EXTREMITY TRAUMA

OBJECTIVES Identify and treat fractures and soft tissue injuries in a tactical environment.

Open Wounds

Closed Wounds

Musculoskeletal - Causes Overuse Acute sprains and strains Trauma

Overuse

Acute Sprains and Strains

Trauma Compound Fracture of the Ankle

Musculoskeletal Presentation Pain Swelling Discoloration Temperature change Numbness/tingling Loss of function

Musculoskeletal Evaluation History Physical examination –skin breaks –tenderness –swelling –discoloration –distal pulses –sensory exam –motor exam

Musculoskeletal Treatment Prevention “RICE” Analgesic –Tylenol Analgesic & Anti-inflammatory –Aspirin –Ibuprofen (Motrin/Ranger Candy) –Naprosyn

Fractures Any break in the continuity of a bone May vary from a simple crack to a completely shattered bone FX Femur

Open Fracture Compound Fracture of the Ulna

Blast Injury De-gloving Injury Other Injuries

Ecchymosis Discoloration caused by bleeding in tissue Blood migrates toward skin and changes color with time

Joints Surrounded by joint capsule and ligaments, muscles and tendons

Dislocations Disruption of a joint such that the bone ends are no longer in contact Torn ligaments and capsule

Common Dislocations Fingers Shoulder Hip Elbow Ankle Dislocated Elbow

Knee Joint Femur, Tibia, and Patella Largest hinge joint in body Held together by complex ligaments Susceptible to injury

Knee Injuries Ligaments and cartilage injuries are common Swelling, pain, limited ROM Frequent athletic injury Splint entire femur and tibia

Dislocation of the Knee Severe deformity Popliteal artery commonly injured If pulse is present, splint in deformed position (RGR MEDIC)If pulse is absent, attempt once to realign limb and splint where pulse is strongest (RGR MEDIC)

Dislocation of the Knee

Ankle Injuries Usually result from twisting, indirect force Fracture, dislocations, sprains can occur Swelling and deformity Note circulation Immobilize with padding and splint

Sprain Partial, temporary joint dislocation Ligaments torn or stretched May produce discoloration

SAM SPLINT

Management of Closed Injuries R - Rest I - Ice C - Compression E - Elevation S - Splint (SAM Splints and cravats or ACE wraps) R/O fracture

Soft Tissue Injuries Open - Violation of overlying skin or mucous membrane

Management Stop the bleeding and bandage

Summary Although quite common, rarely life threatening First priority in management same for all patients ( A,B,C’s) RICES for most soft tissue injuries