Musculoskeletal Injuries

1. ChapterChapter
MusculoskeletalMusculoskeletal
InjuriesInjuries
Twenty-ThreeTwenty-Three

2. ChapterChapter
‡ Major bones and regions of the
musculoskeletal system
‡ How to identify open and closed
extremity injuries
‡ Purposes and general procedures
for splinting
‡ How to splint injured extremities
Twenty-ThreeTwenty-Three
CORE CONCEPTSCORE CONCEPTS

3. Skeletal System: TorsoSkeletal System: Torso

4. Pelvis and LowerPelvis and Lower
ExtremitiesExtremities

5. Upper Upper
ExtremitiesExtremities

6. Ball-and-Socket JointBall-and-Socket Joint Hinge JointHinge Joint

7. ‡ Gives the body shape.Gives the body shape.
‡ Protects internal organs.Protects internal organs.
‡ Provides for body movement.Provides for body movement.
Musculoskeletal SystemMusculoskeletal System

8. ‡ Attaches to the bones.Attaches to the bones.
‡ Forms the major muscle mass ofForms the major muscle mass of
the body.the body.
‡ Is responsible for movement.Is responsible for movement.
‡ Is under conscious control.Is under conscious control.
Voluntary (Skeletal) MuscleVoluntary (Skeletal) Muscle

9. IINJURIES TONJURIES TO
BONESBONES

10. Mechanisms of InjuryMechanisms of Injury

11. Types of Musculoskeletal InjuriesTypes of Musculoskeletal Injuries

12. Patient Patient ASSESSMENTASSESSMENT
Musculoskeletal InjuriesMusculoskeletal Injuries
Signs and SymptomsSigns and Symptoms
‡ Pain and tendernessPain and tenderness
‡ Deformity or angulationDeformity or angulation
‡ Grating (crepitus)Grating (crepitus)
‡ SwellingSwelling
(Continued)(Continued)

13. Patient Patient ASSESSMENTASSESSMENT
Musculoskeletal InjuriesMusculoskeletal Injuries
Signs and SymptomsSigns and Symptoms
‡ Bruising Bruising (discoloration)(discoloration)
‡ Exposed bone endsExposed bone ends
‡ Joint locked in positionJoint locked in position
‡ Nerve/blood vessel compromiseNerve/blood vessel compromise

14. Patient Patient CARECARE
Musculoskeletal InjuriesMusculoskeletal Injuries
Emergency Care StepsEmergency Care Steps
‡ Use body substance isolation.Use body substance isolation.
‡ Administer oxygen if indicated.Administer oxygen if indicated.
‡ After control of life threats, After control of life threats,
splint injuries.splint injuries.
‡ Apply cold pack/elevate.Apply cold pack/elevate.

15. ‡ Bone fragments
‡ Bone ends
‡ Angulated joints
PreventPrevent
Motion ofMotion of
(Continued)(Continued)
Splinting: PurposesSplinting: Purposes

16. MinimizeMinimize
ComplicationsComplications
‡ Damage to muscles,
nerves, blood vessels
‡ Conversion of closed
injury to open injury
‡ Restriction of blood flow
‡ Excessive bleeding
‡ Pain/paralysis
Splinting: PurposesSplinting: Purposes

17. ‡ Assess distal movement,Assess distal movement,
sensation, circulationsensation, circulation
before/after application.before/after application.
‡ Immobilize joints above/Immobilize joints above/
below injury.below injury.
(Continued)(Continued)
Splinting: General RulesSplinting: General Rules

18. ‡ Remove or cut away clothing.Remove or cut away clothing.
‡ Cover open wounds with Cover open wounds with
sterile dressings.sterile dressings.
‡ Do not replace protruding Do not replace protruding
bone ends.bone ends.
‡ Pad splint.Pad splint.
(Continued)(Continued)
Splinting: General RulesSplinting: General Rules

19. Tell new EMT-Bs to always immobilize a
stable patient in the spot where he or she is
found. However, the actual extremity will
need to be moved into a “splintable” position,
which is straight enough to fit on a padded
board. As the saying goes, “immobilize them
where they lie not as they lie.”
PPRECEPTOR RECEPTOR PPEARLEARL

20. ‡ Align with gentle tractionAlign with gentle traction if:if:
• Severe deformitySevere deformity
• Cyanotic distal extremityCyanotic distal extremity
• Pulseless distal extremityPulseless distal extremity
(Continued)(Continued)
Splinting: General RulesSplinting: General Rules

21. ‡ Splint patient before moving.Splint patient before moving.
‡ When in doubt, splint.When in doubt, splint.
‡ If signs of shock, align inIf signs of shock, align in
normal anatomical position normal anatomical position
and transport.and transport.
Splinting: General RulesSplinting: General Rules

22. Types of SplintsTypes of Splints

23. ‡ Compression of nerves,
‡ Delayed transport of life-
tissues, and blood vessels
threatened patient
Hazards of Hazards of
Improper Improper
SplintingSplinting
(Continued)(Continued)
SplintingSplinting

24. Hazards of Hazards of
Improper Improper
SplintingSplinting
‡ Reduced distal circulation
‡ Aggravation of initial injury
(from tight splint)
‡ Cause/worsen injury
(from excessive motion)
SplintingSplinting

25. Assess distal pulse, Assess distal pulse,
motor function, and motor function, and
sensation (PMS).sensation (PMS).
Stabilize extremityStabilize extremity
manually.manually.
Long-Bone SplintingLong-Bone Splinting

26. Make sure splint extends several inchesMake sure splint extends several inches
beyond joints above/below injury.beyond joints above/below injury.

27. Apply splint. Apply splint.
Immobilize joints Immobilize joints
above/below injury.above/below injury.
Secure entireSecure entire
extremity to splint.extremity to splint.

28. Secure foot or hand in position of function.Secure foot or hand in position of function.

29. Reassess distal PMS.Reassess distal PMS.

30. Joint ImmobilizationJoint Immobilization
Stabilize injured area manually.Stabilize injured area manually.

31. Assess distal PMSAssess distal PMS..

32. Immobilize injury site and bones above/below.Immobilize injury site and bones above/below.

33. Reassess distal PMS.Reassess distal PMS.

34. If distal extremity is cyanotic or If distal extremity is cyanotic or
pulseless, align with gentle traction.pulseless, align with gentle traction.

35. Pelvic Injury
‡Pelvic fracture
‡Hip dislocation
‡Maintain strong suspicion of spinal
injury.

36. Treatment of Pelvic Injury
‡Minimize motion of injured area.
‡Assess distal PMS.
‡Attempt to straighten lower extremities
into anatomical position.
‡Pad between extremities with blanket.

37. Treatment of Pelvic Injury
‡Apply PASG if patient is hypotensive.
‡Place patient on spine board. (Use caution with
log-roll!)
‡Reassess distal PMS.
‡Care for shock.
‡Transport.
(Continued)(Continued)

38. Treatment of Pelvic Injury
‡Pelvic wrap is an option.
‡Perform patient assessment.
‡Treat for shock.
‡When correctly placed, sheet will
appear lower than iliac “wings.”

39. Pelvic WrapPelvic Wrap
Prepare backboard.

40. Pelvic WrapPelvic Wrap
Logroll patient & bring sheets around patient.

41. Pelvic WrapPelvic Wrap
Secure sheets without over-compressing.

42. Use traction splint to immobilize a Use traction splint to immobilize a
painful, swollen, or deformed thigh painful, swollen, or deformed thigh
with no joint or lower leg pain.with no joint or lower leg pain.
Traction SplintingTraction Splinting

43. ContraindicationsContraindications
Traction SplintingTraction Splinting
• Knee or nearby areaKnee or nearby area
• Hip Hip (proximal femur)(proximal femur)
• PelvisPelvis
‡ Injury to
‡ Partial amputation or
avulsion of lower leg
(where traction might (where traction might
complete amputation)complete amputation)

44. Stabilize leg manually.Stabilize leg manually.
Assess distal PMS.Assess distal PMS.
Direct applicationDirect application
of manual traction.of manual traction.
Traction SplintingTraction Splinting

45. Adjust splint Adjust splint
length and position.length and position.
Apply proximalApply proximal
securing device.securing device.

46. Apply distalApply distal
securing device.securing device.
Apply mechanicalApply mechanical
traction.traction.

47. Position/fasten supportPosition/fasten support
straps. Reevaluatestraps. Reevaluate
proximal/distal proximal/distal
securing devices.securing devices.
Reassess Reassess
distal PMS.distal PMS.

48. Secure patient and splint to long board.Secure patient and splint to long board.

49. Tell new EMT-Bs to remember: when a bone
breaks, it bleeds. Therefore, a patient with
multiple breaks can easily be in shock from
significant blood loss. In the first 2 hours of an
uncomplicated simple fracture of the tibia and
fibula, a patient can lose a pint of blood. A
fractured femur can cause a 2-pint blood loss.
A pelvic fracture can cause a 3-to 4-pint loss.
PPRECEPTOR RECEPTOR PPEARLEARL

50. 1. List signs and symptoms of musculoskeletal1. List signs and symptoms of musculoskeletal
injuries. injuries.
2. Name the bones in the arms and legs.2. Name the bones in the arms and legs.
3. Explain how to splint a fractured femur.3. Explain how to splint a fractured femur.
4. Explain what is meant by “position of 4. Explain what is meant by “position of
function.” function.”
RREVIEW QUESTIONSEVIEW QUESTIONS