1

MUSCULOSKELETAL
TRAUMA

EMERGENCY MEDICAL TECHNICIAN - BASIC

 Fracture
2

 Break in bone’s continuity

 Fracture Causes
3

 Direct force
 Indirect force
 Twisting forces (torsion)
 Diseases of bones (pathological fractures)
 Osteoporosis
 Tumors
 Open vs. Closed Fractures
4

 Closed = skin over fracture site intact

 Open = break in skin over fracture site
 Bone ends do not have to be exposed
 Small opening in skin communicating with fracture
site = open fracture
 Open fractures more serious due to external blood
loss, possible infection
 Fractures
5

One of the most important things we

do in EMS is prevent closed
fractures from becoming open ones
 Fracture Types
6

 Transverse: fracture is at 90o angle to shaft

 Oblique: fracture is at an angle other than 90o to
shaft
 Spiral: fracture coils through shaft of bone like a
spring
 Impacted: bone ends driven into each other
 Comminuted: bone broken into > 3 pieces
 Fracture Types
7

 Greenstick
 Shaft of bone not completely broken
 Compressed on one side, splintered outward on
other
 What group of patients does this type of fracture
occur in?
 Fracture Signs
8

 Deformity
 Tenderness
 Usually point tenderness
 Overlies fracture site
 Inability to use limb
 Reliable sign of significant injury if present
 Reverse is not true
 Fracture Signs
9

 Swelling, ecchymosis (bruises)

 Exposed fragments
 Crepitus
 Grating of bone ends
 May be heard or felt
 Do NOT actively seek
 Dislocation
10

 Displacement of bones from normal positions at

joint
 Dislocation Signs
11

 Deformity
 Swelling, ecchymosis about joint
 Pain/tenderness in joint
 Loss of motion usually perceived as “locked” joint
 Sprains
12

 Partial, temporary dislocations

 Result in tearing of ligaments
 Bone ends NOT displaced from normal positions
 Sprain Signs
13

 Tenderness
 Swelling, ecchymosis
 Inability to use extremity
 No deformity
 Sprains
14

Degree of joint dislocation at time

of injury cannot be determined
during exam

Extensive damage to neural or

vascular structures may have
occurred
 Strains
15

 “Muscle pull”
 Injury to musculo-tendenous unit
 Pain on active motion
 Pain not present on passive motion
 Assessment
16

 Perform initial (primary) assessment

 Locate, treat life-threats
 Assess for injuries of head, chest, abdomen, pelvis
 Assess distal neurovascular function
 Assessment
17

 With exception of pelvic, possibly femur

fractures, orthopedic injuries are NOT life-
threatening.
 Do NOT let spectacular orthopedic injury
distract you from ABCs
 It’s the unobvious things that kill patients!
 Assessment
18

 Evaluation must ALWAYS be done of distal

neurovascular function.
 Pulse
 Skin color
 Capillary refill
 Sensation
 Movement
 Management
19

 Splinting
 Prevents further movement at injury site
 Limits tissue damage, bleeding
 Eases pain
 Management
20

When in doubt:

SPLINT
 It is difficult to differentiate fractures,
dislocations and sprains
 Principles of Splinting
21

 Do NOT move patients before splinting unless

patient is in danger, or it is a medical emergency
 Remove clothes to allow inspection of limb
 Note, record distal neurovascular function before
and after splinting (check pulses, perfusion,
movement, feeling)
 Principles of Splinting
22

 Cover wounds with dry, sterile compression

dressings
 Fractures: splint joint above, below fracture
 Dislocations: splint bone above, below joint
 Principles of Splinting
23

 Minimize movement
 Support injury until splinting completed
 Pad splint to avoid local pressure
 Principles of Splinting
24

 Angulated fractures
 Realign before splinting
 If resistance or pain is encountered, stop; and
immobilize as is
 Dislocations
 Splint as is unless circulation compromised
 Attempt to reposition once to restore pulse if it as
absent
 If resistance or pain is encountered, stop; and
immobilize as is
 Traction Splinting
25

 Consider if injury is a painful, swollen mid-thigh

injury, with NO joint or lower leg injury
 Consider if a neuro-vascular injury is present
 Done by pulling bone apart, NOT pushing in bones
 Only try once
 Stop if pain worsens
 Assess pulses and nerves before and afterwards
 Apply traction device