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Flashcards in Musculoskeletal Trauma Deck (82)
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Components of Musculoskeletal System

• Bones
• Joints
• Muscles
• Cartilage
• Ligaments
• Tendons


Physiology of Musculoskeletal System

• Bones: framework
• Joints: bending
• Muscles: movement
• Cartilage: flexibility
• Ligaments: connect bone to bone
• Tendons: connect muscle to bone



• Formed of dense connective tissues
• Vascular and susceptible to
bleeding on injury


Shapes of Bones

• Irregular
• Long
• Short
• Flat


Self-Healing Nature of Bone

• Break causes soft tissue swelling and a blood clot in the fracture area
• Interruption of blood supply causes the bone section to die
• Cells further from fracture divide rapidly forming tissue that heals the fracture and develops into new bone


Muscles, Cartilage, Ligaments, & Tendons

Striated Muscle
Cardiac Muscle
Smooth Muscle
Tendon - muscle to bone
Ligament bone to bone


Mechanisms of Musculoskeletal Injury

• Direct force
• Indirect force
• Twisting (rotational) force


Injury to Bones and Connective Tissue

• Fracture: any break in a bone (open or closed)
– Comminuted—broken in several places
– Greenstick—incomplete break
– Angulated—bent at angle
• Dislocation: “coming apart” of a joint


Injury to Bones and Connective Tissue

• Sprain: stretching and tearing of ligaments
• Strain: overstretching of muscle


Injury to Bones and Connective Tissue

• Not all injuries can be confirmed as a fracture in the field
• Splinting an extremity with a
suspected fracture helps prevent blood loss from bone tissues


Assessment: Musculoskeletal Injuries

• Rapidly identify and treat life-threatening conditions
• Be alert for injuries besides grotesque wound
• Pain and tenderness
• Deformity and angulation


Assessment: Musculoskeletal Injuries

• Grating (crepitus)
• Swelling
• Bruising
• Exposed bone ends
• Nerve/blood vessel compromise (decreased CMS)
• Compartment syndrome


Six P’s of Assessment

• Pain or tenderness
• Pallor (pale skin)
• Parasthesia (pins and needles)
• Pulses diminished or absent
• Paralysis
• Pressure


Think About It: Musculoskeletal

• Do my patient’s musculoskeletal injuries add up to serious multiple trauma?
• Does my patient have circulation, sensation, and motor function distal to the suspected fracture or dislocation?


Treatment: Musculoskeletal Injuries

• Take standard precautions
• Perform primary assessment
• Take spinal precautions
• Splint any suspected extremity fractures after treating life threatening conditions
• Cover open wounds with sterile dressings


Advantages of Splinting

• Minimizes movement of disrupted joints and broken bone ends
• Prevents additional injury to soft tissues (nerves, arteries, veins, muscles)
• Decreases pain
• Minimizes blood loss
• Can prevent a closed fracture from becoming an open fracture


Principles of Splinting

• Care for life-threatening problems first
• Expose injury site
• Assess distal CSM
• Align long-bone injuries to anatomical position
• Do not push protruding bones back into place
• Immobilize both injury site and adjacent joints
• Choose splinting method based on severity of condition and priority decision
• Apply splint before moving patient to stretcher
• Pad voids


Realigning Deformed Extremity

• Assists in restoring effective circulation to extremity and to fit it to splint
• If not realigned, splint may be ineffective, causing increased
pain and possible further injury
• If not realigned, increased chance of nerves, arteries, and veins being compromised
• Increased pain is only momentary


Hazards of Splinting

• “Splinting patient to death”—splinting before life-threatening conditions addressed
• Not ensuring ABC’s
• Too tight—compresses soft tissues
• Too loose—allows too much movement
• Splinting in deformed position


Treatment: Splinting Long Bone and Joints

• Select splint appropriate to
• Standard precautions
• Manually stabilize injury site


Treatment: Splinting Long Bone and Joints

• Assess circulation, sensation, and motor function
• Realign injury if deformed or if
distal extremity is cyanotic or pulseless


Treatment: Splinting Long Bone and Joints

• Measure or adjust splint; move it into position
• Apply and secure splint to immobilize injury site, adjacent
• Reassess CSM distal to injury


Treatment Traction Splint



Shoulder Girdle Injuries

• Assessment
– Pain in shoulder
– Dropped shoulder
– Severe blow to back over scapula


Shoulder Girdle Injuries: Tx

• Treatment
– Assess distal CSM
– Use sling and swathe
– Do not attempt to straighten or
– Reassess distal CSM


Forearm, Wrist, and Hand Injuries

• Signs
– Forearm: deformity and tenderness
– Wrist: deformity and tenderness
– Hand: deformity and pain; dislocated fingers


Splinting Forearm, Wrist, and Hand Injuries

• Padded rigid splint
– From elbow past fingertips
– Roll of bandage placed in hand
– Sling and swathe


Splinting Forearm, Wrist, and Hand Injuries

• Soft splint
– Roll of bandage placed in hand
– Tie forearm, wrist, and hand into fold of one pillow or between two pillows
– Tape finger to adjacent uninjured finger


Pelvic Injuries

• Assessment
– Pain in pelvis, hips, or groin
– Pain when pressure applied
– Cannot lift legs
– Lateral rotation of foot
– Unexplained pressure in bladder


Pelvic Injuries

• Treatment
– Move patient as little as possible
– Determine CSM distal to injury
– Straighten lower limbs to anatomical position
– Stabilize lower limbs
– Assume spinal injuries
– Treat for shock