muscle

Attaches to the bones

Forms the major muscle mass of

the bodyResponsible for movement

Under conscious control

Gives the body shape





Injuries toInjuries to

BonesBones





MechanismsMechanisms

of Injuryof Injury





Types of Musculoskeletal

Injuries

Fracture• Bones break

Dislocation• Joints “come apart”

Sprain• Stretching & tearing of ligaments

Strain• Overexertion of muscle





All musculoskeletal injuries may

present with the same symptoms &

signs; care is directed at minimizing

injury, not determining which type!

Types of Musculoskeletal

Injuries





Types of FracturesTypes of Fractures





Signs & Symptoms of

Musculoskeletal Injuries

Pain and tenderness

Deformity or angulation

Grating (crepitus)

Swelling

Continued…





Bruising (discoloration)

Exposed bone endsJoint locked in position

Nerve/blood vessel compromise

Signs & Symptoms of

Musculoskeletal Injuries







SplintingSplinting





Bone fragments

Bone ends

Angulated joints

Splinting prevents motion of:





Splinting minimizes:

Damage to muscles, nerves, bloodvessels

Conversion of closed injury toopen injury

Restriction of blood flow

Excessive bleeding

Pain/paralysis





Splinting – General Rules

Assess distal pulse, motor function, and sensation (PMS)

before & after application.

Immobilize joints above & below

injury.






Remove or cut away clothing.

Cover open wounds with sterile

dressings.Do not replace protruding bone

ends.

Pad splint.






If the following:

• Severe deformity

• Cyanotic distal extremity

• Pulseless distal extremity

Then align with gentle traction

unless resistance is felt.





Align joints with gentle traction.






Splint patient before moving.

When in doubt, splint.

Care for ABCs and life threats first.





Types of SplintsTypes of Splints





Hazards of Improper Splinting

Compression of nerves, tissues,

and blood vessels

Delays transport of criticalpatients

Continued…





Hazards of Improper Splinting

Reduced distal circulation from

tight splints

May aggravate or worsen initial

injury (splint loose or excessive

motion)





Long-Bone SplintingLong-Bone SplintingStabilize extremity manually.





Assess distal PMS.Assess distal PMS.





Make sure splint extends several inchesMake sure splint extends several inches

beyond joints above/below injury.beyond joints above/below injury.





Apply splint. Immobilize jointsApply splint. Immobilize joints

above/below injury.above/below injury.





Secure extremity to splint.Secure extremity to splint.

S f t h d i th itiS f t h d i th iti





Secure foot or hand in the positionSecure foot or hand in the position

of function.of function.





Reassess distal PMS.Reassess distal PMS.





I bili i j it d bImmobili e inj r site and bones





Immobilize injury site and bonesImmobilize injury site and bones

above and below.above and below.

R di t l PMSR di t l PMS





Reassess distal PMS.Reassess distal PMS.





Pelvic Injury

Pelvic fracture

Hip dislocation

Maintain strong suspicion of spinal injury.





Treatment of Pelvic Injury

Minimize motion of injured area.

Assess distal PMS.

Attempt to straighten lower extremities into anatomical position.

Pad between extremities with

blanket.



Limmer et al., Emergency Care, 10th Edition© 2005 by Pearson Education, Inc. Upper Saddle River, NJ


Apply PASG if patient is hypotensive.

Place patient on spine board. (Use

caution with log-roll!)

Reassess distal PMS.

Care for shock.

Transport.

Continued…

f





Pelvic wrap is an option.

Perform patient assessment.

Treat for shock.

When correctly placed, sheet will

appear lower than iliac “wings.”

Pelvic WrapPelvic Wrap




Pelvic WrapPelvic WrapPrepare backboard.

Pelvic WrapPelvic Wrap




Pelvic WrapPelvic WrapLogroll patient & bring sheets around patient.



Traction Splinting




Traction Splinting

Use a traction splint to immobilize

a painful, swollen, or deformed

thigh with no joint or lower legpain.

Traction Splinting




Traction Splinting

Contraindications

Injury to:

• Knee or nearby area

• Hip (proximal femur)

• Pelvis

• Lower leg; or

• Avulsion or partial amputation of lower

leg



Di t li ti f l t tiDi t li ti f l t ti




Direct application of manual traction.Direct application of manual traction.

Adj t li t l th d itiAdj t li t l th d iti




Adjust splint length and position.Adjust splint length and position.

A l i l i d iA l i l i d i




Apply proximal securing device.Apply proximal securing device.

A l di t l i d iA l di t l i d i




Apply distal securing device.Apply distal securing device.

A l h i l t tiA l h i l t ti




Apply mechanical traction.Apply mechanical traction.

Position/fasten support straps.Position/fasten support straps.




Position/fasten support straps.Position/fasten support straps.

Reevaluate proximal/distal securingReevaluate proximal/distal securing

devices.devices.







Assess PMS; position slingAssess PMS; position sling




Assess PMS; position sling.Assess PMS; position sling.

Form slingForm sling




Form sling.Form sling.

Fasten slingFasten sling




Fasten sling.Fasten sling.

Leave fingertips exposed. Check distalLeave fingertips exposed. Check distal




Leave fingertips exposed. Check distalLeave fingertips exposed. Check distal

PMS.PMS.

Secure corner of slingSecure corner of sling




Secure corner of sling.Secure corner of sling.

Tie swathe around slingTie swathe around sling




Tie swathe around sling.Tie swathe around sling.

Splint for Injured ForearmSplint for Injured Forearm




Splint for Injured ForearmSplint for Injured Forearm

Splint for Injured FingerSplint for Injured Finger




Splint for Injured Finger Splint for Injured Finger




1. List signs and symptoms of

musculoskeletal injuries.

2. What complications will you

prevent by splinting properly?

Review Questions










What interventions are appropriate

for this patient?

S TREET S CENES



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