15. Bone Fractures & soft tissue injuries.pptx

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1. Bone Fractures & soft tissue injuries Chemutai Violet

2. Overview Two of the most common bone and joint injuries are fractures and dislocations Both injuries should be considered emergency situations and set into place as soon as possible by a trauma specialist Considerable force is needed to break a bone unless its diseased or old However, bones that are still growing are supple/flexible and may split, bend or crack like a twig A bone may break at the point when a heavy blow is received. Fractures may also result from a twist or a wrench(indirect force).

3. The real problems are not the broken bones themselves but the potential injury to the vital organs next to them People usually don’t die of broken bones, they die of airway obstruction, blood loss, and brain injuries However, broken bones can be painful and debilitating and can cause life long aggravation, disability and deformity

4. Definition of a fracture A disruption or break in the continuity of the structure of bone e.g. broken or cracked Traumatic injuries account for the majority of fractures Described and classified according to: Type Communication or non-communication with external environment Anatomic location

5. Causes of fractures Direct force. This when the bone breaks at the spot where the force is applied e.g. a severe blow, bullet, by fall or crush by wheel Indirect force. This when a bone breaks at some distance from the spot where the force is applied, e.g. fracture of the clavicle due to fall on out stretched hand Due to forcible ligament contraction. Fractures of lower leg bone at the ankle after stumbling Due to forcible muscular contraction. Fracture of patella due to sudden contraction of muscles attached to it . Due to disease of bone which makes them weak and easily breakable, e.g. osteomalacia, tuberculosis of bone

6. Types of fractures The types of fractures are described and classified according to: Type Communication or noncommunication with external environment(open or closed) Anatomic location of fracture Appearance, position, and alignment of the fragments Classic names Stable or unstable

7. Bone fractures can happen in a variety of ways, including accidents, repetitive stress injuries, osteoporosis and tumors

8. Classified according to type

9. Classification by Communication with External Environment

10. Classification by fracture location

11. Closed (also called simple). The bone is broken surface around and the damaged bone is intact Open (also called compound). This when there is wound leading to the broken bone or the broken ends of the bone protrudes through the skin. They cause extensive blood loss, infection Stable fractures Occur when a piece of the periosteum is intact across the fracture External or internal fixation has rendered the fragments stationary Unstable fractures Grossly displaced Poor fixation Complicated fracture. Closed or open are said to be complicated when there is associated injuries to the blood vessels, nerves, muscles etc

12. Directions /patterns Transverse : Forms a right angle with the axis of bone Oblique: Runs slanted to the axis of the bone Longitudinal: Runs along the line of its axis Spiral fracture – breaks coils around the bone Green stick fractures are incomplete that commonly in children whose bones like green sticks are pliable

13. Assessing for the injury It may be difficult to if the bone is fractured, when in doubt, treat the injury as a fracture; Look for: DOTS Deformity Open wound Tenderness Swelling Deformity may not be obvious. Compare the injured part with uninjured part on the other side Open wound may indicate an underlying fracture Tenderness and pain are found at the injury side. Usually the procedure for detecting a fracture is to gently feel along the bone. Victim will complaint of pain or Tenderness

14. Swelling caused by bleeding happens rapidly after a fracture

15. Clinical Manifestations( S s & S s ) Immediate localized pain/difficulty in moving the area  Function of the affected part/loss of function Inability to bear weight or use affected part Guarding May or may not see obvious bone deformity Swelling Discoloration Shortening of the bone, bending or twisting of limb Tenderness A wound, possibly with protruding bone Crepitus(coarse bony grating sound maybe heard) Signs of shock e.g. if thigh or pelvis bone is fractured

16. Emergency first Aid Aims To prevent movement at the injured site To prevent blood loss and infection of the injured site To arrange removal to hospital, with comfortable support during transport

17. First Aid management Check for the ABCs. A fracture even an open fracture, seldom presents an immediate threat to life. Therefore treatment should be deferred until after you have handled any life threatening conditions such a opening and airway or controlling bleeding Determine what happened and the location of the injury Gently remove clothing covering the injured area Examine the area by looking and feeling for DOTs Look at the injury site. Swelling and black, blue marks, which indicate escape of blood into the tissues, which may either come from the bone or associated muscular and blood vessel damage

18. Check for shortening or severe deformity (angulations) between the joints or deformity around the joints Feel the injured area. If the fracture is not obvious, gently press, touch or feel along the length of the bone for deformities, tenderness and swelling Check blood flow and nerves. Use mnemonic CSM(circulation, sensation, movement) as a way of remembering “what to do” Circulation. For an arm injury, feel for the radial pulse, tibial pulse located between the inside ankle bone and the Achilles tendon Sensation. Most useful early sign, lightly touch or squeeze one of the victims toes Movement. Inability to move develops later, check for the nerve damage by asking the victim to wiggle his or her toes or fingers.

19. If the toes are injured, don't have the victim attempt to move them Use the RICE(R=Rest, I= Ice, C= Compression, E=elevate) to relieve pain Use a splint to stabilize the fracture Support with slings or bandages Secure the injured part to uninjured part of the body for extra support if help is delayed. For upper body injuries, use a sling, for lower limb injuries use broad and narrow-fold bandages. Tie the knots on the uninjured side Give pain medication Support the injured part Help the casualty to support the affected part at the joints above and below the injury, in the most comfortable position

20. Protect injury with padding Place padding; such as towels or cushions, around the affected part, and support it in a comfortable position Seek medical attention Take or send the casualty to the hospital A casualty with an arm injury could be taken by car if not in shock, a leg injury should go by an ambulance i.e. call 999/112 for emergency help Treat for shock Monitor and record the casualty response, breathing and pulse till help arrives Prevent infection by covering with a clean dressing Don't tie the knot of a bandage over the area of a fracture

21. Fractures: What to Look For May be difficult to tell if bone is fractured When in doubt, treat as fracture Use DOTS

22. Fractures: DOTS D eformity O pen wound T enderness S welling Not always obvious. Compare

23. Fractures: Additional S&S Loss of Use Grating Sensation History of injury May or may not occur Can be felt or heard when ends of bones rub together Victim may have heard or felt bone snap

24. Fractures: What To Do LAF: Look And Feel Look at injured site. Swelling? Brusiing ? Damaged skin? Gently press, feel for deformity, tenderness

25. Fractures: What To Do RICE R est I ce C ompress E levate With Ace bandage. Injuries heal faster with rest . For 20 - 30 minutes q 2 - 3 hours for first 24 - 48 hours After stabilized

26. RICE: Do Not Apply ice for more than 20- 30 minutes at a time Apply heat until after 48 - 72 hours

27. Splints and slings Splints Splints are used to immobilize the broken bone by fixing the joint above and below Anything which is firm, long and wide enough to keep the joint immediately above and below from moving can be used as a splint. A splint may be modified from a walking stick, umbrella, piece of wood, rifle. Sling A sling can be made with a triangular bandage or a roller bandage. It is used to immobilize the part like a broken jaw, collar bones, and upper limbs. A sling can be improvised from a piece of cloth, shoe lace, belt, tie or by passing the hand inside the buttoned shirt or turn the free end of the shirt and pin it above the pocket.

28. Fractures: What To Do Stabilize with splint And limit movement Reduces pain Prevents damage to muscles, nerves and blood vessels Reduces bleeding and swelling

29. Types of Splints Improvised Folded newspaper, piece of wood, another body part Commercially prepared

30. Splints Stabilize before moving Splint in position found Cover wounds before applying splint

31. Splints Check pulses, if no pulse: try to straighten extremity to restore blood flow. Stabilize above and below injury

32. Splints Use cravats if possible Tie firmly but not too tight Check pulse after each cravat is tied Leave fingers or toes exposed

33. Splints RICE after splint is applied immediately if no pulse in injured extremity

34. Soft tissue injuries Joint injuries: A joint is where two or more bones come together Dislocations Sprains Muscle injuries Strains (Hamstring strain- back of thigh, Charley Horse –injury of thigh muscle) Muscle contusions/bruising of the tissue Muscle cramps Tendinitis. Which is the inflammation of the tendon

35. Joint dislocations Joint dislocation is the displacement of a joint from its normal position, usually caused by a blow, fall or other trauma. In addition to displaced bones, there may be damage to the joint capsule and surrounding muscles, blood vessels and nerves. With the bones no longer in contact, the shoulders, elbows, fingers, hips, kneecaps( patellas ) and ankles are the joints frequently affected

36. Joint Injuries: Dislocation Joint comes apart. Bone ends no longer in contact S&S: similar to fracture

37. Joint Injuries: Dislocation What To Do : Check circulation, sensation, movement Treatment RICE Splint Do not try to reduce Spinal Muscular Atrophy(SMA)

38. Symptoms Symptoms of joint dislocations include Deformity. Visibly deformed or out of place Loss of motion Swollen or discolored Intensely painful/Tenderness Immovable

39. Common of Sites Dislocation is most common in shoulders and fingers Other sites include elbows, knees and hips If you suspect a dislocation, seek prompt medical attention to return your bones to their proper positions

40. Causes of dislocations Dislocations can occur in contact sports, such as football and hockey, and in sports in which falls are common, such as downhill skiing, gymnastics and volleyball. Basketball players and football players also commonly dislocate joints in their fingers and hands by accidentally striking the ball, the ground or another player. A hard blow to a joint during a motor vehicle accident and landing on an outstretched arm during a fall are other common causes

41. Risk factors Risk factors for a joint dislocation include: Susceptibility to falls.  Falling increases your chances of a dislocated joint if you use your arms to brace for impact or if you land forcefully on a body part, such as your hip or shoulder. Heredity.  Some people are born with ligaments that are looser and more prone to injury than those of other people. Sports participation.  Many dislocations occur during high-impact or contact sports, such as gymnastics, wrestling, basketball and football. Motor vehicle accidents.  These are the most common cause of hip dislocations, especially for people not wearing a seat belt.

42. What to do Check for the CSM(circulation, sensation , movement). If the end of the dislocated bone is pressing on the nerves or blood vessels, numbness or paralysis may exist below the dislocation. Always check for pulses. If no pulse on the injured extremity, transport the victim to the health facility immediately Use RICE procedures Use a splint to stabilize the joint in the position in which it was found Don’t try to reduce the joint(put the displaced parts into their normal position in which it was found, because nerve and blood vessels damage could result Seek for medical attention immediately to reduce the dislocation

43. Complications Complications of a joint dislocation can include: Tearing of the muscles, ligaments and tendons that reinforce the injured joint Nerve or blood vessel damage in or around your joint Susceptibility to re-injury if you have a severe dislocation or repeated dislocations Development of arthritis in the affected joint as you age

44. Cont… NB. Stretching or tearing of ligaments or tendons that support your injured joint or damage to nerves or blood vessels surrounding the joint might require surgery to repair these tissues

45. Sprain It is an injury to the soft tissue around the joint such as ligaments, tendons, and capsule. A sprain is an injury to a ligament, which is a band of tissue that connects one bone to another Involves tearing and stretching of the joints, causing mild to severe damage to ligaments and joints capsules It is caused by sudden wrenching or twisting of the part Signs and symptoms Sharp Pain Extreme tenderness when the area is touched Swelling Inability to move the part

46. Management of a sprain Place the limb in a comfortable position Apply firm bandage and keep it wet with cold water or ice cubes to avoid swelling Massage gentle over the muscle above the sprain to relieve spasms Apply crepe bandage if available Give rest to the affected part The elevate the limb

47. Strain A strain is defined as an injury to a muscle or a tendon when it is forcibly stretched beyond its proper length. Overstretching is associated with tearing of muscle fibers A strain is also sometimes referred to as a "torn muscle" or "muscle pull .“ Signs and symptoms Sudden sharp pain at the site of injury Swelling Severe cramp Severe weakness and Loss of power

48. Causes of sprains and strains Trauma to a joint (the space between bones). A strain is usually the result of overstretching or overuse of muscles and tendons They are caused by excessive, reaching, bending, lifting, gripping , squatting, or twisting of hands , shoulders or body Caused by any work performed with high force, with many repetitions , or in an awkward position

49. Management Place the patient in a comfortable position Support the injured part Immobilize the limb incase of fracture NB: T endon is a band of tissue that connects muscle to bone A ligament is a band of tissue that connects one bone to another Use RICE procedures

50. Contusion/bruises A muscle contusion, bruise results from a blow to the muscle Signs and symptoms Swelling Pain and tenderness Black and blue mark appearing hours later Treatment Use RICE procedure

51. Cramps A cramp occurs when a muscle goes into uncontrollable spasms and contractions, resulting in severe pain and restriction or loss of movement Other associated diseases with muscle cramps include: Diabetes Atherosclerosis Dehydration Electrolyte imbalance( potassium and sodium; carry electric charge that trigger muscles to contract and relax)

52. What to do? Have the victim gently stretch the affected muscle. A gradual extension of the muscle may help lengthen the muscle fibers and relieve the cramp Relax the muscle by applying pressure to it Apply ice to the cramped muscle to make it relax(unless you are in a cold environment) Pinch the upper lip hard(an acupressure technique) to reduce calf muscle cramping Drink lightly salted cool water(dissolve 1/4 teaspoon salt in a cup of water) or a commercial sports water

53. Prevention Take precautions to avoid falls .- Get your eyes checked regularly,-   be sure your home is well-lighted and that you remove any potential tripping hazards Play safely.  Wear the suggested protective gear when you play contact sports. Avoid recurrence.  Once you've dislocated a joint, you might be more susceptible to future dislocations. 

54. Learning Activities 1. For a suspected fracture, check blood flow and nerves . Yes Fractures

55. Learning Activities 2. Apply cold on a suspected fracture . Yes Fractures

56. Learning Activities 3. A splint can stabilize a fracture . Yes Fractures

57. Learning Activities Scenerio : falls off 10 foot ladder. Pain in left leg. Find deformity, tenderness, swelling. What to do? Check and treat ABCs Treat for shock Check blood flow and nerves Splint, RICE

58. Learning Activities 1. RICE represents treat for sprains and dislocations . Yes Dislocation and Sprains

59. Learning Activities 2 . Place ice directly on skin. No Dislocation and Sprains

60. Learning Activities 3 . Appling heat too soon to an injury is a common mistake. Yes Dislocation and Sprains

61. Learning Activities RICE Scenario: Limping and in pain. Twisted ankle. What to do?

62. Learning Activities 1. Give salt tablets for cramps. No Muscle Injuries

63. Learning Activities 2. Apply heat initially to muscle injury. No Muscle Injuries

64. Learning Activities 3. An elastic bandage, if used correctly, can help limit swelling. Yes Muscle Injuries

65. Learning Activities RICE Scenario: Bat hits player on thigh. Tenderness and swelling. What to do ?

66. First Aid Kits Item Quantity Cravats 3 Ace bandage 1 Paper clip 1 String 1 (dental floss or thread)