strains, sprains, fractures and dislocations

8/13/2019 Strains, Sprains, Fractures and Dislocations

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Name 14 February 2007

London District LINKS Autumn 2008

Strains, sprains, fracturesand dislocations


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Strains, sprains, fractures and dislocations London District LINKS

What well be covering

What are strains, sprains, fractures anddislocations, and why do they happen?

How to recognise them on duty

How to treat them

What to do and what not to do

Practical skillsbandaging people with

these problems


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The skeleton

Your body is held togetherby bones

Together, bones form theskeleton

The skeleton is very strongall your organs andmuscles are attached to itsomehow

How many bones does anaverage adult have?


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The skeleton

The average adult has 206 bones

The heaviest is the femurin the thigh

The smallest is the stapesin the ear

Any bone in the body can be broken if

things go wrong


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Joints

Bones meet at joints

Joints allow the body to

move

However they areweaker than bone, and

this makes them

vulnerable to injury

Joints contain severalimportant parts


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A simplified joint

Ligamentscover the outside of the joint

Fluidfills the joint space

Cartilagelines the bone surfaces

Bone


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Mechanisms of injury

Strains, sprains, fractures anddislocations are caused by

abnormal forces on joints and bones

These can include:- impacts

- twisting movements

- compression or stretching

- over-bending of joints


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Mechanisms of injury

What sort of duty situations might theseproblems occur in?- Sports matches

- Running events- Ice skating

- Car or cycle races

- Crushing in heavy crowds

- Diving into deep water


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Strains


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What is a strain?

Muscles attach to bones via tendons

You can see tendons on the back of

your hand

If a muscle is pulled too hard, the

tendon becomes damageda strain

Pain occurs whilst the tendon heals


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Common sites for strains

Strains often occur around:- Neck

- Ribs

- Upper arm- Fingers

- Groin!

Why are these strains common?


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Recognising a strain

How would you recognise a strain?

- History of injury e.g. casualty slipped over

- Pain and tenderness

- Swellingusually not much

- Reddening of the skin

- Reduced movement due to the pain

- Locationoften away from a joint unlike asprain


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How to treat a strain

The treatment is RICE


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RICE is a key first aid acronym:

- Rest the affected area

- Ice-pack the affected area

- Compress the affected area

- Elevate the affected area


R

I

C

E


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Advise the casualty they can buysimple painkillers from a pharmacy

Strains can take a few days to a week

to get better (if RICE is followed)

If it doesnt get better they can see their

GP or go to A&E


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Sprains


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What is a sprain?

Remember the joint?

A sprain occurs

when the ligament

around a joint isdamaged

The joint fluid can

leak out

This causes painand swelling


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Common sites for sprains

What joints are commonly sprained?- Ankle

- Knee

- Elbow- Wrist

- Finger joints

Tends to be joints in arms and legs that

sprain the mostwhy?


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Recognising a sprain

How would you recognise a sprain?

- History of injury e.g. fell awkwardly

- Pain and tenderness

- Swellingmore than in a strain

- Reddening of the skin

- Reduced movement due to the pain

- Locationaround a joint, by definition


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RICE is the key again:

- Rest the affected area

- Ice-pack the affected area

- Compress the affected area

- Elevate the affected area

How to treat a sprain

R

I

C

E


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How to treat a sprain

Again the casualty can buy simplepainkillers

Sprains often take longer to heal

up to two weeks

Resting the joint is most important

Again they should see their GP or

A&E if things dont get better


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Fractures


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What is a fracture?

A fracture is a brokenbone

This includes chips and

cracks in bones as well

as full snaps

Bones usually fracture in

their shafts

A strong force is usuallyrequired


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Types of fractures

Doctors like to classify fractures

There are only 2 classes you need to

know about

- Closed fracturewhere the broken ends ofthe bones are in their normal place

- Open fracturewhere the ends of the

bones have moved e.g. sticking out of skin

Why is this important?


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Types of fractures

Closed fracture Open fracture


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Common sites for fractures

Which bones commonly break?- Upper arm (humerus)

- Forearm (radius/ulna)

- Wrist

- Lower leg (tibia/fibula)

- Ankle

Why are these fractures common?


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Recognising a fracture

How would you recognise a fracture?- History of injury e.g. fell onto arm

- Snapping or cracking noise heard

- Lots of pain- Swelling of the area

- Obvious deformity e.g. bone looks bent

- Inability to move the area- Bone sticking out or a wound if open fracture


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Recognising a fracture

You should be more suspicious of afracture in people with weaker bones:

- children

- older people

- people with bone disease e.g. osteoporosis

(thinning of the bones)

- people taking steroids for a long time


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How to treat a fracture

Try to move the area as little as possible

Support the area:- Arm sling for an arm or wrist fracture

- Elevation sling for a collar bone fracture- Blanket padding for a leg fracture

Dress any wounds that are present

Cover any bone ends with dressingssoaked in sterile saline


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How to treat a fracture

The casualty needs to go to hospital assoon as possible

Dont let the casualty eat or drink,

smoke or walk around

Treat for shock if necessary


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Further treatment

The ambulance crewmay use a splint to

hold the bones in

place

They may give the

casualty painkillers:- gas and air (Entonox)

- into the bloodstream

e.g. morphine


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Further treatment

Many fractures canbe treated with a

plaster cast

Others needoperations and

metalwork to hold the

bones in place

This is a tibia fracture


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Dislocations


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What is a dislocation?

Remember the joint? A dislocation occurs

when the two bone

ends come apart

This stops the joint

from moving

It is usually due to

an impact to the joint


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Common sites for dislocations

Which joints commonly dislocate?- Shoulder

- Finger joints

- Hip (often hip replacements)

- Kneecap

- Ankle

Due to the forces involved, fractures

may occur with dislocations


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Recognising a dislocation

How would you recognise a dislocation?- History of injuryimpact to a joint

- Crunching noise heard

- Deformity of the joint- Swelling and redness

- Lots of pain

- Inability to move the joint- Signs of a nearby fracture


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How to treat a dislocation

Keep the joint still and supportedusea sling or padding if necessary

Never try to put the bones back into the

normal position:- Without x-ray cant be sure its a dislocation

- May cause more damage

- Its cruel without painkillers!


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How to treat a dislocation

The casualty needs to go to hospital assoon as possible

Dont let the casualty eat or drink,

smoke or walk about

Treat for shock if necessary


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Further treatment

Sometimes the ambulance crew maymove the bones position if they are

worried about nerve or artery damage

Otherwise the dislocation will be movedin hospital after an x-ray

The casualty will need painkillers and

sedationits very painful!


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Anyquestions?


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Practical skills

Well now teach you how to:- Apply an arm slinguseful for arm

fractures

- Apply an elevation slinguseful for collarbone fractures

- Apply padding and bandages to a leg

to support a leg fracture


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Quiz


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Question 1

A sprain is where:A. The ligaments around a joint have

been damaged

B. The bones in a joint have become

displaced

C. A muscle and its tendon have been

damaged

D. The soft tissues around a bone havebeen bruised


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Question 1

A sprain is where:A. The ligaments around a joint have

been damaged

B. The bones in a joint have become

displaced

C. A muscle and its tendon have been

damaged

D. The soft tissues around a bone havebeen bruised


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Question 2

How long does a strain take to heal, ifRICE is followed?

A. A few hours

B. A few days to a week

C. Up to two weeks

D. Up to a month


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Question 2

How long does a strain take to heal, ifRICE is followed?

A. A few hours

B. A few days to a week

C. Up to two weeks

D. Up to a month


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Question 3

The C in RICE stands for:

A. Calm the patient

B. Circulation

C. Call for medical help

D. Compress the injury


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Question 3

The C in RICE stands for:

A. Calm the patient

B. Circulation

C. Call for medical help

D. Compress the injury

Q i 4


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Question 4

The most important risk with an openfracture is that:

A. The bones might erode each other as

they rub togetherB. Infection can enter the body

C. The doctor might scratch himself on

the protruding bone

D. There might be lots of bleeding

Q ti 4


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Question 4

The most important risk with an openfracture is that:

A. The bones might erode each other as

they rub togetherB. Infection can enter the body

C. The doctor might scratch himself on

the protruding bone

D. There might be lots of bleeding

Q ti 5


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Question 5

Which of these joints is not commonlydislocated?

A. Wrist

B. Ankle

C. Shoulder

D. Finger

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Question 5

Which of these joints is not commonlydislocated?

A. Wrist

B. Ankle

C. Shoulder

D. Finger

S i


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Scenario

You are called at the ice rink to a 75-year-old lady who has slipped on the

ice and fallen. She put her left arm out

as she landed. She is now complainingof severe pain in her upper arm. She

cannot move her shoulder or elbow.

There is a tender swelling halfway

between her shoulder and elbow.

Q ti 6


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Question 6

What is your diagnosis?

A. She has strained her biceps muscle

and tendon

B. She has fractured her humerus bone

C. She has dislocated her shoulder

D. She has sprained her elbow

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Question 6

What is your diagnosis?

A. She has strained her biceps muscle

and tendon

B. She has fractured her humerus bone

C. She has dislocated her shoulder

D. She has sprained her elbow

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Question 7

Which of these features is least usefulfor making your diagnosis?

A. The severity of the pain

B. The mechanism of the injury

C. The presence of skin reddening

D. The age of the patient

Q ti 7


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Question 7

Which of these features is least usefulfor making your diagnosis?

A. The severity of the pain

B. The mechanism of the injury

C. The presence of skin reddening

D. The age of the patient

Q estion 8


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Question 8

What will you do to help the casualtybefore taking her to the first aid post?

A. Give her a hot cup of tea

B. Massage the injury site

C. Tie a crepe bandage tightly around

the swollen area

D. Apply an arm sling

Question 8


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Question 8

What will you do to help the casualtybefore taking her to the first aid post?

A. Give her a hot cup of tea

B. Massage the injury site

C. Tie a crepe bandage tightly around

the swollen area

D. Apply an arm sling

Question 9


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Question 9

As you get the casualty to the first aidpost in a wheelchair, she complains of

feeling sick and faint. What do you do?

A. Walk her to the toilet to be sickB. Lay her down and raise her legs

C. Give her two paracetamol tablets

D. Leave her sat outside in the wheelchairto get some fresh air

Question 9


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Question 9

As you get the casualty to the first aidpost in a wheelchair, she complains of

feeling sick and faint. What do you do?

A. Walk her to the toilet to be sickB. Lay her down and raise her legs

C. Give her two paracetamol tablets

D. Leave her sat outside in the wheelchairto get some fresh air

Question 10


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Question 10

The casualty has left for hospital in anambulance. What is your priority now?

A. Have a cup of coffee

B. Go back to your station at the ice rinkC. Radio control to tell them the casualty

has left the first aid post

D. Fill in a PRF, RIDDOR form and the ice

rinks accident book

Question 10


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Question 10

The casualty has left for hospital in anambulance. What is your priority now?

A. Have a cup of coffee

B. Go back to your station at the ice rinkC. Radio control to tell them the casualty

has left the first aid post

D. Fill in a PRF, RIDDOR form and the ice

rinks accident book

The end


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The end

Any more

questions?

strains, sprains, fractures and dislocations

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