Musculoskeletal Injuries

The musculoskeletal system is made up of over 200 bones and over 600 muscles. Together they give the body shape, protect internal organs, and provide for movement. Any time bones and muscles are injured, one of those functions is either temporarily or permanently impaired.

Mechanisms of Musculoskeletal Injuries As you begin to evaluate your patient

consider the mechanism of musculoskeletal injury.

Direct An injury occurs at the point of impact. Example; in a car crash the victim is thrust

forward striking his knee on the dashboard. The resulting fractured patella is caused by that direct force or direct blow.

Indirect With an indirect force the energy of a blow

travels along a path away from the point of impact.

Example; a patient falls onto her outstretched hand. The force of the blow travels from her hand and wrist up through her arm and shoulder. The injuries caused by the indirect force can lead to a fractured radius, ulna, humerus, or clavicle.

Twisting With a twisting force, one part of a limb

remains stationary while the rest of it twists. Example; a jogger who steps into a hole and

gets his foot caught. When he falls the body would pull the leg one way, while the trapped foot would hold it firmly in its original position. The twisting motion could cause a fracture in any of the bones or joints of the limb.

Bones and Muscles may be injured in four basic ways: A bone is broken (fracture fx) A muscle or muscle and tendon are over

extended. (strain) A joint and ligament are injured. (sprain) A bone is moved out of its normal position in

a joint and remains that way. (dislocation)

Oh no!!! The nurse suspects an ankle sprain when a

patient at the urgent care center: A. was hit by another soccer player on the field. B. has ankle pain after running a 10-mile race. C. dropped a 10-lb weight on his lower leg at

the health club D. had an inversion or twisting injury while

running bases at a baseball game.

A musculoskeletal injury is classified as either open or closed.

In a closed extremity injury the skin is not

broken at the injury site.

In an open extremity injury, the skin is broken, perhaps by protruding bone ends

Your on the right track! The nurse explains to a patient with a distal

tibial fracture retuning for a 3- week checkup that healing is indicated by

A. callus formation B. complete union of bone C. presence of granulation of tissue D. formation of hematoma at the fracture site

Patient Assessment/Signs and Symptoms

Deformity or angulation. When compared to the uninjured limb, the injured one is a different size or has a different shape.

Pain and tenderness.

Grating, or crepitus. This is a sound or feeling of broken bones grinding against each other.

Swelling

Bruising or discoloration (Ecchymosis)

Exposed bone ends

Joint locked in position

When examining a patient with a musculoskeletal injury, remember that he or she may be in a great deal of pain. Be careful not to move the limb or jar the body. Be gentle and reassuring to the patient and family.

First Aid for pt c musculoskeletal injuries Take BSI precautions Identify and treat life threats Stabilize the injured extremity by holding it above

and below the injury site. Maintain manual stabilization until the limb is completely immobilized in a splint.

Expose the injury site. To avoid jarring the limb you may cut away clothing. Remove jewelry.

Treat any open wounds. Control bleeding. Be careful to avoid applying pressure to broken bone ends. Dress any open wound with sterile dressings.

Splinting Any device used to immobilize a body part is

called a splint. A splint may be soft or rigid. It can be commercially made or improvised from almost any object.

Five Good Reasons for Splinting To prevent motion from bone fragments or

dislocated joints Minimize damage to surrounding tissues,

nerves, blood vessels, and the injured bone itself

To help control bleeding and swelling To help prevent shock To reduce pain and suffering

Types of Splints Rigid Splints-padded boards are the most

common type of rigid splint. A rigid splint must be anchored to the limb with

cravats that are secured with square knots making sure not to place the cravat directly over the injured site.

Circumferential Splints- this type of splint completely surrounds, or envelopes, the injured limb. An example is an air splint. An advantage of an air splint is that the

compression it provides helps to reduce swelling.

Improvised Splints-can be made from a cardboard box, cane or walking stick, ironing board, rolled up magazine, umbrella, broom handle, catcher’s shin guards, pillow, or any similar object. It must be wide enough to extend past the joints and prevent movement on both sides of the injury, and be as wide as the thickest part of the injured limb.

General Rules of Splinting BSI Do not release manual stabilization of an injured

extremity until it is properly and completely immobilized.

Never intentionally replace protruding bones or push them back below the skin.

You can’t assess what you can’t see. Cut away clothing before applying the splint and remove jewelry

General Rules of Splinting Cont… Control bleeding and dress all open wounds

before splinting. If a long bone is injured, immobilize the

joints above and below it. If a joint is injured immobilize it and the

bones above and below it

General Rules of Splinting Cont… If a limb is severely deformed by the injury, or if the

limb has no pulse or is cyanotic below the injury site, align it with gentle manual traction. If there is pain or crepitus, stop pulling immediately.

Pad a splint before applying it to keep the patient as comfortable as possible.

Before and after applying a splint assess pulse, motor, and sensation below the injury site. Reassess q 15 min.

Improper Splinting Can compress nerves, tissue, and blood

vessels, which can aggravate the injury. Move displaced or broken bones, causing

even further injury. Reduce blood flow below the injury site,

risking the life of the limb.

This is bad! This is really bad… An indication of a neurovascular problem noted

during assessment of the patient with a fracture is A. exaggeration of extremity movement B. petechiae on the head and upper thorax C. decreased sensation distal to the fracture site. D. A purulent drainage at the site of the open

fracture

Shoulder A dislocated shoulder is a common injury.

The shoulder will appear deformed. You may also see a “hollow” in the upper arm below the clavicle.

Apply a sling and swathe, padding the void between the body and the arm.

Splinting the Radius Ulna Forearm and wrist injuries must be supported

from the elbow to the fingertips. Then a sling and swathe should be applied. Be sure to place something like a roll of cling to maintain the hand in a position of function

Splinting the Olecronon (Elbow) The elbow should be splinted in the position it

was found. If the arm is straight splint from the armpit to the fingertips.

An injured Olecronon immobilized in a straight position

Hands and Fingers

If one finger is injured it may be taped to the finger beside it. If more than one finger is involved, place the hand in a position of function using a 4” roll of bandage in the palm of the injured hand. Wrap the entire hand and place it on an arm board.

Splinting the Lower Extremities Pelvis-Can be life threatening because a large

amount of blood can be lost into the lower abdomen. Be alert for shock with any pelvis injury.

Femur It takes a great deal of force to fracture the

femur. The preferred method of splinting is a traction splint

Danger!!! A patient with a pelvic fractures should be

monitored for… A. sudden thirst B. changes in urinary output C. palpable lump in the buttock D. sudden decrease in blood pressure

Applying a Traction Splint Assess pulse, movement, and sensation below

the injury site.

Manually stabilize the limb.

Measure the splint.

Position splint. Attach ischial strap.

Apply the ankle hitch.

Fasten splint to the ankle hitch. Apply mechanical traction.

Fasten leg support straps.

Reassess pulse, motor, sensation.

http://www.youtube.com/watch?v=Z8TzlbkXsbo

Alternative care involves using two long padded splints to create fixation.

Knee Splint in the position found.

Tibia Fibula Splint using two long padded boards as you

would a femur.

Ankle and Foot Circumferential splints work well, however

the easiest splint may be a pillow splint.

Dx Fx

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