EXTREMITY TRAUMA

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EXTREMITY TRAUMA
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OBJECTIVES

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

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Open Wounds
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Closed Wounds
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Musculoskeletal - Causes

• Overuse
• Acute sprains and strains
• Trauma

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Overuse
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Acute Sprains and Strains
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Trauma
Compound Fracture of the Ankle
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Musculoskeletal Presentation

• Pain
• Swelling
• Discoloration
• Temperature change
• Numbness/tingling
• Loss of function

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Musculoskeletal Evaluation

• History
• Physical examination
• skin breaks
• tenderness
• swelling
• discoloration
• distal pulses
• sensory exam
• motor exam

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Musculoskeletal Treatment

• Prevention
• RICE
• Analgesic
• Tylenol
• Analgesic Anti-inflammatory
• Aspirin
• Ibuprofen (Motrin/Ranger Candy)
• Naprosyn

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Fractures

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

FX Femur
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Open Fracture
Compound Fracture of the Ulna
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Other Injuries
De-gloving Injury
Blast Injury
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Ecchymosis

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

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Joints

• Surrounded by joint capsule and ligaments,
  muscles and tendons

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Dislocations

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

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Common Dislocations

• Fingers
• Shoulder
• Hip
• Elbow
• Ankle

Dislocated Elbow
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Knee Joint

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

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Knee Injuries

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

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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)

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Dislocation of the Knee
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Ankle Injuries

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

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Sprain

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

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SAM SPLINT
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Management of Closed Injuries

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

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Soft Tissue Injuries

• Open - Violation of overlying skin or mucous
  membrane

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Management
Stop the bleeding and bandage
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Summary

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