Musculoskeletal Trauma

April Morgenroth EMT, RN, BSN

Musculoskeletal System

Bones: Provide structure and protect organs

Muscles: serve to connect musculoskeletal structures and allow movement.

Ligaments: Support joints by attaching bones to bones

Tendons: connect muscles to bones

Cartilage: softer than bone but provides structure

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Injuries to the Joint

Luxation: Total dislocation of joint.

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Subluxation: Partial dislocation of a joint.

Pain

Swelling

Decreased Range of Motion

Deformity

Possible Altered Sensation

Clinical Presentation

Splint dislocations in the position found, treat pain, consider anti inflammitory

Sprains and Strains

• Sprain: Overstretching of the ligaments

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Strain: stretching or tearing of the muscle or tendon

Pain

Swelling

Bruising

Weakness

Initial Management

Rest

Ice

Compression

Elevate

Ibuprofen or other non steroidal anti inflammatory

Fractures: Simple vs. Compound

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Simple Fracture: The bone is fractured but the skin remains intact.

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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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.

Fracture AssessmentMechanism of Injury

Pain

Swelling

Deformity (may or may not be present)

Decreased Range of Motion

Decreased function

Always circulatory, motor, and sensory distal to the injury

Crepitus

X-Ray

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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.

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

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

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

Compound Fractures

Never attempt to realign a compound fracture!

Gently cover the open wound with sterile dressings.

Splint in the position found.

Evaluate and treat the patient for signs and symptoms of shock.

Provide pain control as ordered.

This patient may need surgery to repair the fracture.

High risk for infection, consider antibiotics

Rib FracturesAssessment:Pain, swelling, and/or bruising over the injured area.May or may not be deformityPain 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.

Hip Fracture

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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

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

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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

Complications

Infection• Compound fractures are at high risk for

infection, treat with antibiotics prophylactically

• Pain related to rib fractures may cause a patient’s breathing to become shallow and put them at risk for pulmonary complications

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

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

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

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

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