Chapter 32: Orthopedic Injuries

Overview

• Goal: Understand anatomy & physiology of the musculoskeletal system, assess injuries, and understand treatment including use of splints and traction.

Musculoskeletal System

• Function: Provides upright posture, movement, and protects vital organs.
• Components:
  • Skeletal Muscle: Voluntary, striated, largest muscle mass.
  • Smooth Muscle: Involuntary, found in tubular structures, controls movement within.
  • Cardiac Muscle: Involuntary, specialized for the heart.

Skeleton

• Bones: 206 bones, produce red blood cells, store minerals.
• Structure: Skull, thoracic cage, spinal canal, pectoral girdle, and pelvis.
• Upper Extremities: Humerus, elbow, radius, ulna, and hand bones (carpals, metacarpals, phalanges).
• Lower Extremities: Femur, tibia, fibula, ankle (tarsals), foot (metatarsals, phalanges).

Joint and Ligaments

• Joints are where bones meet, held by ligaments.
• Types of motion: Circular (shoulder), hinge (elbow/knee), minimal (sternoclavicular), none (skull sutures).

Mechanism of Injury

• Forces: Direct blows, indirect forces, twisting, high-energy.
• Fractures: Open (external wound) vs. Closed.
• Types: Non-displaced, displaced (e.g., greenstick, oblique, pathologic, transverse).

Musculoskeletal Injuries

Fractures

• Open Fractures: Higher infection risk, treat open wounds immediately.
• Signs: Deformity, tenderness, swelling, crepitus, false motion.

Dislocations

• Description: Bones no longer in contact, ligaments torn.
• Treatment: Do not attempt reduction, stabilize in position found.

Sprains and Strains

• Sprain: Overstretching of ligaments.
• Strain: Pulled muscle, pain, and swelling.

Amputations

• Complete vs. Partial: Treat for shock, control bleeding, preserve severed parts.

Complications

• Complications: Circulatory issues, infection, shock.
• Assessment: Look for life threats, prevent contamination, stabilize appropriately.

Patient Assessment

Scene Size-Up

• Safety: Identify injury forces, use PPE.

Primary Assessment

• Focus: Manage life threats, assess consciousness, XABCs (Extinguish bleeding, Airway, Breathing, Circulation).

Transport Decision

• Rapid Transport: Needed for airway/breathing issues or significant mechanism of injury.

History Taking

• Gather: SAMPLE, OPQRST histories if appropriate.

Secondary Assessment

• Examine: Use DCAP-BTLS, evaluate neurovascular function with the 6 Ps (Pain, Paralysis, Paresthesia, Pulselessness, Pallor, Pressure).

Emergency Care and Splinting

General Principles

• Splinting: Stabilizes injuries, prevents further damage.
• Types: Rigid, formable (e.g., vacuum splints), traction.
• Avoid: Improper splinting can cause additional injuries.

Specific Injuries

• Clavicle: Commonly fractured, use sling & swath.
• Shoulder Dislocations: Splint in comfortable position.
• Humerus & Elbow Fractures: Handle with care, consider neurovascular issues.
• Pelvis & Femur: High risk of blood loss, stabilize promptly.

Compartment Syndrome

• Description: Swelling within a compartment, restricts blood flow.
• Signs: Disproportionate pain, pallor, decreased power.
• Treatment: Immediate transport, reassess neurovascular status frequently.

Review Questions

• Skeletal Muscle: Also called striated muscle.
• Strain: Stretching or tearing of muscles/ligaments.
• Unresponsive Patient: Difficult to assess sensory response.
• Splinting Purpose: Prevent motion, reduce further injury.

Conclusion: Understanding musculoskeletal injuries and proper assessment and treatment techniques is crucial for effective emergency care.