EXTREMITY TRAUMA

OBJECTIVES

Identify and treat fractures and soft tissue injuries in a tactical environment.

Open Wounds

Closed Wounds

Musculoskeletal - Causes

• Overuse

• Acute sprains and strains

• Trauma

Overuse

Acute Sprains and Strains

Trauma

Compound Fracture of the Ankle

Musculoskeletal Presentation

• Pain

• Swelling

• Discoloration

• Temperature change

• Numbness/tingling

• Loss of function

Musculoskeletal Evaluation

• History• Physical examination

– skin breaks– tenderness– swelling– discoloration– distal pulses– sensory exam– motor exam

Musculoskeletal Treatment

• Prevention• “RICE”• Analgesic

– Tylenol• Analgesic & Anti-inflammatory

– Aspirin– Ibuprofen (Motrin/Ranger Candy)– Naprosyn

Fractures

• Any break in the continuity of a bone

• May vary from a simple crack to a completely shattered bone

FX Femur

Open Fracture

Compound Fracture of the Ulna

Blast Injury

De-gloving Injury

Other Injuries

Ecchymosis

• Discoloration caused by bleeding in tissue

• Blood migrates toward skin and changes color with time

Joints

• Surrounded by joint capsule and ligaments, muscles and tendons

Dislocations

• Disruption of a joint such that the bone ends are no longer in contact

• Torn ligaments and capsule

Common Dislocations

• Fingers• Shoulder• Hip• Elbow• Ankle

Dislocated Elbow

Knee Joint

• Femur, Tibia, and Patella

• Largest hinge joint in body

• Held together by complex ligaments

• Susceptible to injury

Knee Injuries

• Ligaments and cartilage injuries are common

• Swelling, pain, limited ROM

• Frequent athletic injury

• Splint entire femur and tibia

Dislocation of the Knee

• Severe deformity

• Popliteal artery commonly injured

• If pulse is present, splint in deformed position

• If pulse is absent, attempt once to realign limb and splint where pulse is strongest (RGR (RGR MEDIC)MEDIC)

Dislocation of the Knee

Ankle Injuries

• Usually result from twisting, indirect force

• Fracture, dislocations, sprains can occur

• Swelling and deformity• Note circulation• Immobilize with padding

and splint

Sprain

• Partial, temporary joint dislocation

• Ligaments torn or stretched

• May produce discoloration

SAM SPLINT

Management of Closed Injuries

• R - Rest

• I - Ice

• C - Compression

• E - Elevation

• S - Splint (SAM Splints and cravats or ACE wraps)

• R/O fracture

Soft Tissue Injuries

• Open - Violation of overlying skin or mucous membrane

Management

Stop the bleeding and bandage

Summary

• Although quite common, rarely life threatening

• First priority in management same for all patients ( A,B,C’s)

• RICES for most soft tissue injuries