Transcript SECTION 2 - Sam Scheller

Chapter 25
Assessment and
Care of Bone and
Joint Injuries
Chapter 25: Assessment and Care of Bone and Joint Injuries
Objectives (1 of 2)
• List the assessment and emergency care for
injuries of the upper extremities.
• List the assessment and emergency care for
injuries of the lower extremities.
• Explain the rationale for stabilization of
specific injuries to the upper extremities.
• Explain the rationale for stabilization of
specific injuries to the lower extremities.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Objectives (2 of 2)
• Demonstrate the assessment and emergency
care for injuries to the:
– Clavicle
– Forearm
– Femur
– Scapula
– Wrist
– Knee
– Shoulder
– Hand
– Tibia
– Humerus
– Elbow
– Pelvis
– Hip
– Fibula
– Ankle
– Foot
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Upper Extremity Injuries
• Causes:
– Fall onto outstretched hand
(FOOSH)
– Can depend on age, position,
forces, equipment, and surface
– Position of limb has significant
influence.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Clavicle and Scapula Injuries
(1 of 2)
• Clavicle is one of the most fractured
bones in the body.
– Usually occur due to FOOSH
– Sometimes due to crush injuries
– Pain, swelling, and deformity
– Lies directly over arteries, veins, and
nerves
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Clavicle and Scapula Injuries
(2 of 2)
• Scapula is well protected.
– Injury is associated with forceful direct
impact
– Watch for associated significant injuries
• Joint between clavicle and scapula is the
acromioclavicular (A/C) joint
– “True dislocation” with point tenderness
• Splint these injuries with a sling and swathe.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Shoulder
(1 of 2)
•
•
•
•
Most commonly dislocated large joint
Usually dislocates anteriorly
Extremely painful injury
Patients will self-splint the arm and
shoulder.
• Numbness and tingling can occur.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Shoulder
(2 of 2)
• Difficult to immobilize
– Sling and swathe
– Blanket roll splint
• Can be a recurrent
injury
• “Reduction” should
occur in clinic or
hospital
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Fractures of the Humerus
• Fracture occur either proximally, in
midshaft, or distally at elbow.
• Consider applying traction to realign a
severely angulated humerus, according
to local protocols.
• Splint with sling and swathe,
supplemented with a padded board
splint or SAM splint.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Elbow Injuries
• Fractures and dislocations often
occur around the elbow.
• Injuries to nerves and blood vessels
are common.
• Assess neurovascular function
carefully.
– Careful realignment may be
needed to improve circulation.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Emergency Care of
Elbow Injuries
• Splint with padded rigid material or
SAM splint, roller gauze, and a sling
and swathe.
• Always monitor distal CMS functions.
• Rapid evacuation is essential in
patients with poor distal circulation.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Fractures of the Forearm
• Usually involves both radius and ulna
• Common injury for snowboard riders
• Known as “Colles” fractures and the
appearance is called a “silver fork”
deformity
• Use a padded board, SAM splint, roller
gauze, and sling and swathe.
• Assess and reassess CMS functions.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Injuries to the Wrist and Hand
• Common injury in all age groups, and
especially riders and skiers
• Many different injuries are possible.
• “Skier’s” thumb is an ulnar collateral
ligament sprain.
• Due to potential complications, these
injuries should be evaluated by a
physician.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Emergency Care of Wrist and
Hand Injuries
• Form hand into position of function by
placing a roller bandage in palm.
• Apply padded board or SAM splint.
• Secure splint with roller gauze.
• Apply a sling and swathe.
• Monitor CMS functions.
• Find and send amputated parts with patient.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Lower Extremity Injuries
• Includes:
– Pelvis fractures
– Hip dislocations
– Femur fractures
– Knee ligament sprains
– Fractures and dislocations of the knee
and patella
– Tibia and fibula fractures
– Ankle and foot sprains and fractures
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Fractures of the Pelvis
• Injuries are the result of a fall, collision or
forceful compression.
• May involve life-threatening internal
bleeding
• Organs within the pelvis can be injured.
• Assess for pain in lower back, lower
abdomen, or pelvic area.
• Patients may lie in a fetal position or with
knees partially flexed.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Emergency Care of a
Pelvic Fracture
• Palpate pelvis for tenderness: lateral
sides, then pelvic rock, then lower
anterior aspects
• Anticipate shock, give high-flow oxygen.
• Stable patients can be secured to a long
backboard or scoop stretcher to
immobilize isolated fractures of pelvis.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Hip (1 of 2)
• Hip dislocation requires significant MOI.
• Patients with posterior dislocations lie
with hip joint flexed and thigh rotated
inward (most common).
• Patients with anterior dislocations lie with
leg extended straight out, and rotated,
pointing away from midline.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Hip (2 of 2)
• Monitor CMS functions.
• Splint in position of deformity
on long backboard and
transport.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Fractures of the
Proximal Femur
• Also known as a hip fracture
• Displaced fractures present with
characteristic deformity.
• Apply high-flow oxygen, monitor CMS
functions.
• Fractures from trauma injuries best
managed by splinting to uninjured leg and
long backboard or scoop stretcher.
• Traction splinting is not usually indicated.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Femoral Shaft Fractures
• Leg is externally rotated, shortened, with
deformity (bulge) at the thigh
• Muscle spasms can cause deformity of the limb.
• Significant blood loss can occur.
• Monitor distal CMS functions.
• Immobilize with traction splint.
• Traction should be maintained until
hospitalization.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Anatomy of the Knee
• Modified hinge joint
• 4 main ligaments: medial
and lateral “collateral,”
anterior and posterior
cruciate
• Patella aids flexion and is
a “sesamoid” bone.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Injuries of Knee Ligaments
• Most common injury in skiing
• Frequently a “pop” is heard or felt.
• Definitive assessment is best done before
knee becomes swollen and painful.
• MOI can often help indicate type of injury.
• Splint (quick splint) and transport.
• Monitor distal CMS function.
• Apply ice and advise patient to seek
physician’s care.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Fractures About the Knee
• Can occur at three locations:
– Distal femur
– Proximal tibia
– Patella
• Deformity, swelling, impaired CMS functions
• Perform re-alignment once if CMS functions
are impaired.
• Apply rigid splint (quick splint).
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Knee
• Produces significant deformity
• More urgent injury is to popliteal artery,
which is often lacerated or compressed.
• Always monitor distal CMS functions.
• Perform realignment once if CMS
functions are impaired.
• Apply a rigid splint (quick splint).
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Dislocation of the Patella
• Patella usually dislocates to
lateral side
• Injury produces significant
deformity
• Splint (quick splint) in
position found.
• Monitor distal CMS
functions.
• May reduce spontaneously
during splinting
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Injuries to the Tibia and Fibula
•
•
•
•
•
Usually, both bones fracture at the same time.
Skiers may suffer “boot-top” or spiral fractures.
Open fracture of tibia is common.
Realignment is frequently required.
Concurrent femur fracture produces a “floating
knee.”
• Immobilize with a padded quick splint that
extends from foot to upper thigh.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Ankle Injuries (1 of 2)
• The ankle is the most commonly injured joint.
• MOI includes abruptly “turning the foot under”
or “twisting the foot in.”
• Apply cold packs or ice.
• Assess distal CMS functions.
• Fractures are difficult to distinguish from
severe sprains.
• Patient should seek physician’s care if
symptoms do not diminish within a day or
two.
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Ankle Injuries (2 of 2)
• Fractures usually involve the distal tibia
and/or fibula (lateral and medial malleoli).
• Snowboard riders suffer talus fractures that
mimic ankle sprains.
• Dislocations are associated with distal
fractures.
• Perform realignment/traction once if CMS
functions are impaired.
• Monitor CMS functions and splint (soft or
well-padded rigid splint).
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Chapter 25: Assessment and Care of Bone and Joint Injuries
Foot Injuries
• Usually occur after a patient falls or jumps.
• Also consider possibility of spinal injury from
a fall. Apply a long backboard if needed.
• Stress fractures occur with “overuse.”
• Immobilize ankle joint and foot in a soft
splint.
• Elevate foot to reduce swelling.
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