EMT Chapter 31: Orthopedic Injuries

skeletal muscle

-A muscle that is attached to the bones of the skeleton and provides the force that moves the bones; also called striated muscle (characteristic stripes). -this is under voluntary control of the brain. -largest portion of the body's muscle mass. -primary functions are movement and posture

smooth muscle

-all/other body systems -ex: inside the lining of vessels and intestines, etc.. -involuntary muscle

steps of caring for a musculoskeletal injury

-cover wounds with dry sterile dressing/control bleeding -apply splint; elevate the extremity 6", assess distal pulse -apply cold packs if there is swelling; not directly on skin -position the patient for transport, secure injured area

cardiac muscle

-specifically the cardiovascular system/the heart -involuntary muscle

sling

A bandage or material that helps to support the weight of an injured upper extremity.

swathe

A bandage that passes around the chest to secure an injured arm to the chest.

deformity and fractures

A disfigurement; the limb may appear shortened, rotated, angulated, or there is no clear joint.

splint

A flexible or rigid device used to protect and maintain the position of an injured extremity.

displaced fracture

A fracture in which bone fragments are separated from one another and not in anatomic alignment, producing a deformity of the limb

crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together.

position of function

A hand position in which the wrist is slightly dorsiflexed and all finger joints are moderately flexed.

sprain

A joint injury involving damage to supporting ligaments, and sometimes partial or temporary dislocation of bone ends.

non-displaced fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a hairline fracture.

hairline fracture

A simple crack in the bone that has not caused the bone to move from its normal anatomic position; also called a non-displaced fracture

hemodynamic instability

A state requiring pharmacologic or mechanical support to maintain a normal blood pressure or adequate cardiac output.

compartment syndrome

An elevation of pressure within a closed fascial compartment, characterized by extreme pain, decreased pain sensation, pain on stretching of affected muscles, and decreased power; frequently seen in fractures below the elbow or knee in children. usually develops within 6-12 hours after injury due to excessive bleeding

dislocation

Disruption of a joint in which ligaments are damaged and the bone ends are completely displaced.

free movement

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called false motion.

false motion

Movement that occurs in a bone at a point where there is no joint, indicating a fracture; also called free movement.

reduce

Return a dislocated joint or fractured bone to its normal position; set.

sprain vs. strain

Sprain: overstretching/damaging ligaments. Strain: T for TENDON, overstretching/damaging tendon; no ligament or joint damage (typically) occurs

fascia

The fiber like connective tissue that covers arteries, veins, tendons, and ligaments.

sciatic nerve

The major nerve to the lower extremities; controls much of muscle function in the leg and sensation in most of the leg and foot.

glenoid fossa

The part of the scapula that joins with the humeral head to form the glenohumeral joint.

retroperitoneal space

The space between the abdominal cavity and the posterior abdominal wall, containing the kidneys, certain large vessels, and parts of the gastrointestinal tract.

ligament

a band of fibrous tissue that connects bones to bones; it supports and strengthens a joint

fracture

a break in the continuity of a bone

fracture-dislocation

a combination injury at the joint in which the joint is dislocated and there is a fracture at the end of one or more of the bones

pelvic binder

a devise to splint the bony pelvis to reduce hemorrhage from bone ends, venous disruption, and pain.

spiral fracture

a fracture caused by a twisting or spinning force, causing a long, spiral-shaped break in the bone. this is sometimes the result of abuse in young children.

oblique fracture

a fracture in which the bone is broken at an angle across the bone. this is usually the result of a shrp, angled blow to the bone

comminuted fracture

a fracture in which the bone is broken into more than two fragments

pathologic fracture

a fracture of weakened or disease bone, seen in patients with osteoporosis, infection, or cancer; often produced by minimal force

incomplete fracture

a fracture that does not run completely through the bone; a non-displaced partial crack

epiphyseal fracture

a fracture that occurs in a growth section of a child's bone and may lead to growth abdnomalities

transverse fracture

a fracture that occurs straight across the bone. this is usually the result of a direct blow injury.

locked joints and fractures

a joint that is locked into a position is often painful to move; and is often a possibility of an underlying fracture. do not move the joint/manipulate it

articular cartilage

a pearly white layer of specialized cartilage coverings the articular surfaces (contact surfaces on the ends) of bones in synovial joints

acromioclavicular (AC) joint

a simple joint where the bony projections of the scapula and the clavicle meet at the top of the shoulder

what causes a strain

abnormal contraction or from excessive stretching- may range from minute separation to complete rupture. patients may report a "snap" when the muscle tears.

pectoral girdle

aka shoulder girdle; consists of two scapulae and two clavicles. it is slender and very exposed, thus susceptible to injury

what type of injury can damage every aspect of the musculoskeletal system

amputation

greenstick fracture

an incomplete fracture that passes only partway through the shaft of a bone but may still cause substantial angulation; occurs in children

amputation

an injury in which part of the body is completely severed

open fracture

any break in a bone in which the overlying skin has been broken

closed fracture

any break in a bone in which the overlying skin is not broken

when do you splint fractures, dislocations, and sprains

before moving the patient always - unless the patients life is in immediate danger and rapid transport is required

hematuria

blood in the urine

exposed fragments and fractures

bone ends protruding or is visible within the wound; definite sign of a fracture

ecchymosis

bruising or discoloration associated with bleeding within or under the skin

commonly sprained joints

can occur anywhere; but most commonly knee, shoulder, and ankle

terms to describe particular types of fractures

comminuted, epiphyseal, greenstick, incomplete, oblique, pathologic, spiral, transverse.

twisting forces

common musculoskeletal injury (ACL/MCL) when you twist force to a lower extremity; a ski becomes caught and the skier falls and twists their knee.

pain and fractures

commonly occurs in associated with fractures.

suspect a fracture if the patient shows/has signs of what

deformities, tenderness, guarding, swelling, bruising, crepitus, false motion, exposed fragments, pain, locked joints

force may be applied to the limb either

direct blows, indirect forces, twisting forces, or high-energy injuries

serious injuries

displaced long bone fractures, multiple hand and foot fractures, open long bone fractures, displaced pelvic fractures, dislocations of major joints, multiple digit amputations, laceration of major nerves or blood vessels.

commonly dislocated joints

fingers, shoulder, elbow, hip, knee

bruising and fractures

fractures are almost always associated with ecchymosis of the surrounding soft tissues- but can take hours to develop.

direct blow

fractures the bone at the point of impact; a patella that fractures when it strikes the dashboard during an MVA.

crepitus and fractures

grating or grinding sensation can be felt sometimes when fractured one ends rub together

s/sx often indicated a sprain

guarding of the limb, swelling, ecchymosis, pain, unable to move

pelvic girdle

ilium, ischium, pubis

what are some complications of open fracture wounds

increased blood loss and higher likelihood of infection for the patient

traction

longitudinal force applied to a structure

s/sx of a dislocated joint

marked deformity, swelling, pain that is aggravated by movement, tenderness on palpation, locked joint, numbness or impaired circulation.

indirect force

may cause a fracture or dislocation at a distant point; when a person falls and lands on an outstretched hand

mild strains

mild sprains are caused by ligament stretching rather than tearing.

sprains can range from

mild to severe; depending on the amount of damage done to the supporting ligaments.

minor injuries

minor sprains, fractured digits, dislocated digits

severe, live-threatening injuries (survival is probable)

multiple closed fractures, limb amputations, fractures of both long bones of the legs (bilateral femur fractures)

critical injuries (survival is uncertain)

multiple open fractures of the limbs, suspected pelvic fractures with hemodynamic instability

guarding and fractures

muscles around a fracture will contract to prevent movement of a bone; minimizing pain/further damage

signs of a strain

often no deformity is present and only minor swelling is seen. increasing sharp pain with movement. severe weakness of the muscle. point tenderness.

moderate injuries

open fractures of digits, non-displaced long bone fractures, non-displaced pelvic fractures, major sprains of a major joint

fractures are classified either

open or closed fractures; depending on if the skin is broken or not AND/OR if the bone is moved from its normal position

false motion and fractures

positive indicator of a fracture; also called free movement. a point in the limb where there is no joint.

function of the skeleton

posture/form, protects internal organs, allows movement, production of blood cells (bone marrow), reservoir for minerals and electrolytes.

high-energy injuries

produce significant damage to the skeleton, surrounding soft tissues, and organs; injuries from MVA's, falls, gunshots, extreme forces.

orthopaedic

relating to the branch of medicine dealing with the correction of deformities of bones or muscles.

tenderness and fractures

reliable indicator there is a fracture if it hurts to touch

what are the three basic types of splints

rigid, formable, and traction

complications of orthopaedic injuries

skeletal system deformities, systemic changes, illnesses/overall health of the patient, pregnancies, contamination, where the bones break, punctures of internal wounds from bones

what are the three types of muscles

skeletal, smooth, and cardiac

give examples of joints with no motion, circular motion, minimal motion, and hinge motion...

skull: no motion shoulder joint: circular motion sacroiliac joint: minimal motion elbow joint: hinge motion

strain

stretching or tearing of a muscle; also called a muscle pull

muscle pull

stretching or tearing of a muscle; also called a strain

point tenderness

tenderness that is sharply localized at the site of the injury, found by gently palpating along the bone of the tip of a finger

zone of injury

the area of potentially damaged soft tissue, adjacent nerves, and blood vessels surrounding an injury to a bone or joint.

tourniquet

the bleeding control method used when a wound continues to bleed despite the use of direct pressure and elevation ; useful if a patient is bleeding severely from a partial or complete amputation.

direct impact vs. indirect force

the direct impact may cause a wrist fracture, but the indirect force can also cause dislocation of the elbow or a fracture of the forearm.

calcaneus

the heel bone

tibia

the larger of the two lower leg bones responsible for supporting the major weight-bearing surface of the knee and the ankle; the shinbone

severe strains

the most severe involve actual tearing of the ligament and may dislocate the joint; may hear a "snap" sound

fibula

the outer and smaller bone of the two bones of the lower leg

joint

the place where two bones come in contact

what is the difference between a broken bone and a fractured bone

there is no difference

shinbone

tibia

the golden period

time of injury to time reaching definitive care: critical time for life and limb preservation

swelling and fractures

usually indicates bleeding. it may mask the deformity of a limb.