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. Other Injuries
De-gloving Injury
Blast Injury

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
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