1. Musculoskeletal Trauma
April Morgenroth EMT, RN, BSN

2. Musculoskeletal System
Cartilage: softer than bone but provides structure
Bones: Provide structure and protect organs
Muscles: serve to connect musculoskeletal structures and allow movement.
Tendons: connect muscles to bones
Ligaments: Support joints by attaching bones to bones
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3. Injuries to the Joint Luxation: Total dislocation of joint.
Clinical Presentation
Pain
Swelling
Decreased Range of Motion
Deformity
Subluxation: Partial dislocation of a joint.
Possible Altered Sensation
Splint dislocations in the position found, treat pain, consider anti inflammitory

4. Sprains and Strains Sprain: Overstretching of the ligaments
Pain
Swelling
Bruising
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Sprain: Overstretching of the ligaments
Strain: stretching or tearing of the muscle or tendon
Weakness

5. Initial Management Rest Ice Compression Elevate
Ibuprofen or other non steroidal anti inflammatory
Compression
Elevate

6. Fractures: Simple vs. Compound
Simple Fracture: The bone is fractured but the skin remains intact.
Compound Fracture: The bone is fractured and has pierced the skin. There is communication between the bone and the outside environment.

7. Fractures: Non-displaced vs. Displaced
Non displaced fracture: fracture is present but the bone ends are still aligned
Displaced fracture: fracture is present but the bone ends are displaced. The fracture will need to be reduced before casting in order to heal properly.

8. Fracture Assessment Mechanism of Injury Swelling Crepitus Pain
Deformity (may or may not be present)
Decreased Range of Motion
X-Ray
Decreased function
Always circulatory, motor, and sensory distal to the injury

9. Splinting
Why do it?
Prevent further injury: Further movement of bone ends may cause shearing injury to surrounding tissue.
Control bleeding: immobilizing the injury will help damaged blood vessels form clots to stop the bleeding.
Minimize pain: moving the injured part may cause more pain and further injury.

10. Splinting Remove restrictive clothing (shoes)
Immobilize the joint above and below the injury
Apply the splint with as little movement as possible to the injured part
Secure the splint snugly, enough to restrict movement but not too tight.
Always check circulatory, motor, and sensory after applying a splint.
Reassess frequently.

11. Compound Fractures
Evaluate and treat the patient for signs and symptoms of shock.
Never attempt to realign a compound fracture!
Provide pain control as ordered.
Gently cover the open wound with sterile dressings.
This patient may need surgery to repair the fracture.
Splint in the position found.
High risk for infection, consider antibiotics

12. Rib Fractures Assessment:
Pain, swelling, and/or bruising over the injured area.
May or may not be deformity
Pain will be worse when deep breathing, coughing, or palpated.
Note, work of breathing, respiratory rate, oxygenation, heart rate, symmetry in chest rise.
Flail chest:
Paradoxical chest wall movement during breathing. Caused by multiple rib fractures resulting in floating rib segments. This is an emergency!

13. Treatment of Rib Fractures
Treating pain will help make breathing easier for the patient.
Do not place anything completely around the chest, this may restrict breathing. Have patient hug a pillow when coughing or deep breathing.
You may use the patients own arm to splint a rib fracture by sling and swath method.
Encourage coughing and deep breathing in spite of pain as this will help to prevent fluid accumulation in the lungs.

14. Hip Fracture In the case of Hip fracture: Mechanism of injury
Pain, swelling, bruising, deformity
Lateral rotation or shortening of the
injured leg
Check sensory, motor, circulation in the affected leg
Treat pain
Monitor vitals
Keep the patient in position of comfort
Pt may need surgery to repair the fracture
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15. Fractures of the Pelvis
Can cause life threatening bleeding
May be stable or unstable
Check stability of the pelvic girdle
Evaluate and treat the patient for shock
May have bleeding into the abdomen, check for signs and symptoms.
X-ray of pelvis and chest
An unstable pelvic fracture will need splinting.
Pt will may need surgery
Picture of blanket splint

16. Complications Bleeding: Bones bleed when broken
Trauma to the surrounding area from bone ends or fragments.
Check for bleeding and signs of circulation
Control bleeding as able
Evaluate and treat signs and symptoms of shock

17. Complications Infection
Compound fractures are at high risk for infection, treat with antibiotics prophylactically
Pain related to rib fractures may cause a patient’s breathing to become shallow and put them at risk for pulmonary complications

18. Complications Deep Vein Thrombosis Evaluate circulation frequently
Pulses, capillary refill, skin temperature and color
DVT signs and symptoms: edema, redness, cyanosis, absent pulses, warm, pain
Prevention: early ambulation, physical therapy

19. Complications Compartment Syndrome
Increased pressure in an enclosed compartment restricts circulation and causes tissue damage and/or necrosis
Pressure may be caused by swelling and inflammation, bleeding into the space
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Look for: signs of decreased circulation. pain, pallor, pulselessness, paralysis, pressure, and numbness
Notify MD immediately, pt may need fasciotomy, loosen splint, do not ice or elevate

20. Complications Fat Embolism
Occurs when fatty tissues enter the blood stream and are lodged in the narrowing blood vessels
Signs and symptoms will be similar to DVT unless the embolus is lodged in the lung or brain
If embolus is lodged in the brain, neurological deficits may result from hypoxic brain injury

21. Pulmonary Embolism
Obstruction of the pulmonary artery or one of its branches
Clot usually forms in the veins and then lodges in the pulmonary artery
Shortness of breath, hypoxia, tachycardia, cyanosis, anxiety, sudden death
Do: x-ray and EKG to rule out other causes, monitor vitals and oxygen saturation, provide supplemental oxygen, keep the patient calm and quiet

22. Pneumonia
Pain related to rib fractures may cause a patient to breathe shallow and put them at risk for a atelectasis and fluid build up in the lungs which may cause pneumonia
Prolonged immobility may also lead to build up of fluid in the lungs
Prevention: coughing and deep breathing exercises, treat pain, early mobility