1. Bone & Joint Injuries Monica Hall RN, AE-C, BSN

2. General Info  Injuries to bones and joints are common in accidents and falls  This includes a variety of injuries

3. Examples of joint & bone injury  Fractures  Dislocations  Sprains  Strains

4. Fracture  A break in a bone  Two types  Closed (simple) – fracture is a bone break is not accompanied by an external or open wound on the skin  Open (compound) – fracture is a bone break that is accompanied by an open wound on the skin

5. Signs and Symptoms of Fracture  Can vary  Each person will not exhibit all  Common sign & symptoms:  Deformity  Limited motion or loss of motion  Pain and tenderness at the fracture site  Swelling and discoloration  Protrusion of bone ends through the skin  Victim heard a bone break or snap or felt a grating sensation (crepitation)  Abnormal movements within a part of the body

6. Basic Principles of treatment for fractures  Maintain respirations  Treat for shock  Keep the broken bone from moving  Prevent further injury  Use devices such as splints and slings to prevent movement of the injured part  Obtain medical help whenever a fracture is evident or suspected

7. Videos of Fracture  https://www.youtube.com/watch?v=UWM2G35mE0Y https://www.youtube.com/watch?v=UWM2G35mE0Y  https://www.youtube.com/watch?v=e421jNbbk90 https://www.youtube.com/watch?v=e421jNbbk90

8. Dislocation  When the end of a bone is either displaced from a joint or moved out its normal position within a joint  Frequently associated with tearing or stretching of ligaments, muscles, and other soft tissue

9. Signs & Symptoms of Dislocation  Deformity  Limited or abnormal movement  Swelling  Discoloration  Pain and tenderness  A shortening or lengthening of the affected arm or leg

10. Dislocation Treatment  Basically the same as fractures  No attempt should be made to reduce the dislocation (replace the bone in the joint)  Immobilize the affected part in the position found by using splints and/or slings (movement of the injured part can lead to additional injury to nerves, blood vessels, and other tissue in the area)  Obtain medical help immediately

11. Dislocation Video  https://www.youtube.com/watch?v=CmvUVztaxdQ https://www.youtube.com/watch?v=CmvUVztaxdQ

12. Sprains  An injury to the tissues surrounding a joint; it usually occurs when the part if forced beyond its normal range of movement  Ligaments, tendons, and other tissues are stretched or torn  Common sites for sprains include the ankles and wrist

13. Sprains (Signs & Symptoms)  Swelling  Pain  Discoloration  Sometimes impaired motion

14. Ankle Sprain Video  https://www.youtube.com/watch?v=v2NKUIOQ4zA https://www.youtube.com/watch?v=v2NKUIOQ4zA

15. Strain  Overstretching of a muscle, it is caused by overexertion or lifting  Backs are the most frequent site

16. Signs/Symptoms of Strain  Sudden pain  Swelling  Bruising

17. Strain treatment  Encourage the victim to rest the affected muscle while providing support  Recommend bedrest with a backboard under the mattress for a strained back  Apply cold application to reduce the swelling  After the swelling has decreased, apply warm, wet applications because warmth relaxes the muscles  Obtain medical help for severe strains and back injuries

18. Neck and Spine Injuries  Most dangerous types of injuries to bones and joints  If a victim with such injury is moved, permanent injury resulting in paralysis can occur  If at all possible avoid any movement of a person with potential neck or spinal injuries  Wait until a backboard, cervical collar, and adequate help for transfer arrives

19. Videos  https://www.youtube.com/watch?v=W-BmKXU12yE https://www.youtube.com/watch?v=W-BmKXU12yE  https://www.youtube.com/watch?v=zz7Xm5yTkH4 https://www.youtube.com/watch?v=zz7Xm5yTkH4

20. Splints  Devices used to immobilize injured parts  Can be used in fractures, dislocations, and other similar injuries are present or suspected  Commercial splints are available such as air or inflatable splints, padded boards and traction splints  Can also be made from cardboard, newspapers, pillows, etc.

21. Basic principles of splints  Should be long enough to immobilize the joint above and below the injured part  Should be padded especially over bony areas and over the site of injury  Can be secured in place with triangular bandages, strips of cloth, roller gauze, or similar materials  Must be applied in a way to not cause pressure over the site of injury  If an open wound is present, use a sterile dressing to apply pressure and control bleeding

22. Basic principles of splints – cont.  Never make an attempt to replace broken bones or reduce a fracture or dislocation – do not move the victim, splint wherever you find the victim  Pneumatic splints are available but must be used with caution – there are air and vacuum  Traction splints provide a pulling or traction effect on the injured bone – only trained people would apply  After a splint is applied, one should check circulation  Check skin temperature (should be warm)  Skin color (pale or blue indicates poor circulation)  Any swelling, numbness, or tingling  Check pulse

23. Splint Video  https://www.youtube.com/watch?v=b_pjE_tAtgg https://www.youtube.com/watch?v=b_pjE_tAtgg

24. Slings  Generally used to support the arm, hand, forearm, and shoulder  Many different types  Commercial slings usually have a series of straps that extend around the neck and/or thoracic region  A common first aid sling is the triangular bandage  May be used to provide immobility if a fracture of the arm or shoulder is suspected

25. Basic Principles of Slings  Always position where hand is higher than the elbow (promotes circulation, prevents swelling, and decreases pain)  Check circulation frequently (skin temperature, color, tingling, amount of pain, and numbness) – nail beds is an easy way to check, when pressing them should blanch (turn white) then return to the normal pink color immediately  If applying sling due to potential fracture, used caution not to move area and cause increased injury while trying to apply sling  If using a triangular bandage, tie knot to either side of spinal column and pad knot  If sling is for shoulder injury, can secure limb to body after applying sling with bandage around thoracic region

26. Sling Video  https://www.youtube.com/watch?v=9Cifk_ohsDo https://www.youtube.com/watch?v=9Cifk_ohsDo

27. Summary  Victims with injury to bones or joints can also experience shock  Be alert for signs of shock and treat as indicated  These injuries cause emotions to soar – reassure  All first aid measures are directed toward decreasing pain  Obtain medical help  The only definite medical dx of a closed fx is a x-ray  Always if suspected injury is noted, treat as if it is a true injury