ObjectivesEstablish the principles for assessing the patient
with musculoskeletal injuries.Establish treatment
priorities.Identify the importance of musculoskeletal injuries in
the multiply injured patient.
Key QuestionsHow do musculoskeletal injuries impact on the
primary survey?What are my priorities?What are my management
principles?
External bleeding Occult blood loss Long bone fracturesPelvic
fractures
Primary survey management?The 3 SsStop the bleeding!Splint the
extremityStabilize the pelvis
Why is splinting useful?Prevents further blood loss and
injuryMay restore or maintain perfusion Relieves pain Important
during evaluationDo not delay
What are my early concerns?Vascular compromise Open
fractures
Assess and manage vascular compromise?Reduce fracture(s)Splint
fracture(s)Assess by DopplerObtain consult (time is
critical)Consider angiography
Information to help my assessment?Mechanism of injury Energy
forces involvedAssociated factorsTime of injury Location of
injury
How do I manage open fractures?Apply appropriate splintCleanse /
debride (now or later)Consider time factorObtain orthopaedic
consult
Secondary SurveyLookFeel Listen
For What?
For What?LookDeformity Pain TendernessWound(s)FeelCrepitusSkin
flaps Neurologic deficit PulsesListen Doppler signalsBruit
Secondary SurveyWhat x-rays do I need?Any suspected area One
joint above and below When do I obtain them?Patient is
hemodynamically normal
Secondary SurveyWhen should I delay getting x-rays?If
life-threatening injuries take priorityIf patient transfer will be
delayed
What injuries may cause compartment syndrome?
What injuries may cause compartment syndrome?Tibia and forearm
fracturesVascular and bony injuries Injuries immobilized in tight
dressings or castsSevere crush injuries to muscle Burns
How do I recognize compartment syndrome?PainParesthesia
PallorParalysisPulse loss (late)Tissue pressures >35 to 45 mm
Hg
What are the pitfalls?Occult fracturesVascular injuryCompartment
syndromeMinor injuries AnticoagulationAltered sensorium
Manage life-threatening injuries first Stop the bleeding!Reduce
and immobilize fractures and dislocationsRecognize vascular
compromise Avoid delay in management
