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Musculoskeletal Trauma
Sections
 Introduction to Musculoskeletal Trauma
 Anatomy and Physiology of the
Musculoskeletal System
 Pathophysiology of the Musculoskeletal
System
 Musculoskeletal Injury Assessment
 Musculoskeletal Injury Management
Introduction to
Musculoskeletal Injuries
 Millions of Americans experience
annually.
 Multiple MOI
 Falls, Crashes, Violence, etc
 Multi-system trauma
Anatomy & Physiology of the
Musculoskeletal System
 Skeletal Tissue & Structure
 Protects organs
 Allows for efficient movement
 Stores salts and other materials needed for
metabolism
 Produces RBC’s
Musculoskeletal System
 Bone Structure
 Diaphysis
 Epiphysis
 End of a long bone
 Metaphysis
 Between epiphysis and
diaphysis
 Growth plate
 Medullary Canal
 Contains bone marrow
 Periosteum
 Fibrous covering of diaphysis
 Cartilage
 Connective tissue that
provides a smooth articulation
surface for other bones.
Figure 7-1
Anatomy & Physiology of the
Musculoskeletal System
 Joint Structure
 Joint
 Where bones interact
 Synarthrosis
 A joint that does not permit movement
 Diarthroses (Synovial Joints)
 Monaxial: hinge or pivot joints
 Biaxial: gliding, sliding, or saddle joints
 Triaxial: Ball & socket joints
 Ligaments
 Joint Capsule
 Synovial fluid
Anatomy & Physiology of the
Musculoskeletal System
 Skeletal Organization
 206 Bones
 Axial Skeleton
 Head, Thorax & Spine
 Appendicular Skeleton
 Upper Extremities
 Lower Extremities
Anatomy & Physiology of the
Musculoskeletal System
 Bone Aging
 Birth to Adult (18-20)
 Transition from flexible to firm bone
 Adult to elderly (40+)
 Reduction in collagen matrix and calcium salts
 Diminution of bone strength
 Spinal curvature
Anatomy &
Physiology of the
Musculoskeletal
System
 Muscular
Tissue &
Structure
 600 muscle
groups
(continued)
Anatomy &
Physiology of the
Musculoskeletal
System
 Types of
muscles
 Smooth
 Striated
 Cardiac
Pathophysiology of the
Musculoskeletal System


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
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
Muscular Injury
Contusion
Compartment Syndrome
Penetrating Injury
Fatigue
Muscle Cramp
Muscle Spasm
Strain
Pathophysiology of the
Musculoskeletal System
 Joint Injury
 Sprain
 Subluxation
 Dislocation
 Bone Injury



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Open Fracture
Closed Fracture
Hairline Fracture
Impacted Fracture
Pathophysiology of the
Musculoskeletal System
 Pediatric Considerations
 Flexible nature
 Geriatric Considerations
 Osteoporosis
 Pathological Fractures
 Pathological diseases
Pathophysiology of the
Musculoskeletal System
 General Considerations with
musculoskeletal injuries
 Neurological compromise
 Decreased stability
 Muscle spasm
 Bone Repair Cycle
 Osteocytes produce osteoblasts
 Deposition of salts
 Increasing strength of matrix
Pathophysiology of the
Musculoskeletal System
 Inflammatory & Degenerative
Conditions
 Bursitis
 Tendinitis
 Arthritis
 Osteoarthritis
• Degenerative
 Rheumatoid Arthritis
• Chronic, systemic, progressive, debilitating
 Gout
• Inflammation of joints produced by accumulation of uric
acid crystals
Musculoskeletal Injury
Assessment
 Scene Size-up
 Initial Assessment
 Categories of urgency




Life & Limb threatening injury
Life threatening injury and minor musculoskeletal injury
Non-life threatening injuries but serious musculoskeletal injuries
Non-life threatening injuries and only isolated minor musculoskeletal
injuries
 Rapid Trauma Assessment
 Focused H&P
 6 P’s: Pain, Pallor, Paralysis, Paresthesia, Pressure, Pulses
 Detailed Physical Exam
 Ongoing Assessment
 Sports Injury Consideration
Musculoskeletal Injury
Management
 General Principles

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Protecting Open Wounds
Positioning the limb
Immobilizing the injury
Checking Neurovascular Function
Musculoskeletal Injury
Management
 Splinting Devices
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Rigid splints
Formable Splints
Soft Splints
Traction Splints
Other Splinting Aids
 Vacuum Splints
 Air Sprints
 Cravats or Velcro Splints
 Fracture Care
 Joint Care
 Muscular & Connective Tissue Care
Musculoskeletal Injury
Management
 Care for Specific Fractures
 Pelvis
 Scoop Stretcher
 PASG
 Fluid Resuscitation
 Femur
 Traction Splints
 PASG
 Fracture versus hip dislocation
Musculoskeletal Injury
Management
 Care Specific Fractures
 Tibia/Fibula
 Clavicle
 Most frequently fractured bone in the body
 Transmitted to 1st and 2nd rib
 Alert for lung injury
 Humerus
 Radius/Ulna
Musculoskeletal Injury
Management
 Care for Specific Joint Injuries
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Hip
Knee
Ankle
Foot
Shoulder
Elbow
Wrist/Hand
Finger
Joint Injuries
Alert for
neurological
Compromise
Musculoskeletal Injury
Management
 Soft & Connective Tissue Injuries
 Tendon
 Ligament
 Muscle
Musculoskeletal Injury Management
Medications
 Nitrous Oxide
 50% O2:50% N2O
 Non-explosive
 Effects dissipate in
2-5 minutes
 Easily diffused into
air filled spaces in
body.
 Dose
 Inhaled & self
administered
 Onset
 1-2 minutes
 Diazepam

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Benzodiazepine
Antianxiety
Analgesic
Dose
 5-15 mg titrated
 Onset
 10-15 minutes
 Duration
 15-60 minutes
 Counter Agent
 Flumazenil
Musculoskeletal Injury Management
Medications
 Morphine Sulfate

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Opiate alkaloid
Reduces vascular volume and cardiac preload
Do not administer to hypovolemic patients
Dose
 2mg IVP slow
 Counter Agent
 Narcan
(continued)
Musculoskeletal Injury Management
Medications
 Meperidine
 Demerol
 Narcotic Analgesic
 Dose
 50-100 mg
 Counter Agent
 Narcan
Musculoskeletal Injury Management
Medications
 Nalbuphine




Nubain
Narcotic Analgesic
Equivalent to Morphine
Dose
 2-5 mg
 Onset
 2-3 minutes
 Duration
 3-6 hours
Musculoskeletal Injury
Management
 Other Injury Consideration
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Pediatric Musculoskeletal Injury
Athletic Musculoskeletal Injury
Patient Refusals & Referral
Psychological Support