Lesson 9:
Bone & Joint Injuries
Emergency Reference Guide p. 33-43
Objectives
• Define strain, sprain, fracture and
dislocation
• List Signs & Symptoms of strain, sprain,
fracture & dislocation
• Demonstrate field assessment
• Define RICE (Rest, Immobilization, Cold,
Elevation)
• Describe use of RICE
Objectives (cont’d.)
• Demonstrate & describe the emergency
treatment for:
– Strains & sprains
– Fractures
– Dislocations, including re-alignment
• Describe treatment for:
– Angulated fractures
– Open fractures
• Describe long term care for injuries to bones &
joints
• Describe when to evacuate
Bone & Joint Injury Overview
• Injuries to musculoskeletal system are
among most common wilderness injuries
• Care is same, regardless of exact
diagnosis
• Strains are overstretched muscles or
tendons
• Sprains are injuries to ligaments (e.g.
holding bones to bones)
Bone & Joint Injury Overview (cont’d.)
• A fracture is a bone break, chip or crack
– Open fracture: open wound in skin over
fracture
– Closed fracture: no break in the skin
– Closed fractures more common…open ones
more dangerous
• Dislocation: movement of bone or joint
away from normal position, often includes
tearing of ligaments.
Fracture
Fracture Types
Guidelines for Preventing Bone
& Joint Injuries
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Pay attention to safety
Wear adequate footwear
Engage in pre-trip physical conditioning
Set up camp or home so there are few trip
hazards
Checking for Strains, Sprains &
Fractures
• Signs & Symptoms:
– Deformity, Open injuries, Tenderness & Swelling
(DOTS)
– Moderate to severe pain or discomfort
– Bruising (may take hours to appear)
– Inability to move or use affected area
– Broken bone or fragments sticking out
– Bones grating or sounds of grating
– Feeling or hearing snap or pop
– Loss of Circulation, Sensation, Motion
– MOI such as fall, suggests injury may be severe
Checking for Possible Bone or
Joint Injury
• Have patient rest in comfortable position
• Remove clothing as necessary to check
injured area
• Ask how injury happened & what areas
hurt (MOI)
• Visually inspect entire body. Compare
both sides of body to look for differences.
Feel for DOTS
Checking for Possible Strain or
Sprain
• Have patient actively move joint &
evaluate pain involved
• Manipulate joint with your hands &
evaluate pain
• If joint appears usable, have patient test it
with his/her weight
Checking for Possible Fracture
• Determine whether injured part looks broken
(deformed). Compare to uninjured side
• Ask patient whether he/she thinks it is broken
• Gently touch injured area look for:
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Patients reaction to touch
Muscles appear to be in spasm
Injured area seems unstable
One spot hurts noticeably more than the rest
Check CSM beyond site of injury
Caring for Strains, Sprains &
Fractures
• Whether usable or not, general care is RICE
– Rest: don’t allow injured area to be used for at least ½
hour
– Immobilization: prevent further injury by keeping
injured area still
– Cold: ice works best, avoid direct contact with the skin
– Elevation: Keep injury higher than patient’s heart
– 20-30 min of cold followed by 10-15 min of warming
– Repeat RICE cycle 3-4 times a day, if possible
RICE
Rest
Immobilization
Cold
Elevation
Splinting
• In remote areas, patients will likely need to be moved
• The splint should restrict movement to prevent further
injury & increase comfort
• The splint must be made of something to pad injury &
rigid enough to provide support
• Padding should fill in all spaces to help prevent
movement
• Possible splint materials include branches, hiking poles,
SAM splints, magazines, etc.
• Use triangular bandages, tape, elastic wraps, etc. to
secure splints
Improvised Splinting Material
• What items can be used for splinting?
– Sticks
– Tent poles
– Oars/paddles
– Ski/trekking poles
– SAM Splints
– Internal Pack frames
Improvised Splinting Material (cont’d.)
• Padding:
– Sleeping bags
– Foamlite pads
– Extra clothing
– Soft debris from forest floor
– Rolls of sterile dressing
Splinting
• Prepare splinting material before starting trip
• Splints must be able to hold injury in natural,
neutral position:
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Spine inline, pad the small of the back
Legs almost straight, pad behind knees
Feet 90 degrees to legs
Arms flexed to cross the heart
Hands in functional curve with padding on palms
Leave shoe on foot, it can act as splint. Remove, if
circulation is an issue
– Remove rings, bracelets, watches…may restrict flow
Splinting Types
• Hard Splint: splinting material is rigid (i.e.
poles, sticks, etc)
• Soft Splints: splinting material is soft &
bulky (i.e. newspaper, sleeping pad,
sweatshirt, etc)
• Anatomical: splint material is another body
part (i.e. fingers taped together, legs splinted &
tied together)
Hard Splint
Soft Splint
Preparing for Leg Splint
Hard Splint - Leg
Anatomical Splint - Leg
Applying a Sling & Swathe
• Support injured arm above & below site of injury
• Place triangular bandage under arm & over
uninjured shoulder.
• Wrap outside of bandage around other side of
neck. Tie on side of neck add padding
• Bind arm to torso with folded bandage
• Check CSM below in hand
Arm Sling
Arm Sling
Splinting Skills Session
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Form pairs or groups of 3:
Splint lower leg with rigid material
Splint legs anatomically
Splint Forearm with soft material (using a
sling & swath)
Splinting Specific Fractures
• Jaw: hold jaw in place, wide wrap around head
Make sure can be removed (in case of vomiting)
• Collarbone: Secure collarbone with sling &
swathe
• Fingers and toes: Bind to adjacent finger/toe
• Ribs: support arm on injured side with sling &
swathe…make sure patient breathes deeply
• Hip/pelvis: secure legs together…watch for
shock/internal bleeding
Caring for Complicated
Fractures
• Angulated fractures leave bones distorted, open
fractures expose body to infection
• Irrigate open fracture, dress appropriately
• If bone ends sticks out & help is more than 4
hours away:
– Control bleeding
– Clean wound & bones ends (do not touch)
– Apply gentle inline traction
– Dress wound
Caring for Complicated
Fractures (cont’d.)
• Splint the fracture, infection likely, but bones
survive better in body
• With angulated fracture, bones must be
straightened w/ in-line traction:
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Pull in direction in which bones are pointed
Slowly & gently move broken bone back to place
Do not force
Do not continue, if increasing pain
Splint limb once aligned
Dislocations
Checking and Caring for
Dislocations
• Dislocation will produce pain in joint & loss
of normal motion
• Joint “Looks wrong”
• Many dislocations can only be splinted in
the field
• Some can be put back by realignment
through process called “reduction”
Dislocation Reduction
• Work quickly, but calmly. The sooner
reduction is done, the better
• Encourage patient to relax, particularly
when a joint is injured
• Stop, if pain increases dramatically
• Splint joint after it is back in place
Shoulder Reduction
• Anterior Shoulder dislocations most
common:
– Position patient face down on rock/log, injured
arm dangling down
– Tie something 10-15 lbs in weight to dangling
wrist…patient does not hold weight
– Wait…process takes 20-30 min. to work
– Key is for patient to be relaxed & allow gentle
pull to ease joint back in place
Shoulder Reduction (cont’d.)
• Injured patients can do this on themselves,
as well
• The sooner the better, waiting may cause
chest muscles to tighten & spasm
• As soon as process completed, put arm in
sling & swathe to secure it
Toe/Finger Relocation
• Keep injured finger partially bent
• Pull on end with one hand, press gently
back in place with other
• Place gauze pad between injured finger &
the finger next to it
• Tape in place
• Do not tape over injured joint
Kneecap Dislocation
• Apply gentle traction to the leg to
straighten it
• Kneecap may pop in place with just
traction
• Massage thigh & use hand to push
kneecap gently back in place
• Apply a splint that does not put pressure
on the kneecap.
• Patient may be able to walk
Guidelines for Evacuation
• If injured body part is usable, level of pain
determines whether evacuation is needed
• Evacuate anyone with un-usable body part
& first time dislocations
• GO FAST with angulated fractures, open
fractures, fractures of pelvis, hip, femur
(thigh), more than one long bone or
decrease in CSM below injury
Scenario
• During a trail restoration, an adult leader
falls on downed branch & down a 5 foot
embankment. You can call the ranger
station, but help is at least 1 hour away
• Break into groups of 4, 1 victim and 3
rescuers.
Questions???
What else could you add to your
First Aid Kit?