1. Chapter 8 Specific Bone and Joint Injuries

2. Lesson Objectives (1 of 3) Identify major bones of the skeletal system. Assess and manage upper extremity injuries, including shoulder injuries, upper arm injuries, elbow injuries, lower arm injuries, hand injuries, and finger dislocations and fractures.

3. Lesson Objectives (2 of 3) Assess and manage lower extremity injuries, including hip injuries, pelvic injuries, thigh injuries, knee injuries, lower leg injuries, ankle injuries, and foot and toe injuries. Assess and treat spinal injuries. Know how to move a victim with a spinal injury.

4. Lesson Objectives (3 of 3) Know when to remove spine immobilization. Know the evacuation guidelines for musculoskeletal injuries.

5. Upper Extremity Injuries (1 of 19) Shoulder injury –Collarbone (clavicle) can by injured by a direct blow or fall. –Fractures of the upper humerus (arm bone) are treated as shoulder injuries.

6. Upper Extremity Injuries (2 of 19) Shoulder injury –What to look for: Tenderness Swelling Deformity Extreme pain

7. Upper Extremity Injuries (3 of 19) Shoulder injury –What to do: Treat all shoulder injuries with a sling.

8. Upper Extremity Injuries (4 of 19) Shoulder dislocation

9. Upper Extremity Injuries (5 of 19) Shoulder dislocation –What to look for: Upper arm is usually held away from the body. Shoulder looks squared off rather than rounded. Check circulation, sensation, movement.

10. Upper Extremity Injuries (6 of 19) Shoulder dislocation –What to do: Apply traction to relocate.

11. Upper Extremity Injuries (7 of 19) Upper arm injury –Can be caused by a fall, twisting, or a direct blow. –Usually obvious.

12. Upper Extremity Injuries (8 of 19) Upper arm injury –What to look for: Swelling and deformity Severe pain Grating sensation and abnormal motion Check circulation, sensation, and movement.

13. Upper Extremity Injuries (9 of 19) Upper arm injury –What to do: Remove rings. Place a rigid splint on outside of the arm. Place padding between the victim’s arm and chest. Allow the arm to hang in the sling position.

14. Upper Extremity Injuries (10 of 19) Elbow injury –Can be caused by direct blow –Can happen indirectly from a fall on an outstretched hand.

15. Upper Extremity Injuries (11 of 19) Elbow injury –What to look for: Deformity, severe pain, swelling, tenderness Inability to move the elbow without severe pain Impaired circulation, sensation, or movement below the elbow

16. Upper Extremity Injuries (12 of 19) Elbow injury –What to do: Remove rings. Immobilize the affected arm with a sling. Keep the elbow in the position found. If there is severe deformity or medical care will be delayed more than a few hours, attempt reduction.

17. Upper Extremity Injuries (13 of 19) Lower arm injury –What to look for: Can be caused by a direct blow or a fall when the victim lands on the outstretched hand.

18. Upper Extremity Injuries (14 of 19) Lower arm injury –What to do: Remove rings. Attempt to straighten severe angulation of the forearm. Apply a splint from the middle of the palm to just below the elbow. Seek medical care.

19. Upper Extremity Injuries (15 of 19) Hand injury –What to look for: Deformities, tenderness, swelling. Fingers may be out of alignment. Check circulation, sensation, and movement.

20. Upper Extremity Injuries (16 of 19) Hand injury –What to do: Place hand in position of function. Place a rolled pair of socks in the palm. Gently realign displaced fingers and buddy tape. Attach a rigid splint along the forearm and under the hand.

21. Upper Extremity Injuries (17 of 19) Finger dislocation and fractures –Fingers are easily injured. –Minor injury can cause dislocation. –Injuries include: Fractures Sprains Dislocations Tendon injuries

22. Upper Extremity Injuries (18 of 19) Finger dislocation and fractures –What to look for: Deformity and inability to use or bend finger Pain and swelling Restricted movement Bruising Abnormal position of adjoining bones

23. Upper Extremity Injuries (19 of 19) Finger dislocation and fractures –What to do: Reduce dislocations immediately following injury. Tape finger to its neighbor after reducing. Fashion a splint that includes the thumb and wrist.

24. Lower Extremity Injuries (1 of 22) Hip injury –Hip is a ball-and-socket joint. –Socket joint is in the pelvic bone. –Hip can be dislocated or fractured.

25. Lower Extremity Injuries (2 of 22) Hip injury: What to look for –Pain around the hip that increases with movement –Inability to bear weight –Foot rotated outward or inward –Injured limb appears shorter than uninjured limb –With dislocation, hip and knee are both held bent, with knee turned inward.

26. Lower Extremity Injuries (3 of 22) Hip injury: What to do –Carry victim out of the wilderness. –Realign the limb and rotate the foot into normal position. –Splint affected leg to uninjured leg and secure. –Pad between the legs and around injured leg. –Evacuate.

27. Lower Extremity Injuries (4 of 22) Pelvic injury –What to look for: Pain when you press the affected area or squeeze the pelvis side to side or front to back Inability to bear weight Signs of shock Blood in urine or inability to urinate

28. Lower Extremity Injuries (5 of 22) Pelvic injury –What to do: Stabilize on a rigid backboard, litter, or sled. Evacuate.

29. Lower Extremity Injuries (6 of 22) Thigh injury –Fractures of the femur require a large amount of energy. –Victim can lose up to 2 quarts of blood due to internal bleeding. –Stabilization can reduce bleeding be lifesaving.

30. Lower Extremity Injuries (7 of 22) Thigh injury –What to look for: Severe pain Inability to bear weight Motion at fracture site Swelling and deformity Thigh or leg may appear shortened. Foot rotated abnormally

31. Lower Extremity Injuries (8 of 22) Thigh injury –What to do: Apply manual traction If victim must be moved without traction, stabilize in position of comfort and splint the injured leg to the uninjured leg. Monitor circulation beyond the injury.

32. Lower Extremity Injuries (9 of 22) Knee injury –Fractures –Dislocations –Sprains

33. Lower Extremity Injuries (10 of 22) Knee injury: What to look for –Pain when attempting to bend or straighten the knee –Gap or marked tenderness along the edges of the kneecap –Displaced patella –Major deformity –Swelling –Tenderness

34. Lower Extremity Injuries (11 of 22) Knee injury: What to do –Flex hip slightly to relax the thigh muscle. –Gently straighten the knee. –Wrap the leg in a cylinder splint or an elastic bandage.

35. Lower Extremity Injuries (12 of 22) Lower leg injury –What to look for: Severe pain Swelling Instability Deformity Inability to bear weight

36. Lower Extremity Injuries (13 of 22) Lower leg injury –What to do: Correct deformities with gentle traction. Splint lower leg fractures to immobilize knee and ankle. Evacuate.

37. Lower Extremity Injuries (14 of 22) Ankle injury –Most ankle injuries are sprains of the outside (lateral) ligaments. –Ligament injuries and fractures often occur together. –Dislocations are nearly always associated with multiple fractures.

38. Lower Extremity Injuries (15 of 22) Ankle injury –What to look for: Swollen, tender, bruised ankle Pain and marked tenderness over the bones Difficulty putting weight on foot

39. Lower Extremity Injuries (16 of 22) Ankle injury –What to do: Decide whether to remove footwear. Check circulation, sensation, and movement in the foot. Straighten deformities. Apply RICE procedures. Splint ankle fractures.

40. Lower Extremity Injuries (17 of 22) Foot injury –Fractures can occur from: Direct blow Sudden twisting injury Stress of repetitive activity

41. Lower Extremity Injuries (18 of 22) Foot injury –What to look for: Local tenderness and pain with walking Swelling Bruising Tenderness

42. Lower Extremity Injuries (19 of 22) Foot injury –What to do: Provide a stiff-sole boot and cane or crutch. If pain increases with walking, evacuate.

43. Lower Extremity Injuries (20 of 22) Toe injury –Toes are usually fractured by a direct blow. –Usually painful –Not usually serious

44. Lower Extremity Injuries (21 of 22) Toe injury –What to look for: Compare injured and uninjured sides. Injured toe will likely be swollen and deformed.

45. Lower Extremity Injuries (22 of 22) Toe injury –What to do: Apply traction. Realign toes that are out of alignment. Buddy tape with padding between toes.

46. Spinal Injuries (1 of 6) Assessing and treating spinal injuries –What to look for: Numbness, tingling, weakness, or burning sensation in arms or legs Loss of bowel or bladder control Paralysis of arms and/or legs Tenderness along the spine Pain resembling electric shock when attempting to move hands and feet.

47. Spinal Injuries (2 of 6) Assessing and treating spinal injuries –What to do: Check breathing. Instruct victim to lie still. Stabilize neck. Improvise a short backboard.

48. Spinal Injuries (3 of 6) Assessing and treating spinal injuries –What to do (continued): Place the board behind the head, neck, and chest with rolled clothing on either side of the head. Secure the trunk securely to the board around the chest, below the arms, and around the forehead. Fashion a neck collar.

49. Spinal Injuries (4 of 6) Moving a victim with a spinal injury –Extricate victim and place on the back with spine straight. –Straighten the head and neck of an unresponsive victim to maintain open airway. –Roll victim onto backboard by log-rolling.

50. Spinal Injuries (5 of 6) When to remove spine immobilization –Victim is calm, fully alert, cooperative, and not intoxicated –No numbness, tingling, burning sensation, or paralysis or weakness in extremities –No marked tenderness of spine –No marked muscle spasm

51. Spinal Injuries (6 of 6) When to remove spine immobilization –No severe midline spine pain with movement –No other painful injuries that would make evacuation difficult

52. Guidelines for Evacuation of Musculoskeletal Injuries Evacuate as rapidly as possible for –Open fractures –Injuries with nerve damage, serious blood loss, and suspected spinal cord injury –Major fractures and dislocations