1. EXTREMITY TRAUMA

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

3. Open Wounds

4. Closed Wounds

5. Musculoskeletal - Causes Overuse Acute sprains and strains Trauma

6. Overuse

7. Acute Sprains and Strains

8. Trauma Compound Fracture of the Ankle

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

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

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

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

13. Open Fracture Compound Fracture of the Ulna

14. Blast Injury De-gloving Injury Other Injuries

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

16. Joints Surrounded by joint capsule and ligaments, muscles and tendons

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

18. Common Dislocations Fingers Shoulder Hip Elbow Ankle Dislocated Elbow

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

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

21. 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)

22. Dislocation of the Knee

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

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

25. SAM SPLINT

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

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

28. Management Stop the bleeding and bandage

29. 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