Musculoskeletal Trauma

Anatomy and Physiology Bones Muscles Joints Tendons Ligaments Soft tissues

Epidemiology More than half of all hospital admissions because of

trauma are patients with some type of fracture, usually of the lower limb.

The elderly are at a particularly high risk of being hospitalized for an extremity injury.

Of those injuries sustained by passengers involved in nonfatal motor vehicle crashes, 46% sustain pelvic fractures and 41% sustain femur fractures. Drivers sustain femur fractures (65%), pelvic fractures (46%), and ankle fractures (39%).0

Mechanisms of Injury Musculoskeletal trauma can be sustained as a single

system injury or in combination with other systems. Injuries to the extremities are not usually considered

the first priority. Mechanisms of injury include motor vehicle crashes,

assaults, falls, sports, leisure, or home activities. Abuse should be considered as a possible cause of

the injury. Musculoskeletal injuries can result from the

application of both acceleration and deceleration forces.

Basic Mechanisms of Musculoskeletal Injuries

Primary Injury - Direct force Secondary Injury - Indirect force Twisting or rotational force

Musculoskeletal Injuries Fracture: is break of the bone Dislocation: is disruption of a joint Sprain: is stretching and tearing of ligaments Strain: is muscle injury resulting from

overstretching or over exertion of muscle

Specific Musculoskeletal Injuries Hemorrhage

Radius or ulna 250 – 500 ml Humorous 500 – 750 Tibia or fibula 500 – 1000 Femur 1000 – 2000 Pelvis 1000 – massive

Instability Fractures (open or closed) Dislocation

Types of fractures Oblique Spiral Transverse Linear Greenstick Segmented Angulated

Comminuted Butterfly Impacted Open Closed Displaced

Signs and Symptoms Pain and tenderness Deformity or angulation Grating or crepitus Swelling Bruising Exposed bone ends Joint locked into position Nerve and blood vessel compromise

Care of Patient with Musculoskeletal Injury Take and maintain appropriate standard

precautions Perform the initial assessment (ABCD) Apply cervical collar if spine injury is

suspected After ABCD is established splint injured

extremity Cover open wounds, elevate extremity and

apply cold pack

Splinting Immobilization of adjacent joints and bone ends It decreases pain and prevents additional injury

to the soft tissues It prevents closed injuries from becoming open

injuries Traction splint: is a splint that apply constant

pull along the length of lower extremity to help stabilize the fractured bone and to reduce muscle spasm in the limb. (used primarily on femoral fractures)

Realignment Straightening to restore effective circulation to

the extremity Strategies:

Grasp the distal end of injured extremity and another one grasp above injured site

Pull the distal end gently in direction axis of extremity (manual traction)

Maintain gentile traction (if no resistance felt) till extremity properly splinted

Joint Injuries A joint may become

dislocated when the normal range of motion is exceeded.

Delayed reduction of a hip dislocation can lead to a vascular necrosis of the femoral head and permanent disability.

Signs and Symptoms Pain Joint deformity Edema Inability to move the

affected joint Abnormal range of motion Neurovascular

compromise: distal pulses may be diminished or absent; sensory function may be affected

Femur Fractures Femur fractures are a

result of major trauma, such as falls, motor vehicle crashes.

Fractures of the femoral neck are common after a fall in the elderly population.

Signs and Symptoms Pain and inability to bear weight Shortening of the affected leg Rotation internally or externally

depending on the location of the fracture site in the hip

Edema of the thigh Deformity of the thigh Evidence of hypovolemic shock

Pelvic Fractures Pelvic fractures are classified as either stable or

unstable. A stable fracture is defined as "one that can withstand

normal physiologic forces without abnormal deformation. An unstable fracture occurs when the pelvic ring is

fractured in more than one place resulting in two displacements on the ring; rotational

Signs and Symptoms Pain Evidence of hypovolemic shock Shortening or abnormal rotation of the affected leg Genitourinary or intra-abdominal injury

Open Fractures All open fractures are considered contaminated

because of the foreign materials and bacteria that can be introduced into the wound. Any open fracture may result in an infection.

Infections can be manifested by poor tissue healing, osteomyelitis, or sepsis.

Signs and Symptoms Evidence of skin disruption (e.g., laceration or puncture)

near or over the fracture Protrusion of bone through open wounds Pain Neurovascular compromise Bleeding may be minimal to severe