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Chapter 8

Chapter 8. Specific Bone and Joint Injuries. Lesson Objectives (1 of 3). Identify major bones of the skeletal system.

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Chapter 8

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  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

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