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

2. 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.

3. 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

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

5. 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

6. 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.

7. 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.

8. 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

9. 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.

10. 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.

11. 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.

12. 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.

13. 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.

14. 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.

15. 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

16. 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.

17. 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.

18. 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.

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

20. 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.

21. 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.

22. 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.

23. 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.

24. 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).

25. 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).

26. 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

27. 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.

28. 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.

29. 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).

30. 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.