1. SOFT TISSUE INJURIES, DISLOCATIONS AND FRACTURES

2. Soft tissue injuries
Contusions, strains and sprains all fall under the classification of soft tissue injury.
Contusions (bruises)
Result of trauma to the skin which causes damage to the underlying blood vessels.
Does not cause the skin to break
Amount of discolouration and swelling under the skin will depend upon the size and the number of blood vessels disrupted.

3. Strains
Occurs when a muscle is exposed to a greater workload than is normally encountered and is stretched beyond its normal limit.
It can also occur if a muscle comes under stress before it is has properly warmed up.
Can occur within the muscle belly itself, or in the tendon which attaches the muscle to the bone.
Severity of the strain can vary from minor discomfort and damage through to a complete rupture of the muscle.

4. Sprains
A sprain occurs at a joint and is normally associated with the stretching of that joint beyond its normal range of movement, often causing the ligaments to stretch and sometimes tear.
Some joints also have cartilage pads located in them to provide cushioning.
IMPORTANT!
If you are unsure whether the injury is a soft tissue injury or a fracture or a dislocation, treat as a fracture or dislocation until proven otherwise. After going through the usual assessment procedures, the management of this group of injuries is similar.

5. Managing soft tissue injuries
Signs and symptoms
Pain
Bruising
Swelling
Loss of motion
Deformity
Shock
Management of soft tissue injuries require the application of the RICER principle.
Rest- The injured part
Ice- An ice pack or cold compress should be applied to the injured site. Do not apply directly to the skin, but wrap in a damp cloth. The ice should be applied for 10 to 20 minutes every 2 hours.
Compression-Apply a compression bandage to the injured site
Elevation-The injured area should be elevated
Referral- If unsure of the extent of the injury, medical advice should be sought
“ IF IN DOUBT, GET IT CHECKED OUT”

6. Dislocations
Injuries to joints where one bone is displaced from another
Can be caused by direct trauma or abnormal twisting, often resulting in displacement of a bone from its normal position in a joint. Joint is pushed past it’s normal ROM.
Signs and symptoms include: pain, deformity and loss of motion.
Surrounding connective tissue, ligaments and tendons are also damaged.
Urgent medical attention is required if a distal pulse (i.e. one furthest from the heart than the injury site) is unable to be located, or there is altered sensation, such as numbness.
Common sites of dislocations are:
Fingers, shoulder and patella.

7. Left Shoulder Dislocation Photograph

8. Right Knee Dislocation Photograph

9. Left Knee Dislocation Photograph

10. Can you spot the difference????

11. Left ankle fracture/dislocation Photograph

12. Dislocations-treatment
The following guidelines should be observed when treating a dislocation:
Never attempt to relocate the displaced bone yourself nor let anyone besides a doctor attempt to relocate the bone.
Risk = disrupting blood supply to joint, therefore can lead to necrosis of the limbs. Damage to the nerve supply and increased damage to the surrounding tissue.

13. Hard Tissue Injuries: Fractures
A fracture is a break in a bone. Sometimes the fracture may be a single, clean break or there may be several breaks. Children often suffer a “greenstick” fracture, which is the splintering of bone.
CAUSES:
Direct force-bone is broken at site of impact
Abnormal muscle contraction
Indirect force-bone breaks some distance from the point of impact.
Diseased bone-(causes include osteoporosis and cancer)

14. Signs and symptoms of fractures include:
Pain at the site of the injury
Inability to move the injured part, or unnatural movement of the injured part
Deformity of the injured part
Swelling and discolouration
Grating of bones
Tenderness
Possible shock

15. Types of Fractures Type of Fracture Definition Associated Factors
Closed
(simple)
The bone is fractured but there is no cut or wound at the fracture site
Bleeding remains concealed beneath the skin
Open
(compound)
The end of the fractured bone protrudes through the skin
Visible external bleeding occurs.
Infection may enter the body and the bone.
Complicated
The fractured bone damages the local tissues, i.e. organ(s)

16. Compound Fracture Photographs

17. Fractures-treatment & management
If responsive:
Conduct a Primary Survey and act accordingly
The main aim is to prevent any movement at the site of the fracture. If unsure, keep the victim still and comfortable and call an ambulance.
Immobilise the joint above and below the fracture site, if possible.
If necessary, splint in position of comfort for the victim.
(Refer to Lippmann & Natoli (2006), pp 51-52) for splinting and immobilisation technique examples.
Do not attempt to realign a badly deformed limb
Where possible, an immobilised fractured limb should be elevated to reduce pain and swelling.
Treat for shock
Support a fractured jaw with the hand. If necessary, pull the lower jaw forward to keep the airway open.
Note: If in a metropolitan region or one in which is close to medical assistance it may be preferable not to splint the affected site. Leave this to ambulance or paramedical services.

18. Fractures-treatment & Management
If unresponsive:
Arrange urgent medical treatment
Immediately place the victim in the recovery position
Conduct a Primary Survey and Vital Sign Surveys and act accordingly.

19. Slings-Full Arm Sling When to use: Injuries to the forearm and wrist
How to apply:
-Support the injured forearm approximately parallel to the ground with the wrist slightly higher than the elbow
-Place an opened triangular bandage between the body and the arm, with its apex towards the elbow
-Extend the upper point of the bandage over the shoulder on the uninjured side
-Bring the lower point up over the arm, across the shoulder on the injured side to join the upper point and tie firmly.
-Ensure the elbow is secured by folding the excess bandage over the elbow and securing with a safety pin

20. Slings-Elevation Sling
When to use: Injuries to the shoulder and collar bone
How to apply:
Support the casualty’s arm with the elbow beside the body and the hand extended towards the uninjured shoulder
-Place an opened triangular bandage over the forearm and hand, with the apex towards the elbow
-Extend the upper point of the bandage over the uninjured shoulder
-Tuck the lower part of the bandage under the injured arm, bring it under the elbow and around the back and extend the lower point up to meet the upper point at the shoulder
-Tie firmly with a reef knot
-Secure the elbow by folding the excess material and applying a safety pin, then ensure that the sling is tucked under the arm giving firm support

21. Slings-Collar and Cuff Sling
When to use: Injuries to the upper arm
How to apply:
-allow the elbow to hang naturally at the side and place the hand extended towards the shoulder on the uninjured side
-using a narrow fold triangular bandage, form a clove hitch by forming two loops – one towards you, one away from you
-put the loops together by sliding your hands under the loops and closing with a “clapping” motion.
-If you are experienced at forming a clove hitch, then apply a clove hitch directly on the wrist, but take care not to move the injured arm
-slide the clove hitch over the hand and gently pull it firmly to secure the wrist
-extend the points of the bandage to either side of the neck and tie firmly with a reef knot
-allow the arm to hang comfortably. Should further support be required, eg for support to fractured ribs, apply triangular bandages around the body and upper arm to hold the arm firmly against the chest