Assessment and Care of Bone and Joint Injuries Chapter 25 Assessment and Care of Bone and Joint Injuries

Objectives (1 of 2) List the assessment and emergency care for injuries of the upper extremities. List the assessment and emergency care for injuries of the lower extremities. Explain the rationale for stabilization of specific injuries to the upper extremities. Explain the rationale for stabilization of specific injuries to the lower extremities.

Objectives (2 of 2) Demonstrate the assessment and emergency care for injuries to the: Clavicle Forearm Femur Scapula Wrist Knee Shoulder Hand Tibia Humerus Pelvis Fibula Elbow Hip Ankle Foot

Upper Extremity Injuries Causes: Fall onto outstretched hand (FOOSH) Can depend on age, position, forces, equipment, and surface Position of limb has significant influence.

Clavicle and Scapula Injuries (1 of 2) Clavicle is one of the most fractured bones in the body. Usually occur due to FOOSH Sometimes due to crush injuries Pain, swelling, and deformity Lies directly over arteries, veins, and nerves

Clavicle and Scapula Injuries (2 of 2) Scapula is well protected. Injury is associated with forceful direct impact Watch for associated significant injuries Joint between clavicle and scapula is the acromioclavicular (A/C) joint “True dislocation” with point tenderness Splint these injuries with a sling and swathe.

Dislocation of the Shoulder (1 of 2) Most commonly dislocated large joint Usually dislocates anteriorly Extremely painful injury Patients will self-splint the arm and shoulder. Numbness and tingling can occur.

Dislocation of the Shoulder (2 of 2) Difficult to immobilize Sling and swathe Blanket roll splint Can be a recurrent injury “Reduction” should occur in clinic or hospital

Fractures of the Humerus Fracture occur either proximally, in midshaft, or distally at elbow. Consider applying traction to realign a severely angulated humerus, according to local protocols. Splint with sling and swathe, supplemented with a padded board splint or SAM splint.

Elbow Injuries Fractures and dislocations often occur around the elbow. Injuries to nerves and blood vessels are common. Assess neurovascular function carefully. Careful realignment may be needed to improve circulation.

Emergency Care of Elbow Injuries Splint with padded rigid material or SAM splint, roller gauze, and a sling and swathe. Always monitor distal CMS functions. Rapid evacuation is essential in patients with poor distal circulation.

Fractures of the Forearm Usually involves both radius and ulna Common injury for snowboard riders Known as “Colles” fractures and the appearance is called a “silver fork” deformity Use a padded board, SAM splint, roller gauze, and sling and swathe. Assess and reassess CMS functions.

Injuries to the Wrist and Hand Common injury in all age groups, and especially riders and skiers Many different injuries are possible. “Skier’s” thumb is an ulnar collateral ligament sprain. Due to potential complications, these injuries should be evaluated by a physician.

Emergency Care of Wrist and Hand Injuries Form hand into position of function by placing a roller bandage in palm. Apply padded board or SAM splint. Secure splint with roller gauze. Apply a sling and swathe. Monitor CMS functions. Find and send amputated parts with patient.

Lower Extremity Injuries Includes: Pelvis fractures Hip dislocations Femur fractures Knee ligament sprains Fractures and dislocations of the knee and patella Tibia and fibula fractures Ankle and foot sprains and fractures

Fractures of the Pelvis Injuries are the result of a fall, collision or forceful compression. May involve life-threatening internal bleeding Organs within the pelvis can be injured. Assess for pain in lower back, lower abdomen, or pelvic area. Patients may lie in a fetal position or with knees partially flexed.

Emergency Care of a Pelvic Fracture Palpate pelvis for tenderness: lateral sides, then pelvic rock, then lower anterior aspects Anticipate shock, give high-flow oxygen. Stable patients can be secured to a long backboard or scoop stretcher to immobilize isolated fractures of pelvis.

Dislocation of the Hip (1 of 2) Hip dislocation requires significant MOI. Patients with posterior dislocations lie with hip joint flexed and thigh rotated inward (most common). Patients with anterior dislocations lie with leg extended straight out, and rotated, pointing away from midline.

Dislocation of the Hip (2 of 2) Monitor CMS functions. Splint in position of deformity on long backboard and transport.

Fractures of the Proximal Femur Also known as a hip fracture Displaced fractures present with characteristic deformity. Apply high-flow oxygen, monitor CMS functions. Fractures from trauma injuries best managed by splinting to uninjured leg and long backboard or scoop stretcher. Traction splinting is not usually indicated.

Femoral Shaft Fractures Leg is externally rotated, shortened, with deformity (bulge) at the thigh Muscle spasms can cause deformity of the limb. Significant blood loss can occur. Monitor distal CMS functions. Immobilize with traction splint. Traction should be maintained until hospitalization.

Anatomy of the Knee Modified hinge joint 4 main ligaments: medial and lateral “collateral,” anterior and posterior cruciate Patella aids flexion and is a “sesamoid” bone.

Injuries of Knee Ligaments Most common injury in skiing Frequently a “pop” is heard or felt. Definitive assessment is best done before knee becomes swollen and painful. MOI can often help indicate type of injury. Splint (quick splint) and transport. Monitor distal CMS function. Apply ice and advise patient to seek physician’s care.

Fractures About the Knee Can occur at three locations: Distal femur Proximal tibia Patella Deformity, swelling, impaired CMS functions Perform re-alignment once if CMS functions are impaired. Apply rigid splint (quick splint).

Dislocation of the Knee Produces significant deformity More urgent injury is to popliteal artery, which is often lacerated or compressed. Always monitor distal CMS functions. Perform realignment once if CMS functions are impaired. Apply a rigid splint (quick splint).

Dislocation of the Patella Patella usually dislocates to lateral side Injury produces significant deformity Splint (quick splint) in position found. Monitor distal CMS functions. May reduce spontaneously during splinting

Injuries to the Tibia and Fibula Usually, both bones fracture at the same time. Skiers may suffer “boot-top” or spiral fractures. Open fracture of tibia is common. Realignment is frequently required. Concurrent femur fracture produces a “floating knee.” Immobilize with a padded quick splint that extends from foot to upper thigh.

Ankle Injuries (1 of 2) The ankle is the most commonly injured joint. MOI includes abruptly “turning the foot under” or “twisting the foot in.” Apply cold packs or ice. Assess distal CMS functions. Fractures are difficult to distinguish from severe sprains. Patient should seek physician’s care if symptoms do not diminish within a day or two.

Ankle Injuries (2 of 2) Fractures usually involve the distal tibia and/or fibula (lateral and medial malleoli). Snowboard riders suffer talus fractures that mimic ankle sprains. Dislocations are associated with distal fractures. Perform realignment/traction once if CMS functions are impaired. Monitor CMS functions and splint (soft or well-padded rigid splint).

Foot Injuries Usually occur after a patient falls or jumps. Also consider possibility of spinal injury from a fall. Apply a long backboard if needed. Stress fractures occur with “overuse.” Immobilize ankle joint and foot in a soft splint. Elevate foot to reduce swelling.