Musculoskeletal Trauma

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Musculoskeletal Trauma

• April Morgenroth EMT, RN, BSN

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Musculoskeletal System
Cartilage softer than bone but provides
structure
Bones Provide structure and protect organs
Muscles serve to connect musculoskeletal
structures and allow movement.
Tendons connect muscles to bones
Ligaments Support joints by attaching bones to
bones
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Injuries to the Joint

Luxation Total dislocation of joint.
Clinical Presentation
Pain
Swelling
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Decreased Range of Motion
Deformity
Subluxation Partial dislocation of a joint.
Possible Altered Sensation
Splint dislocations in the position found, treat
pain, consider anti inflammitory
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Sprains and Strains
Pain
Swelling
Bruising
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• Sprain Overstretching of the ligaments

Strain stretching or tearing of the muscle or
tendon
Weakness
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Initial Management
Rest
Ice
Ibuprofen or other non steroidal anti
inflammatory
Compression
Elevate
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Fractures Simple vs. Compound
Simple Fracture The bone is fractured but the
skin remains intact.
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/8856.htm
Compound Fracture The bone is fractured and has
pierced the skin. There is communication between
the bone and the outside environment.
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/typical_fractures.jpg
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Fractures Non-displaced vs. Displaced

• Non displaced fracture fracture is present but
  the bone ends are still aligned
• Displaced fracture fracture is present but the
  bone ends are displaced. The fracture will need
  to be reduced before casting in order to heal
  properly.

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Fracture Assessment
Mechanism of Injury
Swelling
Crepitus
Pain
Deformity (may or may not be present)
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0001_0001_0_img0046.jpg
Decreased Range of Motion
X-Ray
Decreased function
Always circulatory, motor, and sensory distal to
the injury
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Splinting

• Why do it?
• Prevent further injury Further movement of bone
  ends may cause shearing injury to surrounding
  tissue.
• Control bleeding immobilizing the injury will
  help damaged blood vessels form clots to stop the
  bleeding.
• Minimize pain moving the injured part may cause
  more pain and further injury.

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Splinting

• Remove restrictive clothing (shoes)

• Immobilize the joint above and below the injury

• Apply the splint with as little movement as
  possible to the injured part

• Always check circulatory, motor, and sensory
  after applying a splint.
• Reassess frequently.

• Secure the splint snugly, enough to restrict
  movement but not too tight.

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Compound Fractures
Evaluate and treat the patient for signs and
symptoms of shock.
Never attempt to realign a compound fracture!
Provide pain control as ordered.
Gently cover the open wound with sterile
dressings.
This patient may need surgery to repair the
fracture.
Splint in the position found.
High risk for infection, consider antibiotics
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Rib Fractures
Assessment Pain, swelling, and/or bruising over
the injured area. May or may not be
deformity Pain will be worse when deep breathing,
coughing, or palpated. Note, work of breathing,
respiratory rate, oxygenation, heart rate,
symmetry in chest rise.
Flail chest Paradoxical chest wall movement
during breathing. Caused by multiple rib
fractures resulting in floating rib segments.
This is an emergency!
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Treatment of Rib Fractures

• Treating pain will help make breathing easier
  for the patient.
• Do not place anything completely around the
  chest, this may restrict breathing. Have patient
  hug a pillow when coughing or deep breathing.
• You may use the patients own arm to splint a rib
  fracture by sling and swath method.
• Encourage coughing and deep breathing in spite of
  pain as this will help to prevent fluid
  accumulation in the lungs.

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Hip Fracture

• In the case of Hip fracture
• Mechanism of injury
• Pain, swelling, bruising, deformity
• Lateral rotation or shortening of the
• injured leg
• Check sensory, motor, circulation in the affected
  leg
• Treat pain
• Monitor vitals
• Keep the patient in position of comfort
• Pt may need surgery to repair the fracture

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Fractures of the Pelvis

• Can cause life threatening bleeding
• May be stable or unstable
• Check stability of the pelvic girdle
• Evaluate and treat the patient for shock
• May have bleeding into the abdomen, check for
  signs and symptoms.
• X-ray of pelvis and chest
• An unstable pelvic fracture will need splinting.
• Pt will may need surgery

Picture of blanket splint
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Complications

• Bleeding
• Bones bleed when broken
• Trauma to the surrounding area from bone ends or
  fragments.
• Check for bleeding and signs of circulation
• Control bleeding as able
• Evaluate and treat signs and symptoms of shock

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Complications

• Infection
• Compound fractures are at high risk for
  infection, treat with antibiotics
  prophylactically
• Pain related to rib fractures may cause a
  patients breathing to become shallow and put
  them at risk for pulmonary complications

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Complications

• Deep Vein Thrombosis
• Evaluate circulation frequently
• Pulses, capillary refill, skin temperature and
  color
• DVT signs and symptoms edema, redness,
  cyanosis, absent pulses, warm, pain
• Prevention early ambulation, physical therapy

www.clotcare.com/clotcare/images/dvt4.jpg
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Complications

• Compartment Syndrome
• Increased pressure in an enclosed compartment
  restricts circulation and causes tissue damage
  and/or necrosis
• Pressure may be caused by swelling and
  inflammation, bleeding into the space

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• Look for signs of decreased circulation. pain,
  pallor, pulselessness, paralysis, pressure, and
  numbness

• Notify MD immediately, pt may need fasciotomy,
  loosen splint, do not ice or elevate

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Complications

• Fat Embolism
• Occurs when fatty tissues enter the blood stream
  and are lodged in the narrowing blood vessels
• Signs and symptoms will be similar to DVT unless
  the embolus is lodged in the lung or brain
• If embolus is lodged in the brain, neurological
  deficits may result from hypoxic brain injury

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Pulmonary Embolism

• Obstruction of the pulmonary artery or one of its
  branches
• Clot usually forms in the veins and then lodges
  in the pulmonary artery
• Shortness of breath, hypoxia, tachycardia,
  cyanosis, anxiety, sudden death
• Do x-ray and EKG to rule out other causes,
  monitor vitals and oxygen saturation, provide
  supplemental oxygen, keep the patient calm and
  quiet

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Pneumonia

• Pain related to rib fractures may cause a patient
  to breathe shallow and put them at risk for a
  atelectasis and fluid build up in the lungs which
  may cause pneumonia
• Prolonged immobility may also lead to build up of
  fluid in the lungs
• Prevention coughing and deep breathing
  exercises, treat pain, early mobility