Bone & Joint Injuries Monica Hall RN, AE-C, BSN
General Info Injuries to bones and joints are common in accidents and falls This includes a variety of injuries
Examples of joint & bone injury Fractures Dislocations Sprains Strains
Fracture A break in a bone Two types Closed (simple) – fracture is a bone break is not accompanied by an external or open wound on the skin Open (compound) – fracture is a bone break that is accompanied by an open wound on the skin
Signs and Symptoms of Fracture Can vary Each person will not exhibit all Common sign & symptoms: Deformity Limited motion or loss of motion Pain and tenderness at the fracture site Swelling and discoloration Protrusion of bone ends through the skin Victim heard a bone break or snap or felt a grating sensation (crepitation) Abnormal movements within a part of the body
Basic Principles of treatment for fractures Maintain respirations Treat for shock Keep the broken bone from moving Prevent further injury Use devices such as splints and slings to prevent movement of the injured part Obtain medical help whenever a fracture is evident or suspected
Videos of Fracture
Dislocation When the end of a bone is either displaced from a joint or moved out its normal position within a joint Frequently associated with tearing or stretching of ligaments, muscles, and other soft tissue
Signs & Symptoms of Dislocation Deformity Limited or abnormal movement Swelling Discoloration Pain and tenderness A shortening or lengthening of the affected arm or leg
Dislocation Treatment Basically the same as fractures No attempt should be made to reduce the dislocation (replace the bone in the joint) Immobilize the affected part in the position found by using splints and/or slings (movement of the injured part can lead to additional injury to nerves, blood vessels, and other tissue in the area) Obtain medical help immediately
Dislocation Video
Sprains An injury to the tissues surrounding a joint; it usually occurs when the part if forced beyond its normal range of movement Ligaments, tendons, and other tissues are stretched or torn Common sites for sprains include the ankles and wrist
Sprains (Signs & Symptoms) Swelling Pain Discoloration Sometimes impaired motion
Ankle Sprain Video
Strain Overstretching of a muscle, it is caused by overexertion or lifting Backs are the most frequent site
Signs/Symptoms of Strain Sudden pain Swelling Bruising
Strain treatment Encourage the victim to rest the affected muscle while providing support Recommend bedrest with a backboard under the mattress for a strained back Apply cold application to reduce the swelling After the swelling has decreased, apply warm, wet applications because warmth relaxes the muscles Obtain medical help for severe strains and back injuries
Neck and Spine Injuries Most dangerous types of injuries to bones and joints If a victim with such injury is moved, permanent injury resulting in paralysis can occur If at all possible avoid any movement of a person with potential neck or spinal injuries Wait until a backboard, cervical collar, and adequate help for transfer arrives
Videos
Splints Devices used to immobilize injured parts Can be used in fractures, dislocations, and other similar injuries are present or suspected Commercial splints are available such as air or inflatable splints, padded boards and traction splints Can also be made from cardboard, newspapers, pillows, etc.
Basic principles of splints Should be long enough to immobilize the joint above and below the injured part Should be padded especially over bony areas and over the site of injury Can be secured in place with triangular bandages, strips of cloth, roller gauze, or similar materials Must be applied in a way to not cause pressure over the site of injury If an open wound is present, use a sterile dressing to apply pressure and control bleeding
Basic principles of splints – cont. Never make an attempt to replace broken bones or reduce a fracture or dislocation – do not move the victim, splint wherever you find the victim Pneumatic splints are available but must be used with caution – there are air and vacuum Traction splints provide a pulling or traction effect on the injured bone – only trained people would apply After a splint is applied, one should check circulation Check skin temperature (should be warm) Skin color (pale or blue indicates poor circulation) Any swelling, numbness, or tingling Check pulse
Splint Video
Slings Generally used to support the arm, hand, forearm, and shoulder Many different types Commercial slings usually have a series of straps that extend around the neck and/or thoracic region A common first aid sling is the triangular bandage May be used to provide immobility if a fracture of the arm or shoulder is suspected
Basic Principles of Slings Always position where hand is higher than the elbow (promotes circulation, prevents swelling, and decreases pain) Check circulation frequently (skin temperature, color, tingling, amount of pain, and numbness) – nail beds is an easy way to check, when pressing them should blanch (turn white) then return to the normal pink color immediately If applying sling due to potential fracture, used caution not to move area and cause increased injury while trying to apply sling If using a triangular bandage, tie knot to either side of spinal column and pad knot If sling is for shoulder injury, can secure limb to body after applying sling with bandage around thoracic region
Sling Video
Summary Victims with injury to bones or joints can also experience shock Be alert for signs of shock and treat as indicated These injuries cause emotions to soar – reassure All first aid measures are directed toward decreasing pain Obtain medical help The only definite medical dx of a closed fx is a x-ray Always if suspected injury is noted, treat as if it is a true injury