1. Musculoskeletal Trauma

2. Anatomy and Physiology
Bones
Muscles
Joints
Tendons
Ligaments
Soft tissues

3. Epidemiology
More than half of all hospital admissions because of trauma are patients with some type of fracture, usually of the lower limb.
The elderly are at a particularly high risk of being hospitalized for an extremity injury.
Of those injuries sustained by passengers involved in nonfatal motor vehicle crashes, 46% sustain pelvic fractures and 41% sustain femur fractures. Drivers sustain femur fractures (65%), pelvic fractures (46%), and ankle fractures (39%).0

4. Mechanisms of Injury
Musculoskeletal trauma can be sustained as a single system injury or in combination with other systems.
Injuries to the extremities are not usually considered the first priority.
Mechanisms of injury include motor vehicle crashes, assaults, falls, sports, leisure, or home activities.
Abuse should be considered as a possible cause of the injury.
Musculoskeletal injuries can result from the application of both acceleration and deceleration forces.

5. Basic Mechanisms of Musculoskeletal Injuries
Primary Injury - Direct force
Secondary Injury - Indirect force
Twisting or rotational force

6. Musculoskeletal Injuries
Fracture: is break of the bone
Dislocation: is disruption of a joint
Sprain: is stretching and tearing of ligaments
Strain: is muscle injury resulting from overstretching or over exertion of muscle

7. Specific Musculoskeletal Injuries
Hemorrhage
Radius or ulna 250 – 500 ml
Humorous 500 – 750
Tibia or fibula 500 – 1000
Femur – 2000
Pelvis – massive
Instability
Fractures (open or closed)
Dislocation

8. Types of fractures Oblique Spiral Transverse Linear Greenstick
Segmented
Angulated
Comminuted
Butterfly
Impacted
Open
Closed
Displaced

10. Signs and Symptoms Pain and tenderness Deformity or angulation
Grating or crepitus
Swelling
Bruising
Exposed bone ends
Joint locked into position
Nerve and blood vessel compromise

11. Care of Patient with Musculoskeletal Injury
Take and maintain appropriate standard precautions
Perform the initial assessment (ABCD)
Apply cervical collar if spine injury is suspected
After ABCD is established splint injured extremity
Cover open wounds, elevate extremity and apply cold pack

12. Splinting Immobilization of adjacent joints and bone ends
It decreases pain and prevents additional injury to the soft tissues
It prevents closed injuries from becoming open injuries
Traction splint: is a splint that apply constant pull along the length of lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. (used primarily on femoral fractures)

13. Realignment
Straightening to restore effective circulation to the extremity
Strategies:
Grasp the distal end of injured extremity and another one grasp above injured site
Pull the distal end gently in direction axis of extremity (manual traction)
Maintain gentile traction (if no resistance felt) till extremity properly splinted

14. Joint Injuries
A joint may become dislocated when the normal range of motion is exceeded.
Delayed reduction of a hip dislocation can lead to a vascular necrosis of the femoral head and permanent disability.
Signs and Symptoms
Pain
Joint deformity
Edema
Inability to move the affected joint
Abnormal range of motion
Neurovascular compromise: distal pulses may be diminished or absent; sensory function may be affected

15. Femur Fractures
Femur fractures are a result of major trauma, such as falls, motor vehicle crashes.
Fractures of the femoral neck are common after a fall in the elderly population.
Signs and Symptoms
Pain and inability to bear weight
Shortening of the affected leg
Rotation internally or externally depending on the location of the fracture site in the hip
Edema of the thigh
Deformity of the thigh
Evidence of hypovolemic shock

16. Pelvic Fractures
Pelvic fractures are classified as either stable or unstable.
A stable fracture is defined as "one that can withstand normal physiologic forces without abnormal deformation.
An unstable fracture occurs when the pelvic ring is fractured in more than one place resulting in two displacements on the ring; rotational
Signs and Symptoms
Pain
Evidence of hypovolemic shock
Shortening or abnormal rotation of the affected leg
Genitourinary or intra-abdominal injury

17. Open Fractures
All open fractures are considered contaminated because of the foreign materials and bacteria that can be introduced into the wound. Any open fracture may result in an infection.
Infections can be manifested by poor tissue healing, osteomyelitis, or sepsis.
Signs and Symptoms
Evidence of skin disruption (e.g., laceration or puncture) near or over the fracture
Protrusion of bone through open wounds
Pain
Neurovascular compromise
Bleeding may be minimal to severe