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Musculoskeletal trauma. Miss Shurouq Qadous RN,MSN 17/3/2011. Epidemiology. Injuries to the limbs comprise by far the greatest number of trauma cases, the limbs being injured in about 85% of victims of blunt trauma.
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Musculoskeletal trauma Miss Shurouq Qadous RN,MSN 17/3/2011
Epidemiology • Injuries to the limbs comprise by far the greatest number of trauma cases, the limbs being injured in about 85% of victims of blunt trauma. • Limb injury, in the survivors of major trauma, is a common source of disability.
Life-threatening injuries Trauma to the musculoskeletal system may represent a threat to life, place the limb at risk, or interfere with eventual return to full function and activity.
Life-threatening complications arising from the limb wound itself include haemorrhage, fat embolism, venous thromboembolism and infection.
Types of MusculoskeletalInjuries • Fracture - Bones break • Dislocation - Joints “come apart” • Sprain - Stretching & tearing of ligaments التواء : ينتج من وضع المفصل في وضعية غير طبيعية فتنشد الاربطة او تتمزق او ينفصل مكان اتصالها بالعظام . • Strain • Overexertion of muscle • الاجهاد : ينتج من كثرة استعمال العضلات او اوتار العضلات وينتج عن شد العضلات اكثر من درجة الاحتمال .
Limb-threatening injuries Some injuries may threaten the viability of a limb, or a portion of that limb. Such injuries often involve compromise of the blood supply to the limb that may arise from: • direct vascular damage (penetrating or blunt intimal damage). • vascular occlusion in the distorted limb (for example due to a dislocated joint or severely displaced fracture). • microcirculatory compromise caused by contained swelling (leading to compartment syndrome).
The limbs tolerate vascular compromise poorly, and irreversible damage to the metabolically active tissues such as muscle is likely to occur if the limb remains ischaemic for more than about 6 h.
Threats to limb function The limb that is skeletally unstable, has a compromised vascular supply, or has major neurological damage cannot be expected to function properly. Small, low-energy injuries, often situated peripherally in the limb, can bring about a major impairment to function. Such injuries include: • digital nerve injuries; • dislocation of small (for example carpal/tarsal or phalangeal) joints; • tendon injuries; and peri-articular and ligamentous injuries.
Management of the Musculoskeletal Trauma • Assessment of: • Casualty • Limb as a whole • Traumatized structures and the extent of injury.
The initial assessment of the casualty should proceed using the ABC system, identifying and treating life-threatening injuries as they are found. This examination identifies injuries and conditions compromising the airway, breathing and circulation.
Look: for deformity, discoloration, wounds, swelling, shortening. • Feel: for abnormal movement, crepitus, pulses, temperature, sensation. • Move: assess the ranges of active and passive movement as well as joint stability.
Types of injury • Pelvic fracture
Immediate treatment • Orthopaedic consultation (evaluation of stable versus unstable injury pattern) • Temporary splintage (Mast trousers, binding feet together, pelvic wrapping) • Skeletal stabilization (pelvic Ex-fix, clamp) • Assessment of related injuries (visceral, rectal, urological)
Pelvic Fracture Stabilization Fast Splinting Leg Splint
Mast trousers pelvic Ex-fix
Major limb haemorrhage Immediate treatment • Direct pressure on sites of compressible • haemorrhage • Dressings and compression applied to • wounds • Splintage of limbs
Large/contaminated open wound Immediate treatment • Sterile wound dressing • Splintage • Irrigation if appropriate • Attention to tetanus immune status
Splintage • Splintage helping to: • reduce haemorrhage • prevent further tissue damage • aid analgesia • reduce the incidence of fat embolism.
Splinting – General Rules • Immobilization of the limb, including the joint above and below the fractured segment. • Realignment of the limb. • Application so as not to compromise arterial supply or venous return. • Application to allow examination and re-assessment of distal neurovascular status.
Make sure splint extends several inchesbeyond joints above/below injury.
