• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to secondary sidebar
  • Skip to footer

EMT Review

powered by Limmer Education

  • Home
  • For Students
  • For Instructors
  • Join Now
  • Contact Us
  • Login
  • Airway

    Assessment

    Medical

    Trauma

    Special Populations

    Operations

    Pathophysiology

Musculoskeletal Trauma

Study Center > Student Study Guides > Musculoskeletal Trauma

Anatomy and Physiology Review

skeleton

Click for larger image

  • The skeleton
  • Types of bones
  • Ligaments and tendons

Pathophysiology

  • Musculoskeletal injuries occur when traumatic forces are applied to bones, joints and connective tissues.
  • Traumatic forces that cause musculoskeletal injuries include:
    • Direct force—Trauma applied to a specific area
    • Indirect force—Trauma applied to one area that damages a different area (as when someone falls and lands feet first but the pelvis breaks as trauma is transmitted up the bones of the leg)
    • Twisting/rotational forces
    • Crush mechanisms
Click for larger image

Click for larger image

  • Fracture occurs when the bone is broken:
    • Comminuted fractures are characterized by shattered bone or bone broken into several pieces.
    • Greenstick fractures are incomplete fractures and cracks in the bone.
    • Angulated fractures occur when the fracture of a long bone creates an angle or bend that normally would not be present.
  • Extremities and fractures may be open or closed.
    • Open extremity injuries are characterized by bone exposed through broken skin or penetrating wounds that injure the bone.
  • Injuries to the joint are classified as follows:
    • Dislocation—The joint is disrupted and the bones of the joint are now misaligned.
    • Subluxation—The joint was temporarily disrupted, but the bones of the joint are now back in place.
    • Sprain—The ligaments connecting the bones together were stretched or torn by excessive motion.
    • Strain—The tendons connecting muscle to bone were stretched or torn by excessive motion.
  • Swelling and bleeding within an extremity can cause compression of soft tissue and diminished blood flow. This condition is called compartment syndrome.

Signs and Symptoms

  • Mechanism of injury
  • Obvious fractures, including exposed bone ends, angulation and crepitusshutterstock_18468700
  • Pain and tenderness
  • Loss of function of joint, decreased range of motion
  • Bruising
  • Swelling
  • Loss of distal circulation and sensory or motor function
  • Especially with hip fractures, leg shortening or unnatural rotation of the foot
  • Signs of impending compartment syndrome, include the “six Ps”
    • Paralysis of the extremity
    • The sensation of pressure
    • Increase in pain
    • The sensation of paresthesia (pins and needles)
    • Pallor in the extremity
    • Diminished or absent pulses

Treatment

  • Consider the need for advanced life support for pain management.
  • Recognize critical loss of circulation and make transport decisions appropriately.
  • Realign angulated fractures with gentle traction. Stop the realignment process if the patient’s pain increases significantly or if you feel resistance.
  • Realign joints only if circulation is impaired.
  • When splinting:
    • Splint musculoskeletal injuries in position of function.
    • Splint in a long bone such that the joint above and the joint below the injury are immobilized.
    • Splint in a joint injury such that the bone above and the bone below are immobilized.
    • Assess circulatory, sensory and motor function before and after splinting.
    • Use a traction splint to immobilize an isolated femur fracture.
  • Use a pelvic wrap or pelvic binder to immobilize a potentially fractured pelvis.

Important Concepts

  • Beware of allowing grotesque musculoskeletal injuries to distract your attention from more immediate life threats.
  • For all musculoskeletal injuries, including those in pediatric patients, consider the need for pain management.
  • Fractures of the pelvis and femur can pose a risk of internal bleeding and hypovolemic shock.
  • Be creative with splinting and do not allow standardized procedures to limit possible methods. It’s the principle, not the application itself, that is important.
  • Remember to reassess. As with compartment syndrome, musculoskeletal injuries occasionally change and worsen over time.

Primary Sidebar

sidebar-alt

Footer

Copyright © 2022 Limmer Education | Terms of Service | Privacy | Contact
Website Designed and Developed by Graphic Beans