Chapter 37
Orthopedic Trauma
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37-1
Objectives
37-2
Musculoskeletal System
• Gives the body its shape
• Provides a rigid framework that
supports and protects internal organs
• Provides for body movement
• Maintains posture
• Helps stabilize joints
• Produces body heat
37-3
Skeletal System
• Gives the body shape, support, and form
• Works with muscles to provide for body
movement
• Stores minerals, such as calcium and
phosphorus
• Produces red blood cells
• Protects vital internal organs
37-4
Axial Skeleton
Skull
Vertebral
column
Appendicular
Skeleton
(shown in blue)
Shoulder girdle
Sternum
Pelvic girdle
Ribs
Limb bones
37-5
Skull
• Cranial bones
– Protect the brain
• Upper jaw (maxilla)
• Lower jaw (mandible)
• Facial bones
• Cheek (zygomatic)
bones
37-6
Vertebral (Spinal) Column
• Cervical
– 7 vertebrae
• Thoracic
– 12 vertebrae
• Lumbar
– 5 vertebrae
• Sacrum
– 5 vertebrae (fused)
• Coccyx
– 3-4 vertebrae (fused)
37-7
Chest (Thorax)
37-8
Upper Extremities
37-9
Lower Extremities
37-10
Joints
• Place where two bones come together
• Some bone ends are covered with cartilage
– Cartilage cushions bones
• Held together by ligaments
37-11
Ball-and-Socket Joints
• Allow movement in all directions
37-12
Hinge Joints
• Allow only flexion and extension
37-13
Muscular System
• Gives body shape
• Protects internal
organs
• Provides body
movement
• Maintains posture
• Helps stabilize joints
• Produces body heat
37-14
Skeletal Muscles
•
•
•
•
Move bones to which they are attached
Produce heat
Help maintain posture
House a rich supply of blood vessels and
nerves
• Must receive a signal from a nerve in order to
contract
37-15
Skeletal Muscles
Three main parts:
1. Origin: Stationary attachment of muscle to bone
2. Insertion: Movable attachment to a bone
3. Body: Main part of the muscle
37-16
Musculoskeletal Injuries
37-17
Mechanism of Injury
(a) Direct force injury
(b) Indirect force injury
(c) Twisting force injury
37-18
Types of
Musculoskeletal Injuries
37-19
Open and Closed Injuries
• Open injury
– Skin surface is broken
– Can result in serious blood loss
– Increased risk of contamination and
infection
• Closed injury
– Skin surface is not broken
37-20
Growth (Epiphyseal) Plate
37-21
Fractures
37-22
Open Femur Fracture
37-23
Dislocation
Dislocation of the right hip joint. (a) Anterior view. (b) Frontal section.
37-24
Knee Dislocation
37-25
Sprain
• Stretching or tearing of a ligament
• Pain and bruising usually present
• May be mild, moderate, or severe
37-26
Strain
• Twisting, pulling, or
tearing of a muscle
• Signs and symptoms
– Pain with movement
– Little or no swelling
– Limited ability to bear
weight
– Tender to the touch
– Possible bruising
37-27
Patient Assessment
• Scene safety
• Assess the mechanism of injury
• Put on appropriate personal protective
equipment
• Perform a primary survey
37-28
Patient Assessment
• Quickly determine if the patient’s injury is life
or limb-threatening.
• Classes of patients with musculoskeletal
trauma:
1. Patients with life/ limb-threatening
injuries or conditions, including life/ limbthreatening musculoskeletal trauma
37-29
Patient Assessment
2. Patients with other life/ limb-threatening
injuries and only simple musculoskeletal
trauma
3. Patients with life/ limb-threatening
musculoskeletal trauma and no other life/
limb-threatening injuries
4. Patients with only isolated, non-life/ limbthreatening injuries
37-30
Patient Assessment
• Treat all life-threatening conditions first
• Then address limb-threatening injuries.
• If signs of shock are present or if internal
bleeding is suspected, treat for shock.
• Provide care for non-life/limb threatening
injuries as time permits.
37-31
Patient Assessment
• The 6 P’s of musculoskeletal assessment:
1. Pain or tenderness (on palpation,
movement)
2. Pallor
3. Paresthesia (pins and needles sensation)
4. Pulses (present, diminished, absent)
5. Paralysis (inability to move)
6. Pressure (swelling/edema)
37-32
Emergency Care
• Secondary survey
– DCAP-BTLS
– PMS
• Vital signs, medical history
37-33
Emergency Care
– Put on appropriate PPE
– Keep on-scene time to a minimum
– Spinal precautions, if appropriate
– Establish and maintain an open airway
– Give oxygen
37-34
Emergency Care
• Apply a cold pack to the injured area
• Dress open wounds
• Splint bone or joint injuries
– Support joints above and below the
injured bone
– Support bones above and below the
injured joint
37-35
Emergency Care of Sprains and Strains
• Rest
• Ice
• Elevation
37-36
Splinting
37-37
Splinting
• Splint
– Device used to limit movement of a body
part to reduce pain and further injury
37-38
Reasons for Splinting
• To limit the motion of bone fragments, bone ends, or
dislocated joints
• To lessen damage to muscles, nerves, or blood
vessels
• To help prevent a closed injury from becoming an
open injury
• To lessen the restriction of blood flow caused by
bone ends or dislocations compressing blood
vessels
• To reduce bleeding
• To reduce pain
• To reduce the risk of paralysis caused by a damaged
spine
37-39
Hazards of Improper Splinting
• Compression of nerves, tissues, and blood
vessels
• Transport delay
• Reduced distal circulation from a splint that
is too tight
• Aggravation of the musculoskeletal injury
• Causing or worsening tissue, nerve, vessel,
or muscle damage
37-40
Principles of Splinting
• Take standard precautions and wear
appropriate PPE
• Remove or cut away clothing to expose the
injury
• Remove jewelry from the injured area
• Assess pulses, movement, and sensation
distal to the injury before and after splinting
• Cover open wounds with a sterile dressing
37-41
Principles of Splinting
• Pad a rigid or a semi-rigid splint
• Splint the area above and below the injury
– Splint joints above and below the
injured bone
– Splint bones above and below the
injured joint
37-42
Position of Function
37-43
Principles of Splinting
• Pad the hollow areas (voids) between the
splint and the extremity
• Do not intentionally replace protruding
bones
• Avoid excessive movement of the injured
area
• Avoid placing ties or straps directly over the
injury
• Splint the injury before moving the patient
unless the patient is in danger or lifethreatening conditions exist
37-44
Principles of Splinting
• When in doubt about whether or not a
musculoskeletal injury is present, splint
• If the patient shows signs of shock:
– Align the patient in the anatomical position
on a long backboard
– Treat for shock
– Transport
37-45
Types of Splints
37-46
Rigid Splints
37-47
Semi-Rigid Splints
37-48
Soft Splints
37-49
Traction Splints
37-50
Pneumatic Splints
37-51
Warning Signs that a Splint Is Too Tight
•
•
•
•
•
•
Fingers or toes become cold to the touch
Fingers or toes begin to turn pale or blue
Inability to move fingers or toes
Increased pain
Increased swelling below the splint
Patient complains of:
– Numbness or tingling
– Burning or stinging
37-52
Upper Extremity Injuries
37-53
Shoulder Injuries
• Shoulder injury typically involves three
bones:
– Collarbone (clavicle)
– Shoulder blade (scapula)
– Upper arm bone (humerus)
• Patient usually holds arm in a position of
comfort
– Immobilize the injury in this position
• Sling and swathe usually used for this injury
37-54
Immobilization of a Shoulder Injury
37-55
Immobilization of a Shoulder Injury
37-56
Immobilization of a Shoulder Injury
37-57
Immobilization of a Shoulder Injury
37-58
Immobilization of a Shoulder Injury
37-59
Immobilization of the Humerus
37-60
Immobilization of the Elbow
37-61
Immobilization of the Forearm or Wrist
37-62
Immobilization of the Hand
37-63
Immobilization of the Fingers
37-64
Lower Extremity Injuries
37-65
Immobilization of the Pelvis or Hip
37-66
Immobilization of the Hip
37-67
Immobilization of the Femur
37-68
Immobilization of the Femur
• Traction splint
– Applying traction:
• Stabilizes bone ends
• Reduces pain
• Reduces the likelihood of a closed
fracture becoming an open one
• Reduces further soft-tissue damage
37-69
Application of the SEFRS Adaptor
37-70
Application of the SEFRS Adaptor
37-71
Application of the SEFRS Adaptor
37-72
Application of the SEFRS Adaptor
37-73
Application of the SEFRS Adaptor
37-74
Application of the SEFRS Adaptor
37-75
Application of the SEFRS Adaptor
37-76
Application of the SEFRS Adaptor
37-77
Application of the SEFRS Adaptor
37-78
Application of the SEFRS Adaptor
37-79
Applying the Sager SX Unipolar
Traction Splint
37-80
Applying the Sager SX Unipolar
Traction Splint
37-81
Applying the Sager SX Unipolar
Traction Splint
37-82
Applying the Sager SX Unipolar
Traction Splint
37-83
Applying the Sager SX Unipolar
Traction Splint
37-84
Applying the Sager SX Unipolar
Traction Splint
37-85
Applying the Sager SX Unipolar
Traction Splint
37-86
Applying the Sager SX Unipolar
Traction Splint
37-87
Applying the Sager SX Unipolar
Traction Splint
37-88
Applying the Sager SX Unipolar
Traction Splint
37-89
Applying the Sager SX Unipolar
Traction Splint
37-90
Applying a Bipolar Traction Splint
37-91
Applying a Bipolar Traction Splint
37-92
Applying a Bipolar Traction Splint
37-93
Applying a Bipolar Traction Splint
37-94
Applying a Bipolar Traction Splint
37-95
Applying a Bipolar Traction Splint
37-96
Applying a Bipolar Traction Splint
37-97
Applying a Bipolar Traction Splint
37-98
Applying a Bipolar Traction Splint
37-99
Immobilization of the Knee
37-100
Immobilization of the Knee
37-101
Immobilization of the Lower Leg
37-102
Immobilization of the Ankle or Foot
37-103
Questions?
37-104