Transcript FRACTURE
Refresher 2003 Common Outdoor Injury Management Instructors This PowerPoint was developed to be used as an instructor- aid for the 2003 OEC Fall Refresher. Please MODIFY its contents to meet your patrol’s needs. A mini-presentation is a good teaching style for this exercise. Your review should not take more than 30 minutes – maximum! Refresher 2003 Common Outdoor Injury Management Common Outdoor Injury Management Objectives Review mechanisms and patterns of traumatic injury Illustrate the types of injury that occur to the skeleton, soft tissue, and skeletal support structures Explain the general principles of wound care and the emergency care for musculoskeletal injuries Mechanism of Injury Mechanism of Injury Types of Trauma Mechanism of Injury Types of Trauma Penetrating Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension Nail in Index Finger Mechanism of Injury Types of Trauma Penetrating Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension Severe Contusion of Foot Mechanism of Injury Types of Trauma Penetrating Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension Cervical (C5-C6) Fracture Dislocation Mechanism of Injury Types of Trauma Penetrating Trauma Compression (Blunt) Trauma Bending Trauma Hyperflexion Hyperextension Dorsal Dislocation, Long Finger Middle Joint (PIP Joint) Mechanism of Injury Types of Trauma Rotational Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma Normal Tibia Left Spiral Fracture Tibia Right Mechanism of Injury Types of Trauma Rotational Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma Dislocation of Right Shoulder Mechanism of Injury Types of Trauma Rotational Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma Train Crush Injury, Leg Mechanism of Injury Types of Trauma Rotational Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma Deceleration Trauma Mechanism of Injury Types of Trauma Rotational Trauma Distraction Trauma Crush Trauma Deceleration Trauma Acceleration Trauma Car struck from behind “accelerates” passengers, producing an extension injury to the neck! Acceleration Trauma Mechanism of Injury Types of Force Mechanism of Injury Types of Force Direct Force Indirect Force Twisting Force High Energy Force Direct Mid-Shaft Fracture, Femur Mechanism of Injury Types of Force Direct Force Indirect Force Twisting Force High Energy Force Indirect Posterior Dislocation, Elbow Mechanism of Injury Types of Force Direct Force Indirect Force Twisting Force High Energy Force Twisting Subtalar Dislocation, Ankle Mechanism of Injury Types of Force Direct Force Indirect Force Twisting Force High Energy Force High Energy Fractured Pelvis Types of Injury Types of Injury Fracture • Any break in the continuity of a bone • May vary from a simple crack to a completely shattered bone Fracture Classification Closed/Open Incomplete/Complete Non-Displaced/Displaced Closed Fracture, Base of Thumb Closed Dorsally Angulated Forearm Fracture n Fracture, Tibia Fracture, Forearm Open Fractures Are More Serious! Blood Potential loss contamination with risk of infection Fracture Classification Closed/Open Incomplete/Complete Displaced/Displaced Incomplete Fracture, Distal Radius Complete Fracture, Femur Fracture Classification Closed/Open Incomplete/Complete Non-Displaced/Displaced Non-Displaced Fracture, Distal Tibia and Fibula Displaced Forearm Fractures Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate Comminuted Femur Fracture Other Types of Fracture Comminuted – fractured into more than two segments Pathologic – fracture through diseased bone Epiphyseal – fracture passes through the growth plate Pathologic Lytic lesion (darker = tumor) in proximal phalanx of finger, with associated transverse fracture Other Types of Fracture Comminuted – fractured into many pieces Pathologic – fracture through diseased bone Epiphyseal – fracture through the growth plate Epiphyseal (growth-line) Fracture, Distal Femur Signs of a Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Fractured Patella Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Angulated Fracture, Radius and Ulna Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Crepitus In a complete fracture, the sounds of bone ends clicking or rubbing against each other; denotes an unstable fracture! Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Open Ankle Fracture Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb False Motion The unusual visual sensation of observing motion at a long bone fracture site where “there is no joint!” Seven Signs of Fracture Tenderness Swelling and Ecchymosis Deformity Crepitus Exposed Fragments False Motion Inability to Use the Limb Fracture, Right Clavicle Right Arm Protected Seven Signs of Fracture The presence of any one of the seven fracture signs just listed is sufficient to assess this injury! Types of Injury Dislocation Disruption of a joint such that the bone ends are no longer in normal contact Must have torn ligaments and joint capsule Signs of Dislocation Tenderness Deformity (usually marked) Swelling and Ecchymosis Loss of normal joint motion Common Dislocations Shoulder Finger Hip Elbow Anterior Dislocation, Right Shoulder Common Dislocations Shoulder Finger Hip Elbow Dislocation, Middle Joint (PIP Joint), Ring Finger Common Dislocations Shoulder Finger Hip Elbow Posterior Hip Dislocation Common Dislocations Shoulder Finger Hip Elbow Posterior Elbow Dislocation Types of Injury Fracture-Dislocation A combined injury with joint dislocation and an adjacent bone fracture Fracture–Dislocation, Ankle Types of Injury Sprain Partial or complete temporary joint dislocation Ligaments are torn partially or completely May produce as much structural damage as a dislocation Sprain, Left Ankle Types of Injury Strain “Muscle Pull” Stretching or tearing of muscle, or muscle fascia (covering) Occurs frequently in the lower back secondary to poor posture and poor abdominal muscle control Assessing Musculoskeletal Injuries MOI on Approach ABC’s Injury History (“What happened?”) Palpation of injury site - “Take one finger and show me where it hurts!” DCAP-BTLS Deformities Contusions Abrasions Puncture Wounds Burns Tenderness Lacerations Swelling Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Motor Function Sensation Radial Pulse Posterior Tibial Pulse Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Motor Function Sensation Extension Ankle Dorsiflexion Flexion Ankle Plantar Flexion Evaluation of Distal Neurovascular Function (CMS) Pulse (circulation) Motor Function Sensation Medial and Lateral Hand Medial Foot Lateral Foot Principles of Musculoskeletal Injury Management ABC’s Evaluate distal neurovascular function Dress all wounds Splint all suspected injuries Prepare patient for transport Injury Management All open wounds should be covered with a dry sterile compression dressing Injury Management Splinting Immobilizes the Injury and: Reduces Pain Facilitates Transport Prevents further damage to blood vessels, nerves and skin adjacent to the injury Decreases Bleeding Principles of Splinting Check and record CMS Dress all wounds Immobilize the joints above and below a suspected fracture With injuries at or near joints, immobilize the bones above and below the injury Stabilize the injury site during splint application Principles of Splinting Use gentle in-line manual traction to realign displaced long bone fractures Expect to encounter increased pain and some resistance when attempting to realign a deformed limb Immobilize all suspected spinal injuries in a neutral in-line position on a spineboard Principles of Splinting If the patient demonstrates major signs of shock, align the limb as close to its normal anatomic alignment as possible on a spineboard (immobilization of total body), and provide rapid transport Total Body Immobilization When in doubt: SPLINT! Rigid Splints Quick Splint Cardboard Splint Ladder Splint SAM Splint Soft Splints Air Splint Sling and Swathe Vacuum Splint Blanket Roll Traction Splint When standard splints are unavailable, improvisation is better than doing nothing! UPPER EXTREMITY All fractures can be immobilized by securing the extremity to the chest! LOWER EXTREMITY All fractures can be immobilized by securing the injured extremity to the opposite lower extremity! The End