Chapter 32: Orthopedic Injuries

Introduction

• Focus on anatomy and physiology of the musculoskeletal system
• Proper assessment of suspected and obvious injuries
• Types of musculoskeletal injuries: fractures, sprains, dislocations
• Emergency treatment including splints and traction splints

Musculoskeletal System Overview

• Provides posture, movement, protection of vital organs
• Common injuries due to pain, swelling, deformity
• Non-life-threatening, but can cause disability

Anatomy and Physiology

Types of Muscles

• Skeletal Muscle: Voluntary, striated, controlled by voluntary system
• Smooth Muscle: Involuntary, performs autonomic work
• Cardiac Muscle: Involuntary with own regulatory system

Skeleton

• Provides form, movement, protection
• Composed of 206 bones, produces red blood cells

Key Bone Structures

• Skull: Protects brain
• Thoracic Cage: Protects heart, lungs, major vessels
• Spinal Canal: Protects spinal cord
• Shoulder Girdle: Scapula and clavicle, vulnerable to injury
• Upper Extremities: Humerus, radius, ulna
• Pelvis: Supports body weight, protects organs
• Lower Extremities: Femur, tibia, fibula, foot bones

Joints

• Held by capsules and ligaments
• Types: Circular motion (shoulder), hinge motion (elbow), minimal/no motion (skull sutures)

Types of Musculoskeletal Injuries

Mechanism of Injury

• Significant force needed for fractures/dislocations
• Can result from direct/indirect blows, twisting, high-energy forces

Fractures

• Break in bone continuity
• Open Fracture: External wound, risk of infection
• Closed Fracture: No external wound
• Types: Non-displaced, displaced, greenstick, oblique, pathologic, spiral, transverse
• Signs: Deformity, tenderness, swelling, bruising

Dislocations

• Bone ends no longer in contact
• Commonly dislocated joints: fingers, shoulders, elbows, knees
• Signs: Deformity, swelling, pain, loss of motion

Sprains and Strains

• Sprain: Joint twisted beyond normal range; affects ligaments
• Strain: Pulled muscle, affects muscle tissue
• Signs: Pain, swelling, bruising, instability

Amputations

• Complete severing of an extremity
• Can damage muscle, bone, ligaments

Complications

• Orthopedic injuries can cause systemic changes
• Importance of preventing contamination and further injury
• Golden period critical for preserving limb viability

Patient Assessment

Scene Size-up

• Ensure scene safety, identify mechanism of injury
• Consider standard precautions, need for additional support

Primary Assessment

• Focus on life threats, EX-ABCs priority
• Check responsiveness, oxygenation, perfusion, bleeding

Transport Decision

• Rapid transport for airway/breathing issues or significant bleeding
• Use backboard for stabilization if needed

History Taking

• Obtain SAMPLE history
• Use OPQRST for pain assessment

Secondary Assessment

• Full-body assessment for significant trauma
• Use DCAP-BTLS for musculoskeletal assessment
• Check neurovascular function

Reassessment

• Repeat primary assessment, reassess every 5 mins for unstable, 15 mins for stable

Emergency Care

Splinting

• Use splints for fractures, dislocations, sprains
• Types: Rigid, formable, vacuum splints
• General principles: Remove clothing, check neurovascular status, pad splints

Specific Injuries

• Clavicle: Common fracture in children
• Shoulder/Elbow: Common dislocations/fractures, require specific splinting techniques
• Forearm/Wrist/Hand: Use padded splints, assess for function
• Pelvis/Hip: High risk of blood loss, stabilize on backboard
• Femur/Thigh: Use traction splints for fractures
• Knee/Ankle/Foot: Various splinting methods depending on injury type

Compartment Syndrome

• Limb-threatening condition from swelling
• Requires surgical intervention
• Monitor for pain, altered sensation, pallor

Conclusion

• Comprehensive understanding of orthopedic injuries key for emergency care
• Effective splinting and transport critical to patient outcome
• Consistent reassessment and careful documentation essential