Chapter 32: Orthopedic Injuries

Introduction

• Focus on anatomy and physiology of the musculoskeletal system.
• Proper assessment for musculoskeletal injuries.
• Understanding fractures, sprains, and dislocations with their signs, symptoms, and treatments.
• Use of splints and traction splints.

Musculoskeletal System

• Functions: Provides structure, movement, and protection for internal organs.
• Common Injuries: Pain, swelling, deformity; rarely fatal but can cause disability.
• Anatomy: Three types of muscles: skeletal, smooth, cardiac.
  • Skeletal Muscles: Voluntary, striated, largest muscle mass.
  • Smooth Muscles: Involuntary, found in walls of tubular structures.
  • Cardiac Muscle: Involuntary, has its own regulatory system.

Human Skeleton

• Composition: 206 bones, supports movement, protects organs, produces blood cells.
• Key Structures:
  • Skull, thoracic cage, spinal canal, pectoral girdle, pelvis.
  • Leg and arm bones: femur, tibia, fibula, humerus, radius, ulna, carpals, phalanges.

Types of Musculoskeletal Injuries

• Fractures: Break in bone continuity; classified as open or closed.
  • Types: Greenstick, oblique, pathologic, spiral, transverse.
• Dislocations: Joint disruption; bone ends lose contact.
• Sprains: Stretching or tearing of ligaments; knees, shoulders, and ankles are vulnerable.
• Strains: "Pulled muscle"; stretching or tearing of muscle.
• Amputations: Extremity completely severed.

Complications of Injuries

• Risk of infection, long-term disability, neurovascular compromise.
• Golden Period: Critical for preserving limb viability.

Patient Assessment

Scene Size-up

• Ensure safety, identify mechanism of injury, use standard precautions.

Primary Assessment

• Identify/manage life-threatening issues; ABCs take priority.

Transport Decision

• Rapid transport for life-threatening conditions or if significant trauma is suspected.

History Taking

• Obtain SAMPLE history; use OPQRST for pain assessment.

Secondary Assessment

• Head-to-toe for significant trauma; focus on hidden injuries.

Reassessment

• Regular reevaluation; every 5 minutes if unstable.

Emergency Care

• Stabilize ABCs, perform secondary assessment, watch for internal bleeding.

Splinting

Types of Splints

• Rigid Splints: Non-formable; stabilize bone.
• Formable Splints: Adjustable, like vacuum splints.
• Pelvic Binders: For pelvic fractures.

General Principles

• Remove clothing, inspect for DCAP-BTLS, check neurovascular status.
• Immobilize joint above/below fracture.

Specific Injuries and Treatments

• Upper Limb Injuries: Fractures or dislocations require sling and swath.
• Pelvic and Femur Injuries: High risk of blood loss; use splints and monitor vitals.
• Knee and Ankle Injuries: Stabilize and transport; use traction splints cautiously.

Compartment Syndrome

• Limb-threatening condition due to swelling within compartment.
• Requires surgical intervention (fasciotomy).

Conclusion

• Review questions highlight key learning points about musculoskeletal injuries and management.