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Bone Injuries
• Associated with a forceful cause of injury
• May present with obvious disfigurement
• The real problems associated with
fractures are the potential injury to the vital
organs next to them.
Fractures
• Fracture and broken bone both mean a
break or crack in a bone.
• Two categories
− Closed—skin is intact.
− Open—skin has been
broken.
© Jones & Bartlett Learning.
Types of Fractures
• Greenstick—incomplete fracture
• Traverse—cut across bone at right angles
• Oblique—cross bone in a slanting direction
© Jones & Bartlett Learning.
Types of Fractures
• Comminuted—bone is fragmented into
more than two pieces
• Impacted—broken ends are jammed
together
• Spiral—results from a twisting injury
Fractures: What to Look For
• Use DOTS to assess
for injury:
− Deformity
− Open wounds
− Tenderness
− Swelling
© E. M. Singletary, M.D. Used with permission.
Fractures: What to Look For
• Loss of function
• Guarding
• Crepitus—grating sensation
• History of injury that includes a serious
incident
Fractures: What to Do
• Check for life-threatening conditions first.
• Gently remove clothing covering the area.
• Look and feel for DOTS.
Fractures: What to Do
• Check pulse and
nerves using the
mnemonic CSM.
− C—Circulation
• For arm injury, feel
for radial pulse.
• For leg injury, feel
for posterior tibial
pulse.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Fractures: What to Do
• Use CSM (cont’d)
− Sensation
• Lightly touch or
squeeze one of the
person’s toes or
fingers while his or
her eyes are
closed.
• Ask which finger or
toe he or she feels.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Fractures: What to Do
• Use CSM (cont’d)
− M—Movement
• Have the person
wiggle his or her
toes and fingers. © Jones & Bartlett Learning. Courtesy of MIEMSS.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
Fractures: What to Do
• Stabilize part.
• For open fracture:
− Do not push on
protruding bones.
− Cover wound with
a dressing.
• Seek medical care.
© American Academy of Orthopaedic Surgeons.
Dislocations
• A dislocation occurs when a joint comes
apart and stays apart with the bone ends
no longer in contact.
© American Academy of Orthopaedic Surgeons.
Dislocations: What to Look For
• Deformity (main sign)
• Tenderness, severe pain
• Swelling
• Inability to move injured part
• Numbness or impaired circulation of
extremity
Dislocations: What to Do
• Call 9-1-1 if:
− Extremity looks blue or extremely pale
− Transport of the person would be difficult or
might aggravate the injury
• Check the CSM.
Dislocations: What to Do
• If EMS will arrive soon, hold injured part to
stabilize until they arrive.
• If EMS will be delayed or you are
transporting to distant medical care, use
the RICE procedure.
• Do not try to reduce a dislocation.
Sprains
• Occurs when a
joint is twisted or
stretched beyond
its normal range of
motion
− Results in partially
or completely torn
ligaments
© Sean Gladwell/Dreamstime.com.
Sprains: What to Look For
• Similar signs and symptoms to a fracture
− Severe pain
− Swelling
− Discolored skin around the joint
Sprains: What to Do
• Use the RICE procedure.
− Rest.
− Ice. Apply for 20 minutes.
− Compression. Apply for 3 to 4 hours.
• Repeat the cycle of ice and compression.
− Elevate. Raise the injured part.
Strains
• Occurs when a muscle is stretched
beyond its normal range of motion
• Inflammation begins immediately.
− Can take 24 to 72 hours for pain and stiffness
to begin
Strains: What to Look For
• Occurs during physical activity
• Sharp pain
• Extreme tenderness
• Inability to use injured part
• Stiffness and pain when muscle is used
Cramps
• Occurs when a muscle goes into an
uncontrolled spasm and contraction
• Associated with diabetes, atherosclerosis,
and physical activity
• Two categories
− Night cramps
− Heat cramps
Cramps: What to Look For
• Sudden, severe muscle pain
• A muscle, often calf muscle, that feels
hard because of muscle contraction
• Residual discomfort, may last for a few
hours
Cramps: What to Do
• Gently stretch the muscle.
• Relax the muscle.
• Apply an ice pack.
• For heat cramps:
− Drink lightly salted cool water.
− Drink a commercial sports drink.
Contusions: What to Look For
• Person reports blow to a muscle
• Swelling
• Pain and tenderness
• Black and blue mark appearing hours later