Principles of Musculoskeletal Injuries Chapter 24 Principles of Musculoskeletal Injuries

Objectives (1 of 3) Describe the function of the muscular system. Describe the function of the skeletal system. List the major bones or bone groupings of the spinal column, the thorax, the upper extremities,and the lower extremities. Differentiate between an open and closed painful, swollen, deformed extremity (fracture).

Objectives (2 of 3) State the reasons for splinting. List the general rules for splinting. List the complications of splinting. Explain the rationale for splinting at the scene versus load and go.

Objectives (3 of 3) Demonstrate the emergency care principles for injured extremities. Demonstrate the basic principles of applying the three basic splint types: rigid fixation, soft fixation, and traction splints.

Anatomy and Physiology of the Musculoskeletal System

Types of Muscle Skeletal muscles Attach to bone by tendons Voluntary Smooth muscles Involuntary Cardiac muscle Specialized and has separate regulatory systems

Skeletal System

Joints A joint is formed wherever two bones come into contact. Ligaments hold bones together. Articular cartilage allows bone ends to glide easily. Joints are lubricated by synovial fluid.

Types of Musculoskeletal Injuries Fracture Broken bone Dislocation Disruption of a joint Sprain Joint injury with tearing of ligaments Strain Stretching or tearing of a muscle

Mechanism of Injury Force may be applied in several ways: Direct blow Indirect force Twisting force High-energy injury

Fractures Closed fracture A fracture that does not break the skin Open fracture External wound associated with fracture Nondisplaced fracture Simple crack of the bone Displaced fracture Fracture in which there is actual deformity.

Greenstick Fracture

Comminuted Fracture

Pathologic Fracture

Epiphyseal Fracture

Signs and Symptoms of a Fracture (1 of 2) Deformity Tenderness Guarding Swelling Bruising

Signs and Symptoms of a Fracture (2 of 2) Crepitus False motion Exposed fragments Pain Locked joint

Signs and Symptoms of a Dislocation Marked deformity Swelling Pain Tenderness on palpation Virtually complete loss of joint function Numbness or impaired circulation to the limb and digit

Signs and Symptoms of a Sprain Point tenderness can be elicited over injured ligaments. Swelling and ecchymosis appear at the point of injury to the ligaments. Instability of the joint is indicated by increased motion. Pain

Assessing Musculoskeletal Injuries (1 of 2) Assess mechanism of injury. Perform initial assessment. Perform focused physical exam. Follow BSI precautions. Give oxygen if needed. Follow DCAP-BTLS.

Assessing Musculoskeletal Injuries (2 of 2) If patient critically injured, arrange for immediate transport. Be alert for compartment syndrome. Splint injury. Transport. Monitor neurovascular status during transport.

Evaluating Neurovascular Function Examination of the injured limb should include assessment of the following: Pulse Capillary refill Sensation Motor function

Severity of Injury Critical injuries can be identified using musculoskeletal injury grading system. Refer to Table 24-1 on page 587.

Emergency Medical Care Completely cover open wounds. Apply appropriate splint. If swelling is present, apply ice or cold packs. Prepare patient for transport. Always inform EMS about wounds that have been dressed and splinted.

Splinting Use a flexible or rigid device to protect extremity. Injuries should be splinted prior to moving the patient, unless patient is critical. Splinting helps prevent further injury. Improvise splinting materials when needed.

General Principles of Splinting (1 of 3) Remove clothing from the area. Note and record patient’s neurovascular status. Cover all wounds with a dry, sterile dressing. Do not move patient before splinting.

General Principles of Splinting (2 of 3) Immobilize the bones above and below the injured joint. Pad all rigid splints. Maintain manual immobilization. Use constant, gentle, manual traction if needed. If you find resistance to limb alignment, splint the limb as is.

General Principles of Splinting (3 of 3) Immobilize all suspected spinal injuries in a neutral in-line position. If the patient has signs of shock, align limb in normal anatomic position on a backboard and transport. When in doubt, splint.

Rigid Fixation Splints Firm material applied to fractures that prevent motion Quick splints Cardboard Wire and ladder splints SAM® splint

Soft Fixation Splints Air splints Vacuum splints Sling and swathe Blanket/pillow splints

Applying a Quick Splint (1 of 2) Open the quick splint. Assess distal CMS functions of the leg. Manually stabilize leg by grasping foot and leg behind and below the knee. Slight longitudinal traction can be used. Elevate the extremity carefully. The “pant-leg pinch lift” can also be used.

Applying a Quick Splint (2 of 2) Have second rescuer slide the open splint under the leg. Lower leg carefully into splint. Second rescuer can fold sides of splint and secure straps, cords, etc. Reassess distal CMS functions of the leg.

Applying a Sling and Swathe (1 of 2) Assess distal CMS functions. Carefully bend injured arm to just < 90° and lay a cravat on the chest under the arm, with a 90° point at the elbow. Bring lower end up and over shoulder on injured side. Bring upper end over opposite, uninjured shoulder and tie at side of neck.

Applying a Sling and Swathe (2 of 2) Secure a second cravat, 3” to 6” wide, around the chest and injured upper arm. To avoid pressure on the injured shoulder, alternately, bring lower end through injured arm’s armpit and tie it over the scapula. Reassess distal CMS functions.

Applying a Blanket Roll (1 of 2) Fold blanket longitudinally into thirds. Lay two or three cravats near end of blanket and roll firmly. Assess distal CMS functions.

Applying a Blanket Roll (2 of 2) Position roll snugly under injured shoulder; tie one cravat over uninjured shoulder. Secure other(s) around chest and/or waist. Secure injured arm with sling and swathe. Reassess distal CMS.

Applying a Vacuum Splint Stabilize and support injury. Place splint and wrap it around limb. Draw air out of splint and seal valve. Check and record distal CMS functions.

Improvised Splints Use rigid or semi-rigid materials. Examples: Skis, ski poles Boards, branches Blankets, pillows, camping pads Shovels, probes, ice axes Uninjured part, ie, finger, leg, chest wall

In-line Traction Splinting Act of exterting a pulling force on a bony structure in the direction of its normal alignment. Realigns fracture of shaft of a long bone. Usually used for femur fractures. Use the least amount of force necessary. If resistance is met or pain increases, splint in deformed position.

Traction Splints Do not use a traction splint under the following conditions: Upper extremity injuries Injuries close to or involving the knee Pelvis and hip injuries Partial amputation or avulsions with bone separation Lower leg or ankle injuries

Applying a Traction Splint (1 of 3) An angulated fracture will need to be realigned before a splint can be applied. Manually stabilize fracture site. Expose site and care for any open wounds. Per local protocol, remove footwear and assess distal CMS functions.

Applying a Traction Splint (2 of 3) Prepare splint for application. Smoothly realign fracture and maintain traction. Fasten ankle hitch. Support fracture and transfer traction to ankle hitch. Position splint; pad and secure ischial strap.

Applying a Traction Splint (3 of 3) Carefully transfer traction to splint. Secure splint to leg. Reassess distal CMS functions. Logroll patient onto backboard and secure.

Applying a Sager Traction Splint (1 of 2) Manually stabilize fracture. Assess distal CMS functions. Expose site and care for any open wounds. Adjust thigh strap. Estimate proper splint length. Arrange ankle pads to fit. Place splint along inner aspect of thigh.

Applying a Sager Traction Splint (2 of 2) Secure ankle harness. Snug cable ring against bottom of foot. Pull out inner shaft of splint to apply traction. Secure splint to leg. Secure patient to backboard. Reassess CMS function.

Hazards of Improper Splinting Compression of nerves, tissues, and blood vessels Delay in transport of a patient with a life-threatening condition Reduction of distal circulation Aggravation of the injury Injury to tissue, nerves, blood vessels, or muscle

Improvised Traction Splints Single-ski technique Pre-made pockets Cravats Two ski poles Two paddles Scoop stretcher

Ski Boot Removal (1 of 2) Guided by local protocol. Many factors can influence protocol. Transport time Injury Type of splint used CMS status Boot should be removed before patient arrives at hospital.

Ski Boot Removal (2 of 2) Stabilize lower leg. Loosen all buckles, straps, and laces. Spread boot shell and pull out boot tongue. Apply tension to back of boot and pressure to boot toe with shoulder. Rotate the boot off the foot. Monitor for pain. Modify as needed. Assess distal CMS functions and splint.