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

• 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:

– 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

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:

– 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

• 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:

– 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?