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 Skeletal or voluntary muscle attaches to bone and forms the major muscle mass of the
body. This muscle contains arteries, veins, and nerves.
 There are 206 bones of the skeleton. When this living tissue is fractured, it can
produce bleeding and severe pain.
 A joint is a junction where two bones come into contact. Joints are stabilized in key
areas by ligaments.
 Tendons connect skeletal muscle to bone. Ligaments connect bone to bone and help
maintain the stability of joints and determine the degree of joint motion. Cartilage is a
flexible connective tissue that forms a smooth surface over bone ends where they
articulate.
 Age-associated changes in the musculoskeletal system include decreased bone
density, degradation of joints, and disk herniation. People with osteoporosis have a
higher risk of fracture.
 When a person has a musculoskeletal injury, many structures may be damaged,
including muscles, bones, tendons, ligaments, cartilage, and vessels.
 A fracture is a broken bone; a dislocation is a disruption of a joint; a sprain is a
stretching injury to the ligaments around a joint; and a strain is stretching of a muscle.
 A pathologic fracture, or nontraumatic fracture, occurs from a force that would not
usually harm a normal healthy bone, but because of a medical condition, the bone has
become abnormally weak.
 Depending on the amount of kinetic energy absorbed by the tissues, the zone of injury
may extend beyond the point of contact. Always maintain a high index of suspicion
for associated fractures and other injuries.
 Fractures are classified as open or closed, and displaced or nondisplaced. Open and
closed fractures are splinted in the same manner, but remember to control bleeding
and apply a sterile dressing to the open extremity injury before splinting. Open
fractures have a higher risk of infection.
 Other specific types of fractures include greenstick, comminuted, epiphyseal, oblique,
transverse, spiral, and incomplete.
 The most common life-threatening musculoskeletal injuries are multiple fractures,
open fractures with arterial bleeding, pelvic fractures, bilateral femur fractures, and
limb amputations.
 Fractures and dislocations are often difficult to diagnose without radiographic
examination. You will treat these injuries similarly. Stabilize the injury with a splint,
and transport the patient.
 Signs of a fracture and dislocation include pain, deformity, point tenderness,
guarding, loss of use, swelling, bruising, crepitus, and false motion. Signs specific to
fractures include shortening and exposed bone ends.
 Signs of a sprain (ligament injury) include swelling, ecchymosis, and instability of the
joint.
 Signs of a strain (pulled muscle) include pain, but there is often no deformity and
only minor swelling at the site of injury.
 Compare the unaffected extremity with the injured extremity for differences
whenever possible.
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Interventions for patients with musculoskeletal injuries include addressing the ABCs;
splinting; securing critical patients to a long backboard; prompt transport, possibly to
a trauma center; and establishing intravenous (IV) access with possible administration
of IV fluids.
For each limb, your neurovascular examination should include assessment of pulse
and motor and sensory functions. Repeat this exam every 5 to 10 minutes.
The principles of splinting include the following: If you suspect a fracture of the shaft
of any bone, make sure the splint stabilizes the joints above and below the fracture;
with injuries in and around a joint, make sure the splint immobilizes the bones above
and below the injured joint; where fracture of a long bone shaft has resulted in severe
deformity, use constant, gentle, manual traction (pull) to align the limb so that it can
be splinted, unless this is too painful.
There are three types of splints: rigid splints, traction splints, and formable splints.
A sling and swathe is used commonly to treat shoulder dislocations and to secure
injured upper extremities to the body. Lower extremities can be secured to the
unaffected limb or to a long backboard.
Pelvic binders can be used to splint the pelvis. Another option may be to use a
pneumatic antishock garment (PASG), depending on local protocols.
Amputations may be partial or complete. Amputated parts may be reattached by
surgeons. Correct prehospital care of the amputated part is vital to successful
reattachment. Never sever a partial amputation. In all cases, control bleeding.
Consider a bolus of an isotonic crystalloid solution if the patient has experienced
significant blood loss or is hypotensive.
Compartment syndrome is a complication of musculoskeletal injury and occurs when
bleeding or swelling lead to pressure within the space a muscle occupies. This
pressure can impair circulation and cause pain, sensory changes, and muscle death.
Compartment syndrome can occur in both open and closed fractures. Immediate
transport is crucial.
Crush syndrome may occur when an entrapped limb has been compressed and is then
freed, causing the release of harmful products (rhabdomyolysis). Before releasing the
compressing force, the patient should receive high-flow supplemental oxygen and a
bolus of crystalloid solution. Albuterol may be given during extrication.
Sprains and strains should be treated with rest, ice, compression, elevation, and pain
management. Also, the limb should be protected from bearing weight.