Assessment and Care of Bone and Joint Injuries

1
Chapter 25

• Assessment and Care of Bone and Joint Injuries

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Objectives (1 of 2)

• List the assessment and emergency care for
  injuries of the upper extremities.
• List the assessment and emergency care for
  injuries of the lower extremities.
• Explain the rationale for stabilization of
  specific injuries to the upper extremities.
• Explain the rationale for stabilization of
  specific injuries to the lower extremities.

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Objectives (2 of 2)

• Demonstrate the assessment and emergency care for
  injuries to the

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Upper Extremity Injuries

• Causes
• Fall onto outstretched hand (FOOSH)
• Can depend on age, position, forces, equipment,
  and surface
• Position of limb has significant influence.

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Clavicle and Scapula Injuries (1 of 2)

• Clavicle is one of the most fractured bones in
  the body.
• Usually occur due to FOOSH
• Sometimes due to crush injuries
• Pain, swelling, and deformity
• Lies directly over arteries, veins, and nerves

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Clavicle and Scapula Injuries (2 of 2)

• Scapula is well protected.
• Injury is associated with forceful direct impact
• Watch for associated significant injuries
• Joint between clavicle and scapula is the
  acromioclavicular (A/C) joint
• True dislocation with point tenderness
• Splint these injuries with a sling and swathe.

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Dislocation of the Shoulder (1 of 2)

• Most commonly dislocated large joint
• Usually dislocates anteriorly
• Extremely painful injury
• Patients will self-splint the arm and shoulder.
• Numbness and tingling can occur.

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Dislocation of the Shoulder (2 of 2)

• Difficult to immobilize
• Sling and swathe
• Blanket roll splint
• Can be a recurrent injury
• Reduction should occur in clinic or hospital

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Fractures of the Humerus

• Fracture occur either proximally, in midshaft, or
  distally at elbow.
• Consider applying traction to realign a severely
  angulated humerus, according to local protocols.
• Splint with sling and swathe, supplemented with a
  padded board splint or SAM splint.

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Elbow Injuries

• Fractures and dislocations often occur around the
  elbow.
• Injuries to nerves and blood vessels are common.
• Assess neurovascular function carefully.
• Careful realignment may be needed to improve
  circulation.

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Emergency Care of Elbow Injuries

• Splint with padded rigid material or SAM splint,
  roller gauze, and a sling and swathe.
• Always monitor distal CMS functions.
• Rapid evacuation is essential in patients with
  poor distal circulation.

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Fractures of the Forearm

• Usually involves both radius and ulna
• Common injury for snowboard riders
• Known as Colles fractures and the appearance is
  called a silver fork deformity
• Use a padded board, SAM splint, roller gauze, and
  sling and swathe.
• Assess and reassess CMS functions.

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Injuries to the Wrist and Hand

• Common injury in all age groups, and especially
  riders and skiers
• Many different injuries are possible.
• Skiers thumb is an ulnar collateral ligament
  sprain.
• Due to potential complications, these injuries
  should be evaluated by a physician.

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Emergency Care of Wrist and Hand Injuries

• Form hand into position of function by placing a
  roller bandage in palm.
• Apply padded board or SAM splint.
• Secure splint with roller gauze.
• Apply a sling and swathe.
• Monitor CMS functions.
• Find and send amputated parts with patient.

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Lower Extremity Injuries

• Includes
• Pelvis fractures
• Hip dislocations
• Femur fractures
• Knee ligament sprains
• Fractures and dislocations of the knee and
  patella
• Tibia and fibula fractures
• Ankle and foot sprains and fractures

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Fractures of the Pelvis

• Injuries are the result of a fall, collision or
  forceful compression.
• May involve life-threatening internal bleeding
• Organs within the pelvis can be injured.
• Assess for pain in lower back, lower abdomen, or
  pelvic area.
• Patients may lie in a fetal position or with
  knees partially flexed.

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Emergency Care of a Pelvic Fracture

• Palpate pelvis for tenderness lateral sides,
  then pelvic rock, then lower anterior aspects
• Anticipate shock, give high-flow oxygen.
• Stable patients can be secured to a long
  backboard or scoop stretcher to immobilize
  isolated fractures of pelvis.

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Dislocation of the Hip (1 of 2)

• Hip dislocation requires significant MOI.
• Patients with posterior dislocations lie with hip
  joint flexed and thigh rotated inward (most
  common).
• Patients with anterior dislocations lie with leg
  extended straight out, and rotated, pointing away
  from midline.

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Dislocation of the Hip (2 of 2)

• Monitor CMS functions.
• Splint in position of deformity on long backboard
  and transport.

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Fractures of the Proximal Femur

• Also known as a hip fracture
• Displaced fractures present with characteristic
  deformity.
• Apply high-flow oxygen, monitor CMS functions.
• Fractures from trauma injuries best managed by
  splinting to uninjured leg and long backboard or
  scoop stretcher.
• Traction splinting is not usually indicated.

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Femoral Shaft Fractures

• Leg is externally rotated, shortened, with
  deformity (bulge) at the thigh
• Muscle spasms can cause deformity of the limb.
• Significant blood loss can occur.
• Monitor distal CMS functions.
• Immobilize with traction splint.
• Traction should be maintained until
  hospitalization.

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Anatomy of the Knee

• Modified hinge joint
• 4 main ligaments medial and lateral
  collateral, anterior and posterior cruciate
• Patella aids flexion and is a sesamoid bone.

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Injuries of Knee Ligaments

• Most common injury in skiing
• Frequently a pop is heard or felt.
• Definitive assessment is best done before knee
  becomes swollen and painful.
• MOI can often help indicate type of injury.
• Splint (quick splint) and transport.
• Monitor distal CMS function.
• Apply ice and advise patient to seek physicians
  care.

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Fractures About the Knee

• Can occur at three locations
• Distal femur
• Proximal tibia
• Patella
• Deformity, swelling, impaired CMS functions
• Perform re-alignment once if CMS functions are
  impaired.
• Apply rigid splint (quick splint).

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Dislocation of the Knee

• Produces significant deformity
• More urgent injury is to popliteal artery, which
  is often lacerated or compressed.
• Always monitor distal CMS functions.
• Perform realignment once if CMS functions are
  impaired.
• Apply a rigid splint (quick splint).

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Dislocation of the Patella

• Patella usually dislocates to lateral side
• Injury produces significant deformity
• Splint (quick splint) in position found.
• Monitor distal CMS functions.
• May reduce spontaneously during splinting

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Injuries to the Tibia and Fibula

• Usually, both bones fracture at the same time.
• Skiers may suffer boot-top or spiral fractures.
• Open fracture of tibia is common.
• Realignment is frequently required.
• Concurrent femur fracture produces a floating
  knee.
• Immobilize with a padded quick splint that
  extends from foot to upper thigh.

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Ankle Injuries (1 of 2)

• The ankle is the most commonly injured joint.
• MOI includes abruptly turning the foot under or
  twisting the foot in.
• Apply cold packs or ice.
• Assess distal CMS functions.
• Fractures are difficult to distinguish from
  severe sprains.
• Patient should seek physicians care if symptoms
  do not diminish within a day or two.

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Ankle Injuries (2 of 2)

• Fractures usually involve the distal tibia and/or
  fibula (lateral and medial malleoli).
• Snowboard riders suffer talus fractures that
  mimic ankle sprains.
• Dislocations are associated with distal
  fractures.
• Perform realignment/traction once if CMS
  functions are impaired.
• Monitor CMS functions and splint (soft or
  well-padded rigid splint).

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Foot Injuries

• Usually occur after a patient falls or jumps.
• Also consider possibility of spinal injury from a
  fall. Apply a long backboard if needed.
• Stress fractures occur with overuse.
• Immobilize ankle joint and foot in a soft splint.
• Elevate foot to reduce swelling.