Bone & Joint Injuries Monica Hall RN, AE-C, BSN

General Info

Injuries to bones and joints are common in accidents and falls

This includes a variety of injuries

Examples of joint & bone injury

Fractures

Dislocations

Sprains

Strains

Fracture

A break in a bone Two types Closed (simple) – fracture is a bone break is

not accompanied by an external or open wound on the skin

Open (compound) – fracture is a bone break that is accompanied by an open wound on the skin

Signs and Symptoms of Fracture

Can vary

Each person will not exhibit all

Common sign & symptoms:

Deformity

Limited motion or loss of motion

Pain and tenderness at the fracture site

Swelling and discoloration

Protrusion of bone ends through the skin

Victim heard a bone break or snap or felt a grating sensation (crepitation)

Abnormal movements within a part of the body

Basic Principles of treatment for fractures

Maintain respirations Treat for shock Keep the broken bone from moving Prevent further injury Use devices such as splints and slings to

prevent movement of the injured part Obtain medical help whenever a fracture is

evident or suspected

Videos of Fracture

https://www.youtube.com/watch?v=UWM2G35mE0Y

https://www.youtube.com/watch?v=e421jNbbk90

Dislocation

When the end of a bone is either displaced from a joint or moved out its normal position within a joint

Frequently associated with tearing or stretching of ligaments, muscles, and other soft tissue

Signs & Symptoms of Dislocation

Deformity Limited or abnormal movement Swelling Discoloration Pain and tenderness A shortening or lengthening of the affected

arm or leg

Dislocation Treatment

Basically the same as fractures No attempt should be made to reduce the

dislocation (replace the bone in the joint) Immobilize the affected part in the position

found by using splints and/or slings (movement of the injured part can lead to additional injury to nerves, blood vessels, and other tissue in the area)

Obtain medical help immediately

Dislocation Video

https://www.youtube.com/watch?v=CmvUVztaxdQ

Sprains

An injury to the tissues surrounding a joint; it usually occurs when the part if forced beyond its normal range of movement

Ligaments, tendons, and other tissues are stretched or torn

Common sites for sprains include the ankles and wrist

Sprains (Signs & Symptoms)

Swelling Pain Discoloration Sometimes impaired motion

Ankle Sprain Video

https://www.youtube.com/watch?v=v2NKUIOQ4zA

Strain

Overstretching of a muscle, it is caused by overexertion or lifting

Backs are the most frequent site

Signs/Symptoms of Strain

Sudden pain

Swelling

Bruising

Strain treatment

Encourage the victim to rest the affected muscle while providing support

Recommend bedrest with a backboard under the mattress for a strained back

Apply cold application to reduce the swelling After the swelling has decreased, apply warm,

wet applications because warmth relaxes the muscles

Obtain medical help for severe strains and back injuries

Neck and Spine Injuries

Most dangerous types of injuries to bones and joints

If a victim with such injury is moved, permanent injury resulting in paralysis can occur

If at all possible avoid any movement of a person with potential neck or spinal injuries

Wait until a backboard, cervical collar, and adequate help for transfer arrives

Videos

https://www.youtube.com/watch?v=W-BmKXU12yE

https://www.youtube.com/watch?v=zz7Xm5yTkH4

Splints

Devices used to immobilize injured parts Can be used in fractures, dislocations, and

other similar injuries are present or suspected Commercial splints are available such as air

or inflatable splints, padded boards and traction splints

Can also be made from cardboard, newspapers, pillows, etc.

Basic principles of splints

Should be long enough to immobilize the joint above and below the injured part

Should be padded especially over bony areas and over the site of injury

Can be secured in place with triangular bandages, strips of cloth, roller gauze, or similar materials

Must be applied in a way to not cause pressure over the site of injury

If an open wound is present, use a sterile dressing to apply pressure and control bleeding

Basic principles of splints – cont. Never make an attempt to replace broken bones or

reduce a fracture or dislocation – do not move the victim, splint wherever you find the victim

Pneumatic splints are available but must be used with caution – there are air and vacuum

Traction splints provide a pulling or traction effect on the injured bone – only trained people would apply

After a splint is applied, one should check circulation Check skin temperature (should be warm) Skin color (pale or blue indicates poor circulation) Any swelling, numbness, or tingling Check pulse

Splint Video

https://www.youtube.com/watch?v=b_pjE_tAtgg

Slings

Generally used to support the arm, hand, forearm, and shoulder

Many different types Commercial slings usually have a series of

straps that extend around the neck and/or thoracic region

A common first aid sling is the triangular bandage

May be used to provide immobility if a fracture of the arm or shoulder is suspected

Basic Principles of Slings Always position where hand is higher than the elbow

(promotes circulation, prevents swelling, and decreases pain) Check circulation frequently (skin temperature, color,

tingling, amount of pain, and numbness) – nail beds is an easy way to check, when pressing them should blanch (turn white) then return to the normal pink color immediately

If applying sling due to potential fracture, used caution not to move area and cause increased injury while trying to apply sling

If using a triangular bandage, tie knot to either side of spinal column and pad knot

If sling is for shoulder injury, can secure limb to body after applying sling with bandage around thoracic region

Sling Video

https://www.youtube.com/watch?v=9Cifk_ohsDo

Summary

Victims with injury to bones or joints can also experience shock

Be alert for signs of shock and treat as indicated These injuries cause emotions to soar – reassure All first aid measures are directed toward

decreasing pain Obtain medical help The only definite medical dx of a closed fx is a x-ray Always if suspected injury is noted, treat as if it is a

true injury