XII. Injuries to the Extremities
Injuries to an extremity—an arm or leg—are quite common. They can range from
a simple bruise to a dangerous or severely painful injury, such as a fracture of the femur
(thigh bone). The prompt care you give can help prevent further pain, damage and a lifelong disability.
The extremities consist of—
1. Bones.
2. Soft tissue.
3. Blood vessels.
4. Nerves.
Signals of a serious extremity injury include—
1. Pain or tenderness.
2. Swelling.
3. Discoloration.
4. Deformity of the limb.
5. Inability to move or use the limb.
6. Severe external bleeding.
7. Loss of sensation, feeling or tingling.
8. A limb that is cold to the touch.
Upper Extremity Injuries
The upper extremities are the parts of the body from the shoulder to the fingers.
The bones of the upper extremity include the—
1. Collarbone (Clavicle).
2. Shoulder blade (Scapula).
3. Upper arm (Humerus).
4. Forearm (Radius and ulna).
5. Wrist (Carpals).
6. Hand (Metacarpals).
7. Fingers (Phalanges).
The shoulder consists of three bones that meet to form the shoulder joint:
1. Clavicle
2. Scapula
3. Humerus
Care for Shoulder Injuries
1. Minimize any movement of the injured part.
2. Control external bleeding with direct pressure.
3. Splint the upper extremity in place. Check for feeling, warmth and color before
and after applying a splint.
4. Apply ice or a cold pack to the injured area.
5. Take steps to minimize shock.
Upper Arm Injuries
The upper arm is the upper extremity from the shoulder to the elbow. The
humerus is the longest bone in the arm. When the humerus is fractured, the blood vessels
and nerves supplying the entire upper extremity may be damaged.
Care for Upper Arm Injuries
1. Support the injured area.
2. Control external bleeding with direct pressure.
3. Place the upper extremity in a sling and binder. Check for feeling, warmth and
color before and after applying the splint.
4. Apply ice or a cold pack to the injured area.
5. Take steps to minimize shock.
Elbow Injuries
The elbow is a joint formed by the humerus and the two bones of the forearm, the
radius and the ulna. Like other joints, the elbow can be sprained, fractured or dislocated.
An injured elbow may be in a bent or straight position.
Care for Elbow Injuries
1. Support the injured area.
2. Control external bleeding with direct pressure.
3. Check for feeling, warmth and color before and after splinting.
4. Immobilize the entire bone above or below the elbow.
5. Apply ice or a cold pack to the injured area.
6. Take steps to minimize shock.
Forearm, Wrist and Hand Injuries
The forearm is the area between the elbow and the wrist. The hand consists of
many small bones: the carpals, metacarpals and phalanges. Injuries to the forearm, wrist
and hand may involve the bones of the joints they form. The wrist is a joint formed by the
hand and forearm. The wrist is a common site of sprains and fractures. Most injuries to
the hands and fingers involve minor soft tissue damage.
Care for Forearm, Wrist and Hand Injuries
1. Support the injured area.
2. Control external bleeding with direct pressure.
3. Support an injured forearm or wrist by placing a soft or rigid splint underneath
the forearm.
4. Check for feeling, warmth and color before and after splinting.
5. Apply ice or a cold pack and elevate.
6. Take steps to minimize shock.
Care for wrist injuries in the same way as forearm injuries. Place a bulky dressing in the
palm of the victim’s hand and wrap the hand with a roller bandage.
For a possible fractured or dislocated finger—
1. Make a rigid splint by taping the injured area to a small object, such as an ice
cream stick or tongue depressor.
2. You can also tape the injured finger to the finger next to it.
3. Apply ice or a cold pack and elevate.
4. Take steps to minimize shock.
Lower Extremity Injuries
The lower extremities are the part of the body from the hip (pelvis) to the toes. The bones
of the lower extremity include the—
Pelvic bones.
Thigh bone (Femur).
Kneecap (Patella).
Lower leg (Tibia and Fibula).
Ankle (Tarsals).
Feet (Metatarsals).
Toes (Phalanges).
The thigh is the lower extremity from the pelvis to the knee. The thigh contains the
femur. Signals of a fractured femur include the following:
1. Deformity
2. The injured leg will be noticeably shorter than the non-injured limb.
3. The injured leg may also be turned outward.
4. Severe pain.
5. Inability to move the lower extremity.
Care for Thigh Injuries
1. Support or immobilize the thigh in the position found.
2. Control external bleeding with direct pressure.
3. Call 9-1-1 or the local emergency number immediately.
4. While waiting for EMS personnel to arrive—
5. Immobilize the injured area.
6. Help the victim rest in the most comfortable position.
7. If the victim’s lower extremity is supported by the ground, do not move it.
8. Use rolled towels or blankets to support the leg in the position you found it.
9. Take steps to minimize shock.
10. Keep the person lying down and try to keep him or her calm.
11. Keep the person from becoming chilled or overheated.
12. Monitor breathing and level of consciousness.
13. Note person’s skin color and temperature.
Lower Leg Injuries
The lower leg is the area between the knee and the ankle. The tibia and fibula are
the two bones in the lower leg. A fracture in the lower leg may involve the tibia, the
fibula or both bones. Sometimes both bones are fractured simultaneously. Lower leg
fractures may cause—
1. Severe deformity in which the lower leg is bent an unusual angle
2. Pain.
3. An inability to move the leg.
Care for Lower Leg Injuries
1. Support the injured area.
2. Control external bleeding with direct pressure.
3. Call 9-1-1 or the local emergency number immediately.
4. While waiting for EMS personnel to arrive, immobilize the injured area and
help the victim rest in the most comfortable position.
5. If the victim’s lower extremity is supported by the ground, do not move it.
6. Use rolled towels or blankets to support the leg in the position you found it.
7. In other situations, you can bind the lower extremities together above and
below the site of the injury.
8. Check for feeling, warmth and color before and after applying the splint.
9. Apply ice or a cold pack to the injured area.
10. Take steps to minimize shock.
Knee Injuries
The knee comprises the lower end of the femur, the upper ends of the tibia and
fibula and the patella. The patella is a free-floating bone that moves on the lower front
surface of the thigh bone. Sprains, fractures and dislocations are especially common in
athletic activities that involve quick movements or exert unusual force on the knee. Deep
lacerations around the area of the knee can cause severe joint infections.
Care for Knee Injuries
1. Support the injured area.
2. Control external bleeding with direct pressure.
3. Immobilize the injured area.
4. If the knee is bent and cannot be straightened without pain, support it on a
pillow or folded blanket in the bent position.
5. If the knee is on the ground, the ground will provide support.
6. If you decide to splint and the knee is straight, secure it to the uninjured leg.
7. Call 9-1-1 or the local emergency number.
8. Check for feeling, warmth and color before and after splinting.
9. Apply ice or a cold pack to the injured area.
10. Take steps to minimize shock.
Ankle and Foot Injuries
The foot consists of many small bones—the tarsal, metatarsals and phalanges.
The ankle is a joint formed by the foot and the lower leg. Ankle and foot injuries are
commonly caused by twisting forces. Injuries range from minor sprains with little
swelling and pain to fractures and dislocations, which may have great pain. Foot injuries
may also involve the toes.
Care for Foot Injuries
1. Support the injured area.
2. Control external bleeding.
3. Check toes for feeling, warmth and color before and after splinting.
4. Use a soft splint to immobilize an ankle or foot.
5. Secure the splint with two or three cravats.
6. Elevate.
7. Apply ice or a cold pack.
8. Call 9-1-1 or the local emergency number.
The purposes of immobilizing an injury are to—
1. Lessen pain.
2. Prevent further damage to soft tissues.
3. Reduce the risk of serious bleeding.
4. Reduce the possibility of loss of circulation to the injured part.
5. Prevent closed fractures from becoming open fractures.
To immobilize an extremity injury you can use a splint.
There are three types of splints:
1. Soft
2. Rigid
3. Anatomic
Applying a Splint
1. Support the injured part in the position in which you find it.
2. Cover any open wounds with a dressing and bandage.
3. Check the area below the injury site for feeling, warmth and color.
4. Apply the splint to immobilize the joints or bones above and below the injured area.
5. Secure the splint in place.
6. Recheck below the injury site for feeling, warmth and color.
7. Elevate the splinted part.
After the injury is immobilized, apply ice or a cold pack. Help the victim rest in the most
comfortable position.
Monitor the victim’s—
1. Level of consciousness.
2. Breathing.
3. Skin color.
4. Temperature.
Take steps to minimize shock.