Lesson 9: Bone and Joint Injuries

Objectives Define strain, sprain, fracture and dislocation List Signs and Symptoms of strain, sprain, fracture, and dislocation Demonstrate field assessment Define RICE (rest, immobilization, cold, elevation) Describe use of RICE

Objectives Demonstrate and describe the emergency treatment for Strains and sprains Fractures Dislocations including re-alignment Describe treatment for Angulated fractures Open fractures Describe long term care for injuries to bones and joints Describe when to evacuate

Bone and Joint Injury Overview Injuries to musculoskeletal system are amongst most common Wilderness injuries Care is same regardless of exact diagnosis Strains are overstretched muscles or tendons Sprains are injuries to ligaments (hold bones to bones

Bone and Joint Injury Overview Fractures is a bone break, chip or crack Open fracture: open wound in skin over fracture Closed fracture: no break in the skin Closed fractures more common, open ones more dangerous Dislocation: movement of bone or joint away from normal position, often includes tearing of ligaments.

Fracture Types

Guidelines for Preventing Bone and Joint Injuries Pay attention to safety War adequate footwear Engage in pre-trip physical conditioning Set up camp/home so there are few trip hazards

Checking for Strains, Sprains, and Fractures Signs and Symptoms Deformity, open injuries, tenderness and swelling (DOTS) Moderate or server pain or discomfort Bruising (may take hours to appear) Inability to move or use affected area Broken bone or fragments sticking out Bones grating or sounds of grating Feeling or hearing snap or pop Loss of circulation, sensation MOI such as fall, suggests injury may be severe

Checking for a Possible Bone or Joint Injury Have patient rest in comfortable position Remove clothing as necessary to check area Ask how injury happened and what areas hurt Visually inspect entire body. Compare 2 sides of body to look for differences. Feel for DOTS

Checking for Possible Strain or Sprain Have patient actively move joint and evaluate pain involved Manipulate joint with your hands and evaluate pain If joint appears usable, have patient test it with their weight

Checking for Possible Fracture Determine whether injured part looks broken (deformed). Compare to uninjured side Ask patient if they think it is broken Gently touch injured area look for: Patients reaction to touch Muscles appear to be spasming Injured area seems unstable One spot hurts noticeably more than the rest Check CSM beyond site of injury

Caring for Strains, Sprains, and Fractures Whether usable or not, general care is RICE Rest: don’t allow injured area to be used for at least ½ hour Immobilization: prevent further injury by keeping injured area still Cold: ice works best, avoid direct contact with the skin Elevation: Keep injury higher than patient’s heart 20-30 min of cold, 10-15 min of warming Repeat RICE cycle 3-4 times a day if possible

RICE

Splinting In remote areas, patients will likely need to be moved Splint should restrict movement to prevent further injury and increase comfort Splint must be made of something to pad injury and rigid enough to provide support Padding should fill in all spaces to help prevent movement Possible splint material includes branches, walking poles, SAM splints, magazines, etc Use triangular bandages, tape, elastic wraps, etc to secure splints

Splinting

Splinting

Improvised Splinting Material What can be used for splinting? Sticks Tent poles Oars/paddles Ski/trekking poles SAM Splints Internal Pack frames

Improvised Splinting Material Padding: Sleeping bags Foamlite pads Extra clothing Soft debris from forest floor Rolls of sterile dressing

Splinting Prepare splinting material before starting Plan splints to hold injury in natural, neutral position Spine inline, padding in the small of the back Legs almost straight, padding behind knees Feet 90 degrees to legs Arms flexed to cross heart Hands in functional curve with padding on palms Shoe left on foot, can act as splint. Remove if circulation issue Remove rings, bracelets, watches if could restrict flow

Splinting Types Hard Splint: splinting material is rigid (poles, sticks, etc) Soft Splints: splinting material is soft and bulky (ex newspaper, sleeping pad, sweatshirt, etc) Anatomical: splint material is another body part (fingers taped together, legs splinted together)

Splinting Skills Session In Pairs or 3’s: Splint lower leg with rigid material Anatomically splint legs Splint Forearm with soft material (provide sling and swath)

Applying a Sling and Swathe Support injured arm above and below site of injury Place triangular bandage under arm and over uninjured shoulder. Wrap outside of bandage around other side of neck. Tie on side of neck Add padding Bind arm to torso with folded bandage Check CSM below in hand

Splinting Specific Fractures: Jaw: hold jaw in place, wide wrap around head. Make sure can be removed (in case of vomiting) Collarbone: Secure collarbone with sling and swathe Fingers and toes: Bind to adjacent finger/toe Rib: support arm on injured side with sling and swathe. Make sure patient breathes deeply Hip/pelvis: secure legs together. Watch for shock/internal bleeding

Caring for Complicated Fractures Angulated fractures leave bone distorted, open fractures expose body to infection Irrigate open fracture, dress appropriately If bone ends stick out, and help is more than 4 hrs away, Control bleeding Clean wound and bones ends (don’t touch) Apply gentle inline traction Dress wound

Caring for Complicated Fractures Splint the fracture, infection likely but bones survive better in body With angulated fracture, bones must be straightened with in line traction Pull in direction in which bones point Slowly and gently move broken bone back to place Do not force Do not continure if increasing pain Splint once aligned

Checking and Caring for Dislocations Dislocation will produce pain in joint and loss of normal motion Joint “Looks wrong” Many dislocations can only be splinted in the field Some can be put back by realignment through process called “reduction”

Dislocations

Dislocation Reduction Work quickly but calmly. The sooner reduction is done, the better Encourage patient to relax, particularly injured joint Stop if pain increase dramatically Splint joint after it is back in place

Shoulder Reduction Anterior Shoulder dislocations most common Position patient face down on rock/log, injured arm dangling down Tie something 10-15 lbs in weight to dangling wrist. Patient does not hold weight Wait. Process takes 20-30 min to work Key is for patient to be relaxed and allow gentle pull to put joint back in place

Shoulder Reduction Injured patient can do this on themselves as well The sooner the better, waiting may cause chest muscles to tighten and spasm As soon as complete, put arm in sling and swathe to secure it

Toe/Finger Relocation Keep injured finger partially bent Pull on end with one hand, press gently back in place with other Place gauze pad between injured finger and next finger Tape in place Do not tape over injured joint

Kneecap Dislocation Apply gentle traction to the leg to straighten it out Kneecap may pop in place with just traction Massage thigh and use hand to push kneecap gently back in place Apply splint that does not pressure kneecap. Patient may be able to walk

Guidelines for Evacuation If injured body part is usable, level of pain determines if evac is needed Evacuate anyone with un-usable body part and first time dislocations GO FAST with angulated fractures, open fractures, fractures of pelvis, hip, femur(thigh), more than one long bone, or decrease in CSM below injury.

Scenario During trail restoration, adult leader falls on downed branch and down 5 foot embankment. You can call the ranger station, but help is at least 1 hour away

f