Pelvis, Hip, Femur Fractures Why are they Important? What General Signs & Symptoms, and Concerns would you see/have? Symptoms = Pain Signs = Decreased Mobility Concerns = –Peritonitis Rupture of hollow abd organs –Hypovolemic Shock Example: Femoral artery –Nerve damage What nerve is in this area?
Pelvis Fracture What you see –Will present supine with knees bent, or fetal position after high-velocity MOI Signs & Symptoms: –Tenderness when palpating pelvis. May feel crepitus. Deformity difficult to see. –Discomfort in lower back, lower abdomen, pelvic area. Need to urinate. Treatment: –High flow O2 –Transfer to BB, supine or on side, backboard, keep knees bent (think about how to do) –Monitor for shock, nothing to eat or drink –Rapid Transport (consider Pelvic wrap or Air Mattress)
Hip Dislocatoin What you see –Will present with hip joint flexed, and thigh rotated inward and adducted across body –Not common, but can present when catch hidden object while powder skiing, or ski releases during turn Signs and Symptoms –Pain on palpation –Hip is “locked”, resists any attempt to move –May be involve sciatic nerve; check CMS Treatment: –High flow O2 –Splint in position. Do not move hip –Transfer to backboard and support bent knee with blankets –Monitor for shock; nothing to eat or drink –Rapid transport
Proximal Femur Fracture What you see –Lie with leg externally rotated, and injured leg shorter than uninjured leg –Would result from collision or fall directly on to lateral aspect of hip Signs and Symptoms: –Pain prevents movement, even from gentle leg rotation (pain might refer to knee) –Hip region tender to palpation –Can have soft tissue damage, muscle damage, compromised distal leg CMS Treatment: –High flow O2 –Tie injured leg to good leg w/broad cravats –Transfer to backboard with blanket under flexed knee –Monitor for shock, nothing to eat or drink –Rapid Transport (aka Hip Fracture)
Mid Shaft Femur Fracture What you see –Externally rotated and shortened limb with tender bulge in middle of thigh –Fracture is often angulated (limb deformity) –MOI is direct blow or violent external rotation Signs and Symptoms: –Patient in severe pain, has thigh muscle spasms, unable to move extremity –Pain on palpation is immediate Treatment: –High flow O2 –If angulation, must realign before splinting –Apply Traction Splint such as the Sager –Transfer to Backboard –Monitor for shock, nothing to eat or drink –Rapid Transport
Why use traction splint? Traction Splinting – Counteracts muscle spasms Prevents bone ends from overriding more Reduces potential for damage from sharp bone fragments Decreases pain by stabilizing site Minimizes blood loss (splint stretches and tightens “envelope” around fracture Under current scope of practice, this is the ONLY fracture for which traction is used
Head Immobilization – some patrols always, some hills only with severe MOI Class protocol = Yes, always (rationale is MOI – largest bone in body) Manual fracture stabilization Stabilize injury site while applying splint – can be released when traction applied Manual Traction – some patrols if no head immobilization if there is free responder Patrol Protocols Vary Learn & Follow Yours
√ Toboggan (will bring sled bag) √ Backboard –Will bring 3 helpers, C-collar, head blocks Our class protocol will be to always do a full backboard for midshaft femur fracture √ Oxygen √ Traction Splint. (Sager in our case) √ Emergency Ambulance –So include LOC/Vitals/ETA Mid Shaft Femur Fracture The Radio Call Add to Radio Call