Orthopedic Trauma
Andrea L. Williams, PhD, RN
Emergency Education & Trauma Program
Specialist
Associate Clinical Professor
UWHC & UW-SON
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Name that Injury!
Associated Conditions
• Hemorrhage – Shock (~2L pelvis, 1L thigh
& 500 ml tibia)
• Instability
• Loss of tissue
• Laceration with contamination
• Interrupted blood supply – Ischemia
• Nerve damage
• Long-term Disability
Sprains
• Partial tear of a ligament by twisting & stretching
of a joint beyond normal ROM
– 1st Degree Sprain – No instability, few fibers torn.
Minimal hemorrhage & swelling
– 2nd Degree Sprain – No instability, ligaments partally
torn, swelling and hemorrhage
– 3rd Degree Sprain – Unstable, ligaments completely,
with significant swelling & hemorrhage.
Sprained Knee
Strains & Ruptures
• Strain - Injury to a muscle or tendon from
overexertion (back, arms, calf)
• Severe strains can cause bone avulsion
Joint Dislocations
• Dislocation – Articulating surfaces of 2 bones
are displaced
–
–
–
–
Luxation – Complete dislocation
Subluxation – Incomplete dislocation
Rotator Cuff injuries – Usually deltoid
Common sites
• Shoulders, elbows, fingers, knees, & ankles
– Complications
• Posterior popliteal injury
Principles of Splinting (p. 1238)
• Splint joints and fractures above & below injuries
• Cover open fractures
• Document pulses, sensation, motor function
before & after splinting
• Stabilize the limb with gentle in-line traction to a
position of normal alignment
• Immobilize dislocations in a position of comfort
with
• Ice, cold compresses
• Elevation – to or just below level of heart
Shoulder Injuries
• Dislocations
• Subluxations
• Rotator cuff tendon
injuries
• Sternoclavicular strain
• Treatment
– Neurovascular status
– Splint in position found
or
– Sling & secure to body
– Ice or cold compresses
Elbow Injuries
• Falling on an outstretched arm or
flexed elbow
• Pulled elbow – Nursemaids elbow
from a sudden lateral force
• Athletic injury
• Complications
– Volkmann’s contracture – Claw-like
contraction of hand & arm deformity
from ischemia
– Laceration of brachial artery
– Ulnar nerve damage
• Treatment
– Check neurovascular status
– Splint in position found
– Ice or cold compresses
Radial, Ulnar, Wrist Injuries
• Check neurovascular
status
• Splint in position found
(rigid or formable
• Ice & elevation
Hand Injury
• Boxer’s fracture 5th
metatarsal bone
• Treatment
– Check neurovascular
status
– Splint (rigid or
semiformable) in
position of function
– Ice & elevation
Finger Injuries
• Assess neurovascular status
• Splint in foam filled aluminum
splint, with tongue blades, or
tape to adjacent finger
• Ice & elevation
Pelvic Injuries
•
•
•
•
Signs & Symptoms
Pain
Hypovolemic shock
Shortening or abnormal
rotation of affected
extremity
Associated with injuries
to the bladder, urethra,
reproductive organs &
sacral nerves
Pelvic Injuries
Treatment of Pelvic Fractures/Ring Injuries
• Open book – Vacuum mattress, Pelvic Binder, or sheet
• Control hemorrhage – Direct pressure or close pelvic
ring
• Fluid volume replacement – Normal Saline
(ED - PRBC, FFP, Platelets., Factor VII A &/or
embolization)
External fixation/ORIF
Classification of Long Bone
Injuries
• Fractures
–
–
–
–
–
–
–
–
–
Complete or incomplete
Open or closed
Epiphyseal – Cause bending or deformity
Comminuted – Several breaks in the bone
Greenstick - Break in periosteum w/i
bowing or buckling
Spiral – Twisted or circular break. ↑ child
abuse
Oblique – Diagonal, slanting break
Transverse – Right angle fracture
Pathological
Long Bone Fractures
•
•
•
•
Pathophysiology
Femur fractures result from major force
Long bone fractures from falls, MVC,
MCC
Femur neck fractures common in
elderly
Blood loss into a femur
– 1,000-1,500 ml
Long Bone Fractures
•
•
•
•
•
•
Signs & Symptoms
Pain
Ecchymosis & edema of the
site
Deformity at the site
Shortening of affected
extremity
Internal or external rotation
Hypovolemia or
hypovolemic shock
Long Bone Fractures
Assessment
• Circulation – Hemorrhage or ischemia
– Neurovascular status
– Pulses
• Deformity – Edema, hematoma, wounds
• Compartment Syndrome
– 6 P’s – Pain, Pallor, Parasthesia, Pulses,
Paralysis, Pressure
Long Bone Fractures
Treatment
•
•
•
•
•
Immobilize
Splint
Control pain
Realign – In ED
Skeletal traction – (In ED)
Usually temporary. Weights
must hang free, meticulous skin
care
• External fixators
• ORIF
Splinting
• Types of splints
– Rigid splint – body part fit to splint
design
– Soft or formable splint – molded to
shape or configuration of the body part
– Traction splint – (Femur fractures) –
traction to stabilize and align
Open Fractures
•
•
•
•
•
Signs & Symptoms
Evidence of skin disruption over a
fracture
Protrusion of bone through an open
wound
Pain
Neurovascular compromise
Bleeding
Open Fractures
•
•
•
•
•
•
•
•
Treatment
Cover the wound
Splint
ED or OR Wound
cleansing & debridement
Realignment
Splint/Cast
External fixation
ORIF
Complications osteomyelitis, cellulitis
Techniques for Realignment
•
•
•
•
•
Finger realignment
Shouldar realignment
Hip realignment
Knee realignment
Ankle realignment
Jumper Syndrome
• Vertical deceleration
• Forces transmitted upwards from lower
extremities, pelvis, spine, chest
• Lower extremity fractures & spinal cord
injuries
• Retroperitoneal hemorrhage is the most
common cause of shock
Amputations
•
•
•
•
Classification
Partial
Complete
Usually involves digits,
foot, lower leg, hand or
forearm
Life over limb
considerations
Amputations
Classification
• Partial
• Complete
• Usually involves digits, foot, lower leg,
hand or forearm
• Life over limb considerations
• Re-implantation (Favorable in Peds &
with guillotine-type amputations)
Amputations
•
•
•
•
Signs & Symptoms
Obvious tissue loss
Pain
Bleeding
Hypovolemic shock
Amputations
•
•
•
•
•
Treatment
Reattachment
Amputation
Rehabilitation
Prosthesis Clinic
Assessment & Care
Keep body part
bagged not directly
on ice
Compartment Syndrome
•
•
•
•
•
•
Signs & Symptoms
Pain disproportionate to injury
Sensory deficit
Progressive muscle weakness
Tense swollen area
Elevated compartment
pressures
Loss of pulses
Compartment Syndrome
Treatment
• Elevation of limb not above heart level
• Placement of an intracompartmental
monitor
– <20 = normal
– >20 = ischemia
– > 30 = necrosis
• Fasciotomies to release the pressure