OVERVIEW

1. Discuss the major immediate and short-term complications and

treatment of the following extremity injuries:
a. Fractures
b. Dislocations
c. Open wounds
d. Amputations
e. Sprains and strains
2. Prioritize extremity trauma in the assessment and management of
life-threatening injuries.
3. Discuss the pathophysiology of compartment syndrome and which
extremity injuries are most likely to develop this complication.
4. Describe the potential amount of blood loss from pelvic and femur
fractures.
FRACTURE IS A MEDICAL CONDITION IN WHICH THERE IS
A PARTIAL OR COMPLETE BREAK IN THE CONTINUITY OF
THE BONE.

In more severe cases, the bone may be broken into

several pieces. A bone fracture may be the result of high
force impact or stress, or a minimal trauma injury as a
result of certain medical conditions that weaken the
bones, such is osteoporosis, osteopenia, bone cancer,
or osteogenesis imperfecta, where the fracture is then
properly termed a pathologic fracture.
 TYPES OF FRACRURES

CLOSED
• NO COMPROMISE
OF SKIN
INTERGRITY
OPEN
• BONE ENDS
PROTIDE FROM
WOUND
• HIGH RISK OF
INFECTION
REMEMBER THAT FRACTURES CAN CAUSED :

- DAMAGE ADJACENT NERVES AND VESSELS

- PRODUCE SEVERE BLEEDING

BLOOD LOSS MAY NOT OBVIOUS !

 NEVER ALLOW AN OBVIOUS
EXTREMITY INJURY TO PREVENT
DIAGNOSIS OF MORE SERIOUS HEAD,
CHEST, ABDOMINAL, OR PELVIC INJURY
 FRACTURE PRIORITIES

• FRACTURES RARELY IMMEDIATELY FATAL

• DON’T BE DISTRACTED BY ORVIOUS INJURIES

PERFORM BTLS PRIMARY SURVEY TO

IDENTIFY LIFE THREATENING INJURIES
BLOOD LOSS
FROM FRACTURES

 PELVIS
 500 CC ROR EACH BREAK
 MAY LACERATE MAYOR VESSELS CAUSING
INTERNAL HEMORRHAGE
 FEMUR
 1000 CC

MULTIPLE FRACTURES CAN PRODUCE LIFE

THREATENING HEMORRHAGE
 SIGNS AND SYMPTOMS OF EXTREMITY INJURIES

 PAIN
 DEFORMITY
 SWELLING
 LOSS OF MOVEMENT
 CREPITUS

Generally, fractures are quite painful. Once you have fully assessed and
stabilized the patient, your management should include splinting of the fracture
not only to avoid further injury, but also for patient comfort. Unless there is a
specific contraindication, you also should consider administering analgesic
medication if your protocols and the patient’s situation allow.
 A joint dislocation is an
extremely painful injury. It is
generally easy to identify
because normal anatomy is
significantly distorted. Although
major joint dislocations are not
life threatening, they are still true
emergencies because of the
neurovascular compromise that
can lead to significant disability
and even amputation if not
recognized and treated promptly.
 CRITICAL POINT

 Assess for pulses, motor function, and sensation (PMS)

distal to major joint dislocations and to reassess
following splinting, reduction, or movement.
 Pain management should be considered for these
patients if that option is available.
 Bleeding almost always can be stopped with direct pressure or
pressure dressings. It is important to apply direct manual pressure
to the source of the bleeding, not just the area of injury. If
necessary, an appropriate tourniquet or blood pressure
For an open wound where bleeding is controlled,
carefully cover it with a moist sterile dressing and
bandage. Gross contamination such as leaves or gravel
should be removed from the wound if possible. Smaller
pieces of contamination can be irrigated from the wound
with normal saline in the same manner youwould irrigate
a chemically contaminated eye.
An amputation is a disabling and sometimes life-threatening
injury that may present as partial or complete. Although it has
the potential for massive hemorrhage, usually the bleeding from
an be controlled with direct pressure applied to the stump.

• CONTROL BLEEDING BY DIRECT PRESSURE

• TOURNIQUET RARELY NEEDED
Small amputated parts should be rinsed off, wrapped in
sterile gauze, and placed in a plastic bag. Label the bag
with the patient’s name, date, time the amputation
happened, and time the part was wrapped and cooled.
A sprain is a stretching or tearing of ligaments of a joint
because of a sudden twist. It will cause pain and swelling.

A strain is a stretching or tearing of a muscle or

musculotendinous unit.
The extremities contain muscles and other
structures surrounded by tough membranes,
known as fascia , that do not stretch, creating
multiple closed spaces known as compartments.

Crush injuries, as well as closed (and some open)

fractures CAN CAUSE BLEEDING AND SWELLING,
which is contained within the closed space by
the fascia. This condition is called compartment
syndrome.
 Scene Size-up and History
 Assessment : DCAP-BTLS ; PMS
MANAGEMENT : SPLINTING
NEVER DELAY TRANPORT OF CRITICAL
PATIENT TO PERFORM SPLINTING OF
MINOR FRACTURES
CLAVICLE FRACTURES

APPLY SLING AND SWATHE

 SHOULDER INJURIES
• CLAVICULAR
SEPARATION : SLING
AND SWATHE
• SHOUDER
DISLOCATION : USE
PILLOW WITH SLING
AND SWATHE
• FRACTURE : USE
SLING AND SWATHE
 ELBOW INJURY

FRACTURE OR DISLACATION MAY CAUSE

NEUROVASCULARAR INJURY
- SPLINT IN POSITION FOUND
- TRANSPORT PROMPTLY
 FORE ARM / WRIST INJURY

RIGID SPLINT
- KEEP HAND IN “POSITION OF FUNCTION”
-AIR SPLINT
- MAY BE HARD TOREASSESS CIRCULATION
- PILLOW
 HIP FRACTURES

 COMMON IN ELDERY PATIENTS

 MAY BE ABLE TO SUPPORT WEIGH
 LEG OFTEN EXTRERNALLY ROTATED
 MAY REFFER PAIN TO KNEE
 USE OTHER LEG FOR SPLINT
 HIP DISLOCATION

ORTHOPEDIC EMERGENCY!

 USUALLY CAUSED BY AUTO ACCIDENT

 POSTERIOR DISLOCATION MOST COMMON
 HIP FLEXED AND LEG ROTATED INTERNALLY
 SEVERE PAIN ON ATTEMPT TO STRAGHTEN
 MANAGEMENT
 SPLINT IN MOST COMFORTABLR POSITION
 DOCUMENT SENSATION AND PULSE
 PROMPT TRANSPORT
 BE ALLERT FOR ASSOSIATED KNEE INJURIES OR FRACTURES
TRANSPORT WITH SCOOP STRETCHER
 FEMUR FRACTURES

- HIGH FORCE INJURY !

- HIGH POTENTIAL FOR HEMORRHAGIC SHOCK
- MAY USE TRACTION SPLINT
- MAST OR AIR SPLINT MAY CIVE ADEQUATE
STABILIZATION
 KNEE FRACTURE OR DISLOCATION

- ORTHOPEDIC EMERGENCY!
- FREQUENTLY CAUSES VASCULAR INJURY
- DISLOCATION OFTEN CAUSES VASCULAR INJURY
LEADING TO AMPUTATION
KNEE FRACTURE OR DISLOCATION
MANAGEMENT
- OBVIOUS DISLOCATION WITHOUT DISTAL PULSE
- APPLY GENTLE TRACTION
- IF GENTLE TRACTION DOES NOT RETORE PULSE
- SPLINT IN PLACE
- PROMT TRANSPORT
 TIBIA - FIBULA INJURY

- FREGUENTLY OPEN FRACTURES

- SIGNIFICANT HEMORRHAGE POSSIBLE
- DRESS OPEN WOUNDS
- DEPENDING ON LEVEL OF FRACTURE USE :
- RIGID SPLINT
- AIR SPLINT
- PILLOW
 FOOT AND HAND INJURY

- COMMON INDUSTRIAL ACCIDENT

- OFTEN DISABLING
- RARELY LIFE THREATENING
- SPLINT FOOT WITH PILLOW
- MANAGE ANKLE INJURIES THIS WAY
- SPLINT HAND IN POSITION OF FUNCTION
 DO NOT EVER FALL!!!

EVEN FALLIN IN LOVE CAN MAKE

YOUR HEART BREAK