sec1.fa7 bone, joint & muscle injuries

BONE, JOINT & MUSCLE INJURIES

INTRODUCTION

Skeleton is a framework of bones.

Functions Supports the tissues of the body.

Protects the vital organs.

Acts as levers that change magnitude and direction of forces generated by muscles.

TYPES OF INJURY

Fracture Dislocation Muscle strain Torn ligaments

FRACTURES

A break, split or crack in a bone

2 main categories of fractures Open fracture Closed fracture

Causes Direct force Indirect force

TYPES OF FRACTURES

DISLOCATIONS

Displacement of bones at a joint

ASSESSMENT OF BONE, JOINT & MUSCLE INJURIES

Note as many features as possible without moving the injured part unnecessarily.

Try to visualise how the injury was caused.

Compare the shape, position and appearance of the injured part with the uninjured side.

If in doubt about the severity of an injury, treat it as a fracture.


Recognition of Fracture Pain at or near the site of injury Tenderness at or near site of fracture Swelling & redness at or near site of injury Loss of function Deformity Casualty feels or hear the break occur Coarse grating sound is heard or felt

DO NOT try to produce this deliberately!


Recognition of Dislocation Pain at or near the site of injury Difficult or impossible normal movement Loss of power Swelling Deformity or abnormal mobility Tenderness Discolouration and bruising

CLOSED FRACTURES & DISLOCATIONS

Recognition Pain, increased by movement Shortening or unnatural shape to the limb Tenderness, swelling & bruising at the site

There would have been a violent blow or fall and there might have been a snapping sound on impact.


Treatment Carefully stabilise and support the injured part with your

hands, holding above and below the injury.

If necessary, gently straighten a bent limb so you can immobilise it. Always pull straight and steadily in the natural line of the bone. Stop if pain is too great.

Use towels and bandages to immobilise the injured limb.

Immobilise lower limb fractures against the sound leg, with padding between them.


Treatment Immobilise upper limb fractures against the trunk in a sling.

Call for an ambulance and treat for shock. Raise the injured limb if possible, without causing pain or further injury.

Every 10 minutes, check circulation beyond the bandages and loosen them if necessary.

DO NOT move casualty until the injury is supported and immobilised (unless it is dangerous to stay at the scene)

DO NOT let casualty eat or drink anything.

OPEN FRACTURES

Recognition Pain, increased by movement Shortening or unnatural shape to the limb Wound, with broken end of bone visible

There would have been a violent blow or fall and there might have been a snapping sound on impact.

OPEN FRACTURES

Treatment Working from the uninjured side, cover the wound with a

sterile dressing.

Apply pressure around the bone to control bleeding.

Place cotton wool or padding over and around the dressing.

If bone protrudes from the wound, treat as an embedded object.

Build up non-fluffy padding around the bone untill it is higher than the bone.

OPEN FRACTURES

Treatment Bandage dressing and padding securely to control bleeding

but without restricting circulation.

Immobilise the injured part, as for a closed fracture.

Call for an ambulance and treat for shock.

Every 10 minutes, check circulation beyond the bandages and loosen them if necessary.

DO NOT move the casualty until the injury is supported and immobilised (unless it is dangerous to stay at the scene).

OPEN FRACTURES

Treatment DO NOT move the casualty until the injury is

supported and immobilised (unless it is dangerous to stay at the scene).

DO NOT let the casualty eat or drink anything.

DO NOT press directly on a protruding bone end.

INJURIES TO THE FACE AND JAW

Recognition Distortion of the eye sockets, nose, upper teeth

and palate.

Swelling and bruising.

Bleeding may occur from the nose or mouth or tissue.

Also signs of head and neck injury.

INJURIES TO THE FACE AND JAW

Treatment Open & clear casualty’s airway.

Place the casualty in recovery position.

Remains in the recovery position, if you have to carry the casualty on stretcher.

If jawbone is injured, place soft padding under the head to keep weight off the jaw.

DO NOT apply a jaw bandage.

INJURIES TO THE UPPER LIMBFRACTURED COLLAR BONE

Recognition Pain & tenderness at the

site of the injury.

Pain, increased by movement.

Casualty may support the arm at the elbow and incline the head to the injured side.

INJURIES TO THE UPPER LIMBFRACTURED COLLAR BONE

Treatment Place the injured arm across the chest and ask

the casualty to support at the elbow.

Apply an elevation sling.

Place soft padding between the injured arm and the body.

Support with a broad bandage.

INJURIES TO THE UPPER LIMBDISLOCATED SHOULDER

Recognition Pain, increased by

movement.

Reluctance to move.

Casualty often supports the arm and inclines the head to the injured side.

A flat, angular look to the shoulder.

INJURIES TO THE UPPER LIMBDISLOCATED SHOULDER

Treatment Place the injured arm across the chest gently at

an angle that causes the least pain.

Support the injured arm with an arm sling.

Send casualty to the hospital, keeping the casualty in a seated position.

DO NOT replace the bone in position.

INJURIES TO THE UPPER LIMBFRACTURED UPPER ARM


movement.

Tenderness over the fracture site.

Rapid swelling.

Bruising.


Treatment Ask the casualty to sit down.

Gently place the injured arm across casualty’s chest in the position that is most comfortable.

Ask the casualty to support the injured arm, if possible.

Place the affected arm in an arm sling.


Treatment Place soft padding between the arm and the

chest.

Secure the limb to the chest by tying a broad bandage around the chest and over the sling.

Send the casualty to hospital, keeping the casualty in a seated position.

INJURIES AROUND THE ELBOW

Recognition Pain, increased by movement.


Possible swelling and bruising.

Fixed elbow if the head of the radius is fractured.

INJURIES AROUND THE ELBOW

Treatment for an elbow that can bend Treat as for a fracture of the upper arm. Check the affected wrist pulse every 10 minutes.

Treatment for an elbow that cannot bend Lay casualty down. Place padding, such as cushions or towels around

the elbow for comfort and support.

INJURIES TO THE FOREARM & WRIST


movement.


Possible swelling & bruising.


Treatment Ask the casualty to sit down.

Gently stabilise and support the injured forearm across casualty’s chest.

If necessary, carefully expose and treat any wound.

Place a triangular bandage between the chest and the injured arm, as for an arm sling.

Gently surround the forearm in soft padding.


Treatment Tie the arm and its padding in an arm sling to

support it.

If necessary, secure the limb to the chest using a broad bandage. Tie it over the sling, positioning it close to the elbow.

Send the casualty to hospital and keeping casualty in a seated position.

Can also use splint to support the injured forearm.

INJURIES TO THE HAND & FINGERS

Treatment Remove any rings before the hand begins to

swell.

Keep the hand raised to reduce swelling.

Protect the injured hand by wrapping it in folds of soft padding.

Gently support the affected arm in an elevation sling.

INJURIES TO THE HAND & FINGERS

Treatment If necessary, secure the arm to the chest by tying

a broad bandage around the chest and over the sling.

Send casualty to hospital, keeping casualty in a seated position.

Use the sound finger as a splint.

FRACTURES OF THE RIBCAGE

Recognition Sharp pain at the site of fracture.

Pain on taking a deep breath.

Shallow breathing.

Paradoxical breathing Chest moves in during inhalation, out during exhalation

An open wound over the fracture through which you might hear air being “sucked” into the chest cavity.

Features of internal bleeding and shock.


Treatment for a fractured rib Support the limb on the injured side in an arm

sling.

Send casualty to hospital.


Treatment for open/multiple fractures Immediately cover and seal any wounds to the

chest wall.

Place casualty in the most comfortable position. Half-sitting, head, shoulders and body turned towards

the injured side.

Support the limb on the injured side in an elevation sling.


Treatment for open/multiple fractures Call for an ambulance.

If casualty becomes unconscious, place casualty in recovery position, uninjured side uppermost.

SPINAL INJURY

Causes Falling from a height.

Falling awkwardly while doing gymnastics.

Diving into a shallow pool and hitting the bottom.

Being thrown from a horse or from a motorbike.

Being in a collapsed rugby scrum.

A heavy object falling across the back.

Injury to the head or face.

SPINAL INJURY

Recognition When only the bones of the spinal column are

damaged, there may be: Pain in the neck or the back at the level of injury

A step, irregularity, or twist in the normal curve of the spine.

Tenderness on gently feeling the spine.

SPINAL INJURY

Recognition When the spinal cord is also damaged, there may

be: Loss of control over limbs; movement may be weak or

absent.

Loss of normal sensation.

Abnormal sensations such as burning or tingling.

Breathing difficulties.

SPINAL INJURYCHECKING FOR SPINAL CORD INJURY

Examine the casualty carefully in the position

found Ask helper to maintain support at casualty’s head.

Ask casualty to move limbs to test for loss of power.

Touch casualty without casualty knowing to test for loss of sensation.

SPINAL INJURY

Treatment for a conscious casualty DO NOT move the casualty from the position found,

unless he or she is in danger or becomes unconscious.

Reassure the casualty and tell casualty not to move.

Stabilise and support casualty’s head in neutral position by placing your hands over casualty’s ears. Maintain this support throughout.

SPINAL INJURY

Treatment for a conscious casualty If you suspect neck injury, get a helper to place

rolled-up blankets or articles of clothing on both sides of the casualty’s neck and shoulders.

Call for an ambulance.

You may apply a collar if the neck is injured.

SPINAL INJURY

Treatment for an unconscious casualty Check ABC & perform CPR if necessary.

Maintain airway.


Keep casualty’s head, trunk and toes in a straight line at all times.

Check for pulse and breathing regularly.

FRACTURED PELVIS

Recognition Inability to walk or even stand.

Pain & tenderness in the region of the hip, groin or back. Increased when the casualty moves.

Blood at the urinary orifice especially in a male casualty.

The casualty may not be able to pass urine or may find this painful.

Signs of shock & internal bleeding.

FRACTURED PELVIS

Treatment Help casualty to lie on his or her back.

Straighten casualty’s leg or if it is more comfortable, help casualty to bend his or her knees slightly and support them.

Immobilise his legs by bandaging them together, placing padding between the bony points.


DO NOT bandage the legs together if this causes intolerable pain.

INJURIES TO THE LOWER LIMBHIP & THIGH FRACTURE

Recognition Pain at the site of the injury.

Inability to walk.

Signs of shock.

Shortening of the thigh.

A turning outwards of the knee and foot.


Treatment Lay the casualty down gently.

Ask helper to stabilise and support the injured limb.

Gently straighten the lower leg and apply traction at the angle, if appropriate.


Treat shock but do not raise casualty’s legs.


Treatment If ambulance is delayed, immobilise the limb by securing or

splinting it to the uninjured limb.

Gently bring the casualty’s sound limb alongside the injured one.

Maintaining traction throughout at the ankle.

Insert padding between the thighs, knees and ankles.

Tie the bandages around casualty’s ankles and knees & above and below the fracture.

Release traction only when all bandaging knots are tied.


Treatment for transporting a casualty over distance Place a leg splint, from the armpit to the foot,

against side.

Pad between the legs and between the splint and body.

Secure the splint and the body with bandages.

INJURIES TO THE LOWER LIMBKNEE JOINT

Recognition A recent twist or blow to the knee.

Pain, spreading from the injury to become deep-seated in the joint.

If the bent knee has “locked”, acute pain on attempting to straighten the leg.

Rapid swelling at the knee joint.


Treatment Help casualty to lie down.

Place soft padding under the injured knee to support it in the most comfortable position.

Hold padding in place with bandage.

Send casualty to hospital.


Treatment DO NOT attempt to straighten the knee forcibly.

DO NOT give anything by mouth.

DO NOT allow the casualty to walk.

INJURIES TO THE LOWER LIMBLOWER LEG

Recognition Localised pain.

A recent blow or wrench of the foot.

Inability to walk.

Open wound may occur.


Treatment Stabilise and support the injured leg.

Gently expose and treat any wound if necessary.

Straighten the leg using traction.

Support the leg with your hands until the ambulance arrives.


Treatment If ambulance is delayed:

Bring the sound limb to the injured leg.

Insert padding between the knees and ankles and between the calves.

Tie the bandages firmly around ankles and knees, then above and below the fracture.

TREATMENT FOR SOFT TISSUE INJURIES

REST I CE COMPRESS ELEVATE

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