strains, sprains, fractures and dislocations
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Name 14 February 2007
London District LINKS Autumn 2008
Strains, sprains, fracturesand dislocations
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What well be covering
What are strains, sprains, fractures anddislocations, and why do they happen?
How to recognise them on duty
How to treat them
What to do and what not to do
Practical skillsbandaging people with
these problems
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The skeleton
Your body is held togetherby bones
Together, bones form theskeleton
The skeleton is very strongall your organs andmuscles are attached to itsomehow
How many bones does anaverage adult have?
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The skeleton
The average adult has 206 bones
The heaviest is the femurin the thigh
The smallest is the stapesin the ear
Any bone in the body can be broken if
things go wrong
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Joints
Bones meet at joints
Joints allow the body to
move
However they areweaker than bone, and
this makes them
vulnerable to injury
Joints contain severalimportant parts
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A simplified joint
Ligamentscover the outside of the joint
Fluidfills the joint space
Cartilagelines the bone surfaces
Bone
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Mechanisms of injury
Strains, sprains, fractures anddislocations are caused by
abnormal forces on joints and bones
These can include:- impacts
- twisting movements
- compression or stretching
- over-bending of joints
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Mechanisms of injury
What sort of duty situations might theseproblems occur in?- Sports matches
- Running events- Ice skating
- Car or cycle races
- Crushing in heavy crowds
- Diving into deep water
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Strains
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What is a strain?
Muscles attach to bones via tendons
You can see tendons on the back of
your hand
If a muscle is pulled too hard, the
tendon becomes damageda strain
Pain occurs whilst the tendon heals
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Common sites for strains
Strains often occur around:- Neck
- Ribs
- Upper arm- Fingers
- Groin!
Why are these strains common?
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Recognising a strain
How would you recognise a strain?
- History of injury e.g. casualty slipped over
- Pain and tenderness
- Swellingusually not much
- Reddening of the skin
- Reduced movement due to the pain
- Locationoften away from a joint unlike asprain
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How to treat a strain
The treatment is RICE
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RICE is a key first aid acronym:
- Rest the affected area
- Ice-pack the affected area
- Compress the affected area
- Elevate the affected area
How to treat a strain
R
I
C
E
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How to treat a strain
Advise the casualty they can buysimple painkillers from a pharmacy
Strains can take a few days to a week
to get better (if RICE is followed)
If it doesnt get better they can see their
GP or go to A&E
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Sprains
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What is a sprain?
Remember the joint?
A sprain occurs
when the ligament
around a joint isdamaged
The joint fluid can
leak out
This causes painand swelling
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Common sites for sprains
What joints are commonly sprained?- Ankle
- Knee
- Elbow- Wrist
- Finger joints
Tends to be joints in arms and legs that
sprain the mostwhy?
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Recognising a sprain
How would you recognise a sprain?
- History of injury e.g. fell awkwardly
- Pain and tenderness
- Swellingmore than in a strain
- Reddening of the skin
- Reduced movement due to the pain
- Locationaround a joint, by definition
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RICE is the key again:
- Rest the affected area
- Ice-pack the affected area
- Compress the affected area
- Elevate the affected area
How to treat a sprain
R
I
C
E
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How to treat a sprain
Again the casualty can buy simplepainkillers
Sprains often take longer to heal
up to two weeks
Resting the joint is most important
Again they should see their GP or
A&E if things dont get better
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Fractures
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What is a fracture?
A fracture is a brokenbone
This includes chips and
cracks in bones as well
as full snaps
Bones usually fracture in
their shafts
A strong force is usuallyrequired
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Types of fractures
Doctors like to classify fractures
There are only 2 classes you need to
know about
- Closed fracturewhere the broken ends ofthe bones are in their normal place
- Open fracturewhere the ends of the
bones have moved e.g. sticking out of skin
Why is this important?
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Types of fractures
Closed fracture Open fracture
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Common sites for fractures
Which bones commonly break?- Upper arm (humerus)
- Forearm (radius/ulna)
- Wrist
- Lower leg (tibia/fibula)
- Ankle
Why are these fractures common?
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Recognising a fracture
How would you recognise a fracture?- History of injury e.g. fell onto arm
- Snapping or cracking noise heard
- Lots of pain- Swelling of the area
- Obvious deformity e.g. bone looks bent
- Inability to move the area- Bone sticking out or a wound if open fracture
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Recognising a fracture
You should be more suspicious of afracture in people with weaker bones:
- children
- older people
- people with bone disease e.g. osteoporosis
(thinning of the bones)
- people taking steroids for a long time
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How to treat a fracture
Try to move the area as little as possible
Support the area:- Arm sling for an arm or wrist fracture
- Elevation sling for a collar bone fracture- Blanket padding for a leg fracture
Dress any wounds that are present
Cover any bone ends with dressingssoaked in sterile saline
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How to treat a fracture
The casualty needs to go to hospital assoon as possible
Dont let the casualty eat or drink,
smoke or walk around
Treat for shock if necessary
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Further treatment
The ambulance crewmay use a splint to
hold the bones in
place
They may give the
casualty painkillers:- gas and air (Entonox)
- into the bloodstream
e.g. morphine
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Further treatment
Many fractures canbe treated with a
plaster cast
Others needoperations and
metalwork to hold the
bones in place
This is a tibia fracture
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Dislocations
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What is a dislocation?
Remember the joint? A dislocation occurs
when the two bone
ends come apart
This stops the joint
from moving
It is usually due to
an impact to the joint
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Common sites for dislocations
Which joints commonly dislocate?- Shoulder
- Finger joints
- Hip (often hip replacements)
- Kneecap
- Ankle
Due to the forces involved, fractures
may occur with dislocations
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Recognising a dislocation
How would you recognise a dislocation?- History of injuryimpact to a joint
- Crunching noise heard
- Deformity of the joint- Swelling and redness
- Lots of pain
- Inability to move the joint- Signs of a nearby fracture
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How to treat a dislocation
Keep the joint still and supportedusea sling or padding if necessary
Never try to put the bones back into the
normal position:- Without x-ray cant be sure its a dislocation
- May cause more damage
- Its cruel without painkillers!
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How to treat a dislocation
The casualty needs to go to hospital assoon as possible
Dont let the casualty eat or drink,
smoke or walk about
Treat for shock if necessary
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Further treatment
Sometimes the ambulance crew maymove the bones position if they are
worried about nerve or artery damage
Otherwise the dislocation will be movedin hospital after an x-ray
The casualty will need painkillers and
sedationits very painful!
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Anyquestions?
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Practical skills
Well now teach you how to:- Apply an arm slinguseful for arm
fractures
- Apply an elevation slinguseful for collarbone fractures
- Apply padding and bandages to a leg
to support a leg fracture
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Quiz
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Question 1
A sprain is where:A. The ligaments around a joint have
been damaged
B. The bones in a joint have become
displaced
C. A muscle and its tendon have been
damaged
D. The soft tissues around a bone havebeen bruised
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Question 1
A sprain is where:A. The ligaments around a joint have
been damaged
B. The bones in a joint have become
displaced
C. A muscle and its tendon have been
damaged
D. The soft tissues around a bone havebeen bruised
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Question 2
How long does a strain take to heal, ifRICE is followed?
A. A few hours
B. A few days to a week
C. Up to two weeks
D. Up to a month
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Question 2
How long does a strain take to heal, ifRICE is followed?
A. A few hours
B. A few days to a week
C. Up to two weeks
D. Up to a month
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Question 3
The C in RICE stands for:
A. Calm the patient
B. Circulation
C. Call for medical help
D. Compress the injury
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Question 3
The C in RICE stands for:
A. Calm the patient
B. Circulation
C. Call for medical help
D. Compress the injury
Q i 4
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Question 4
The most important risk with an openfracture is that:
A. The bones might erode each other as
they rub togetherB. Infection can enter the body
C. The doctor might scratch himself on
the protruding bone
D. There might be lots of bleeding
Q ti 4
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Question 4
The most important risk with an openfracture is that:
A. The bones might erode each other as
they rub togetherB. Infection can enter the body
C. The doctor might scratch himself on
the protruding bone
D. There might be lots of bleeding
Q ti 5
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Question 5
Which of these joints is not commonlydislocated?
A. Wrist
B. Ankle
C. Shoulder
D. Finger
Q ti 5
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Question 5
Which of these joints is not commonlydislocated?
A. Wrist
B. Ankle
C. Shoulder
D. Finger
S i
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Scenario
You are called at the ice rink to a 75-year-old lady who has slipped on the
ice and fallen. She put her left arm out
as she landed. She is now complainingof severe pain in her upper arm. She
cannot move her shoulder or elbow.
There is a tender swelling halfway
between her shoulder and elbow.
Q ti 6
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Question 6
What is your diagnosis?
A. She has strained her biceps muscle
and tendon
B. She has fractured her humerus bone
C. She has dislocated her shoulder
D. She has sprained her elbow
Q ti 6
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Question 6
What is your diagnosis?
A. She has strained her biceps muscle
and tendon
B. She has fractured her humerus bone
C. She has dislocated her shoulder
D. She has sprained her elbow
Q ti 7
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Question 7
Which of these features is least usefulfor making your diagnosis?
A. The severity of the pain
B. The mechanism of the injury
C. The presence of skin reddening
D. The age of the patient
Q ti 7
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Question 7
Which of these features is least usefulfor making your diagnosis?
A. The severity of the pain
B. The mechanism of the injury
C. The presence of skin reddening
D. The age of the patient
Q estion 8
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Question 8
What will you do to help the casualtybefore taking her to the first aid post?
A. Give her a hot cup of tea
B. Massage the injury site
C. Tie a crepe bandage tightly around
the swollen area
D. Apply an arm sling
Question 8
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Question 8
What will you do to help the casualtybefore taking her to the first aid post?
A. Give her a hot cup of tea
B. Massage the injury site
C. Tie a crepe bandage tightly around
the swollen area
D. Apply an arm sling
Question 9
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Question 9
As you get the casualty to the first aidpost in a wheelchair, she complains of
feeling sick and faint. What do you do?
A. Walk her to the toilet to be sickB. Lay her down and raise her legs
C. Give her two paracetamol tablets
D. Leave her sat outside in the wheelchairto get some fresh air
Question 9
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Question 9
As you get the casualty to the first aidpost in a wheelchair, she complains of
feeling sick and faint. What do you do?
A. Walk her to the toilet to be sickB. Lay her down and raise her legs
C. Give her two paracetamol tablets
D. Leave her sat outside in the wheelchairto get some fresh air
Question 10
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Question 10
The casualty has left for hospital in anambulance. What is your priority now?
A. Have a cup of coffee
B. Go back to your station at the ice rinkC. Radio control to tell them the casualty
has left the first aid post
D. Fill in a PRF, RIDDOR form and the ice
rinks accident book
Question 10
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Question 10
The casualty has left for hospital in anambulance. What is your priority now?
A. Have a cup of coffee
B. Go back to your station at the ice rinkC. Radio control to tell them the casualty
has left the first aid post
D. Fill in a PRF, RIDDOR form and the ice
rinks accident book
The end
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The end
Any more
questions?