Extremity-trauma

EXTREMITY TRAUMA

OBJECTIVES Identify and treat fractures and soft tissue injuries in a tactical environment.

Open Wounds

Closed Wounds

Musculoskeletal - Causes • Overuse • Acute sprains and strains • Trauma

Overuse

Acute Sprains and Strains

Trauma

Compound Fracture of the Ankle

Musculoskeletal Presentation • • • • • •

Pain Swelling Discoloration Temperature change Numbness/tingling Loss of function

Musculoskeletal Evaluation

• History • Physical examination – skin breaks – tenderness – swelling – discoloration – distal pulses – sensory exam – motor exam

Musculoskeletal Treatment • Prevention • “RICE” • Analgesic – Tylenol • Analgesic & Anti-inflammatory – Aspirin – Ibuprofen (Motrin/Ranger Candy) – Naprosyn

Fractures • Any break in the continuity of a bone • May vary from a simple crack to a completely shattered bone

FX Femur

Open Fracture

Compound Fracture of the Ulna

Other Injuries

De-gloving Injury Blast Injury

Ecchymosis • Discoloration caused by bleeding in tissue • Blood migrates toward skin and changes color with time

Joints • Surrounded by joint capsule and ligaments, muscles and tendons

Dislocations • Disruption of a joint such that the bone ends are no longer in contact • Torn ligaments and capsule

Common Dislocations • • • • •

Fingers Shoulder Hip Elbow Ankle

Dislocated Elbow

Knee Joint • • • •

Femur, Tibia, and Patella Largest hinge joint in body Held together by complex ligaments Susceptible to injury

Knee Injuries • • • •

Ligaments and cartilage injuries are common Swelling, pain, limited ROM Frequent athletic injury Splint entire femur and tibia

Dislocation of the Knee • • • •

Severe deformity Popliteal artery commonly injured If pulse is present, splint in deformed position If pulse is absent, attempt once to realign limb and splint where pulse is strongest (RGR MEDIC)

Dislocation of the Knee

Ankle Injuries • Usually result from twisting, indirect force • Fracture, dislocations, sprains can occur • Swelling and deformity • Note circulation • Immobilize with padding and splint

Sprain • Partial, temporary joint dislocation • Ligaments torn or stretched • May produce discoloration

SAM SPLINT

Management of Closed Injuries • • • • •

R - Rest I - Ice C - Compression E - Elevation S - Splint (SAM Splints and cravats or ACE wraps) • R/O fracture

Soft Tissue Injuries • Open - Violation of overlying skin or mucous membrane

Management Stop the bleeding and bandage

Summary • Although quite common, rarely life threatening • First priority in management same for all patients ( A,B,C’s) • RICES for most soft tissue injuries