Download Musculoskeletal Trauma - Home

Musculoskeletal Trauma
Anatomy and Physiology






Bones
Muscles
Joints
Tendons
Ligaments
Soft tissues
Epidemiology



More than half of all hospital admissions because of
trauma are patients with some type of fracture,
usually of the lower limb.
The elderly are at a particularly high risk of being
hospitalized for an extremity injury.
Of those injuries sustained by passengers involved in
nonfatal motor vehicle crashes, 46% sustain pelvic
fractures and 41% sustain femur fractures. Drivers
sustain femur fractures (65%), pelvic fractures
(46%), and ankle fractures (39%).0
Mechanisms of Injury





Musculoskeletal trauma can be sustained as a single
system injury or in combination with other systems.
Injuries to the extremities are not usually considered
the first priority.
Mechanisms of injury include motor vehicle crashes,
assaults, falls, sports, leisure, or home activities.
Abuse should be considered as a possible cause of
the injury.
Musculoskeletal injuries can result from the
application of both acceleration and deceleration
forces.
Basic Mechanisms of Musculoskeletal Injuries



Primary Injury - Direct force
Secondary Injury - Indirect force
Twisting or rotational force
Musculoskeletal Injuries




Fracture: is break of the bone
Dislocation: is disruption of a joint
Sprain: is stretching and tearing of ligaments
Strain: is muscle injury resulting from
overstretching or over exertion of muscle
Specific Musculoskeletal Injuries

Hemorrhage






Radius or ulna 250 – 500 ml
Humorous 500 – 750
Tibia or fibula 500 – 1000
Femur 1000 – 2000
Pelvis 1000 – massive
Instability


Fractures (open or closed)
Dislocation
Types of fractures







Oblique
Spiral
Transverse
Linear
Greenstick
Segmented
Angulated






Comminuted
Butterfly
Impacted
Open
Closed
Displaced
Signs and Symptoms








Pain and tenderness
Deformity or angulation
Grating or crepitus
Swelling
Bruising
Exposed bone ends
Joint locked into position
Nerve and blood vessel compromise
Care of Patient with Musculoskeletal Injury





Take and maintain appropriate standard
precautions
Perform the initial assessment (ABCD)
Apply cervical collar if spine injury is
suspected
After ABCD is established splint injured
extremity
Cover open wounds, elevate extremity and
apply cold pack
Splinting




Immobilization of adjacent joints and bone ends
It decreases pain and prevents additional injury
to the soft tissues
It prevents closed injuries from becoming open
injuries
Traction splint: is a splint that apply constant
pull along the length of lower extremity to help
stabilize the fractured bone and to reduce muscle
spasm in the limb. (used primarily on femoral
fractures)
Realignment


Straightening to restore effective circulation
to the extremity
Strategies:



Grasp the distal end of injured extremity and
another one grasp above injured site
Pull the distal end gently in direction axis of
extremity (manual traction)
Maintain gentile traction (if no resistance felt) till
extremity properly splinted
Joint Injuries


A joint may become
dislocated when the
normal range of
motion is exceeded.
Delayed reduction of
a hip dislocation can
lead to a vascular
necrosis of the
femoral head and
permanent disability.






Signs and Symptoms
Pain
Joint deformity
Edema
Inability to move the
affected joint
Abnormal range of motion
Neurovascular
compromise: distal pulses
may be diminished or
absent; sensory function
may be affected
Femur Fractures


Femur fractures are a
result of major
trauma, such as falls,
motor vehicle
crashes.
Fractures of the
femoral neck are
common after a fall in
the elderly
population.






Signs and Symptoms
Pain and inability to bear
weight
Shortening of the affected leg
Rotation internally or externally
depending on the location of
the fracture site in the hip
Edema of the thigh
Deformity of the thigh
Evidence of hypovolemic shock
Pelvic Fractures

Pelvic fractures are classified as either stable or
unstable.



A stable fracture is defined as "one that can withstand
normal physiologic forces without abnormal deformation.
An unstable fracture occurs when the pelvic ring is
fractured in more than one place resulting in two
displacements on the ring; rotational
Signs and Symptoms




Pain
Evidence of hypovolemic shock
Shortening or abnormal rotation of the affected leg
Genitourinary or intra-abdominal injury
Open Fractures



All open fractures are considered contaminated
because of the foreign materials and bacteria that can
be introduced into the wound. Any open fracture
may result in an infection.
Infections can be manifested by poor tissue healing,
osteomyelitis, or sepsis.
Signs and Symptoms





Evidence of skin disruption (e.g., laceration or puncture)
near or over the fracture
Protrusion of bone through open wounds
Pain
Neurovascular compromise
Bleeding may be minimal to severe