MUSCULO-SKELETAL TRAUMA

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INTRODUCTION 

Musculo-skeletal injuries are among the most frequently encountered injuries in the prehospital care setting.  Optimal patient care requires that the EMT-I understand the signs/symptoms and field management of musculo-skeletal trauma.  The following topics will be discussed during this lesson:

 

            •           Structure and function of the musculoskeletal system

 

·                      Signs and symptoms associated with fractures

 

            •           Signs and symptoms associated with injury to the muscle, ligaments, and tendons.

 

·                      Field management of musculoskeletal injuries

 

LESSON OBJECTIVES

At the end of this lesson the participants will be able to:

 

 1.        Identify the structure and function of the musculoskeletal system.

 

 2.        Understand the signs and symptoms associated with fractures

 

 3.        State 3 general complications of fractures

 

 4.        Understand specific complications of fractures of the pelvis, femur, elbow, clavicle, rib, and open           fractures.

 

5.                  Discuss the signs and symptoms and field management of the following fractures:  extremity, hip, clavicle, and rib.

 

 6.        Verbalize signs and symptoms and field management for injuries to the muscles, ligaments, and   tendons.

 

 7.        State the general principles of splinting

 

 8.        List 5 indications for realignment of a fracture in the field.

 

 9.        Discuss transportation decisions for musculoskeletal trauma.

 

10.       Demonstrate the following skills:  application of a traction splint, splinting, and sling and swathe   application.

 

 

 

SKILLS 

            1.         Application of traction splint

 

            2.         Splinting

 

            3.         Sling and swathe application

 

KEY VOCABULARY 

The following terms will be used during this lesson:

 

            •           Closed fracture - fracture where the skin is not broken

 

            •           Open fracture - fracture where the skin has been broken

 

            •           Cartilage - connective tissue covering the ends of long bones

 

            •           Compartment syndrome - a condition that commonly follows crush injuries where there is massive swelling in the muscle compartment with compromised blood flow to the extremity.

 

·                      Contusion - bruising that results from rupture of small vessels, usually after blunt trauma

 

·                      Crepitus - sound and feel created by fractured bone ends rubbing together

 

·                      Dislocation - dislodging of a bone from its normal position in a joint

 

·                      Sprain - stretching and tearing of the ligaments

 

·                      Strain - pulling or spasm of the muscles

 

·                      Subluxation - incomplete dislocation of a joint

 

·                      Muscle cramps - pain that results when vessels are not able to supply a muscle with sufficient oxygen or remove the waste products of metabolism

 

·                      Muscle spasms - painful contractions of the muscles

 

 

 

 

 

 

 

 

 

KEY CONCEPTS 

The following section provides information and space for taking notes on the key concepts discussed by the instructor:

 

STRUCTURE AND FUNCTION OF THE MUSCULO-SKELETAL SYSTEM (OVERVIEW)

 

Components of the Musculoskeletal system

·                    Bones - protect the body and provide shape

·                    Muscles - provide movement and generate heat

·                    Ligaments - connect bone to bone

·                    Tendons - connect muscles to bone

·                    Joints - area where two bones connect

 

SKELETAL INJURIES

 

Structure/function of long bone

·        Diaphysis - central portion of the long bone

·        Periosteum - tough membrane that covers the diaphysis

·        Epiphysis - ends of the long bone which contain the growth plates

 

Skeletal structure (review)

·        Axial skeleton

 

·        Appendicular skeleton

 

·        Bones of the upper extremity

·          Scapula

·          Clavicle

·          Humerus

·          Radius

·          Ulna

·          Bones of the hands and fingers

 

·        Bones of the lower extremity

·          Pelvis

·          Femur

·          Fibula

·          Tibia

·          Bones of the foot and toes

 

 

 

 

Injuries to bones

 

·        Fracture - break in the bone, which may also involve blood vessels and surrounding tissue, may be open or closed.

·        Dislocation - displacement of a long bone or other structure from its normal anatomical location

 

 

Types of long bone fractures

·        Hairline - a small crack in the bone with no displacement of the ends of the bone

·        Greenstick - a partial break, most common in pediatric patients

·        Comminuted - multiple small fragments of bone

·        Impacted - ends of the bone compress together

·        Oblique - a diagonal fracture

·        Spiral - the fracture wraps around the bone

·        Transverse - a horizontal fracture across the bone

 

 

 

Complications of Fractures

·        General complications

·          Hemorrhage (may be visible if skin is broken or may bleed into the surrounding tissues)

·          Interruption of blood and nerve supply (may be from severed arteries or from compartment syndrome)

·          Fat embolus (petechiae develop several days following the fracture)

 

·        Specific complications

·          Pelvic fractures - hemorrhage

·          Femur fractures - hemorrhage

·          Elbow fractures - permanent damage to the hand and wrist

·          Clavicle fractures - nerve and/or blood vessel injury

·          Rib fracture - injury to the lung

·          Open fractures - infection

 

 

 

 

 

 

 

 

SIGNS AND SYMPTOMS AND FIELD MANAGEMENT OF COMMON FRACTURES

 

Extremity fractures

Note:  It is usually impossible to diagnose a fracture in the field, therefore all extremity injuries are assumed to be fractured until proven otherwise!

·        Signs and symptoms

·          Deformity

·          Crepitus

·          Swelling

·          Discoloration

·          Pain

·          Movement

 

 

Field management of extremity fractures

·        BLS procedures:

·        Caution:  be careful not to focus on the obvious fracture and miss the fact that the patient is not breathing!

·          Assess circulation, sensation, and movement

·          Splint

·          Hare traction splint is used for closed mid-shaft femur fractures

·          Reassess circulation, sensation, and motor function

·          Ice

·          Elevate

·          Cover with sterile dressing if open fracture

·          Transportation

·        ALS procedures:

·          Unless there are other injuries these will usually be BLS calls

 

 

Pelvic fractures

·        Common sites:  across the iliac crest or through the pelvic ring

·        Mechanism of injury: significant force is required to fracture the pelvis

·        Signs and symptoms

·          Pain and instability on movement

·          May be no visible signs and symptoms

·          May have massive internal bleeding - assess carefully for signs and symptoms of hypovolemic shock

 

Field management of pelvic fractures:

·        BLS procedures

·          O2 prn

·          Immobilization

·          Assist with ALS procedures

·          Transport

·          Monitor frequently for internal hemorrhage

·        ALS procedures

·          Venous access (large bore)

·          Monitor

 

Hip fractures/dislocations

Signs and symptoms

·          Anterior fracture/dislocation: lateral (external) rotation of the knee and leg

·          Posterior fracture/dislocation: knee flexed and internal rotation of the leg

 

 

Field management of hip fractures:

·        BLS procedures

·          O2 prn

·          Immobilize

·          Assist with ALS procedures

·          Transport

·        ALS procedures

·          Unless other injuries are present these are often BLS calls

·          Venous access prn

 

Clavicle fractures

Signs and symptoms

·          Pain

·          Swelling

·          Deformity

 

 

Field management of clavicle fractures:

·        BLS procedures

·          Immobilize

·          Transport

·        ALS procedures

·          Unless other injuries are present these are often BLS calls

 

 

Rib fractures

Signs and symptoms

·          Pain

·          Bruising

·          Swelling

·          May be short of breath

·          May have flail chest if several ribs are fractured (will be discussed in chest/abdominal trauma)

 

Field management of rib fractures:

·        BLS procedures

·          High flow oxygen

·          Position of comfort

·          Ice

·          Frequent reassessment of breath sounds, shortness of breath, respiratory distress, flail chest, abnormal vital signs or other injuries requiring ALS intervention

·        ALS procedures

·          Advanced airway as required

·          Venous access

·          Needle thoracostomy if signs and symptoms of tension pneumothorax develop

 

 

MUSCULAR INJURIES

 

Types of muscles

·          Cardiac - located only in the myocardium (will not be discussed in this lesson)

·          Smooth - located in the internal organs (blood vessels, bronchioles, etc.) (will not be discussed during this lesson).

·          Skeletal- located throughout the body - provide movement

 

Injuries to muscles

·          Contusions

·          Muscle cramps and spasms (not necessarily associated with injury)

·          Strain

 

SIGNS AND SYMPTOMS AND FIELD MANAGEMENT OF COMMON MUSCULAR INJURIES

 

Contusions

Signs and symptoms

·          Bruising

·          Dull pain

 

Field management of contusions:

·        BLS

·          Ice

·          Elevate

·          Immobilize if underlying injury is suspected

·        ALS

·          Not usually an ALS call unless are other more significant injuries

 

 

Muscle cramps or spasms

Signs and symptoms

·          Pain (usually relieved with rest)

·          Deformity (spasms may look like fractures!)

 

Field management of muscle cramps and spasms:

·        BLS procedures

·          Oxygen prn

·          Immobilize if suspicious of fracture

·          Transport

·        ALS procedures

·          Not usually required

 

 

Strains

Signs and symptoms

·          Pain

·          Swelling

·          Deformity

·          Bruising (not usually in the prehospital period)

 

Field management of strains:

·        BLS procedures

·          Immobilize

·          Ice

·          Elevate

·          Transport

·        ALS procedures

·          Not usually required

 

 

 

 

LIGAMENT, TENDON, AND JOINT INJURIES

 

Structure/function of ligaments, tendons, and joints

·          Ligaments - connective bands that connect bones to bones

·          Tendons - connective bands that connect muscles to bones

·          Joints - area where two bones connect which allows movement and flexibility

 

Injury to ligaments, tendons, and joints

·          Sprain

·          Dislocation/subluxation

 

SIGNS AND SYMPTOMS AND FIELD MANAGEMENT OF LIGAMENT, TENDON, AND JOINT INJURIES

 

Sprains

Signs and symptoms

·          Pain

·          Swelling

·          Deformity

·          Bruising (usually not in the prehospital period)

·          Compartment syndrome may develop

 

Field management of sprains:

·        BLS procedures

·          Immobilize

·          Ice

·          Elevate

·          Transport

·        ALS procedures

·          Not usually required

 

Subluxations/dislocations

Signs and symptoms

·          Pain

·          Swelling

·          Deformity

·          Reduced function