Bone and joint injury

01/11/2024 1
 Fracture
 A fracture is a disruption of the normal architecture of
bone caused by different degree of trauma.

 It is a complete or incomplete break in

a bone resulting from the application of excessive
force.

 is a complete or incomplete disruption in the

continuity of bone structure and is defined according
to its type and extent.
01/11/2024 2
 Mechanism
 Bone break when the force is applied that exceed
inside strength or compressive strength of the bone or
when they cannot withstand a force or trauma applied
to them.

01/11/2024 3
 ETHIOLOGY
 Extrinsic cause
bending force , torsion force
shearing force, compressional force ,
direct blows, crushing forces

 Intrinsic cause
fractures due to extreme muscular contraction;
pathologic fractures

E.g.: neoplasia, bone cysts , nutritional

hyperparathyroidism, osteomyelitis, osteoporotic bone
01/11/2024 4
 Classification of fracture

Why do we Classify?

 As a treatment guide
 To assist with prognosis
 To speak a common language with others
 In order to compare results

01/11/2024 5
 Classification

By cause

A. Traumatic fracture - This is a fracture due to

sustained trauma. e.g.- Fractures caused by a fall, road
traffic accident, fight etc.
B. Pathological fracture - A fracture through a bone
which has been made weak by some underlying disease
e.g.- a fracture through a bone weakened by metastasis.
Osteoporosis is the most common cause of pathological
fracture.
01/11/2024 6
 Classification,,,,,,,,
Broad classification
• Based on the presence and absence of
communication with the external environment
Simple (closed) fracture
 Fracture is not exposed to the environment and skin is
intact .
Compound (open) fracture
 A break in the skin and underlying soft tissue leading
directing into or communicating with the fracture
and its hematoma.
01/11/2024 7
 classification

Simple # (compound(complex #))

A fracture that remains contained, is one in which the skin or mucous
with no disruption of the skin integrity membrane wound extends to the
fractured bone
01/11/2024 8
Classification by degree of separation of the fracture
fragments
1. Complete fractures
2. Incomplete fractures
Complete fracture :- involves a break across the entire
cross section of the bone and is frequently displaced
(removed from its normal position).
Types of complete fracture
A. Transverse:- A fracture that is straight across the bone
shaft fragments usually remain in place after reduction

01/11/2024 9
 Classification,,,,,
Types of complete #
B. Oblique :A fracture occurring at an
angle across the bone (less stable than a transverse
fracture).

01/11/2024 10
 Classification,,,,,

Types of complete #
c. Spiral :- A fracture that twists around the shaft of the bone.

Oblique or spiral # are slip and redisplaced even if the bone is

splinted.
01/11/2024 11
 Classification,,,,,

Types of complete #
D. Impacted:-A fracture in which a bone fragment is
driven into another bone fragment.
 The fragments are tightly jammed together and
fracture is indistinct.

01/11/2024 12
 Classification,,,,,

Types of complete #
E. Comminuted:- A fracture in which bone has splintered
into several fragments
 There are more than two fragments and highly unstable.

01/11/2024 13
 classification
Incomplete fractures:
 it is seen in children whose bones are more elastic than those of
adults. Reduction is easy and healing is quick.
A. Greenstick fracture:- bend on one side of the bone and a
partial fracture on the other side

B. Plastic deformity:- Bending without fracture

• non reversible deformation after elastic limit surpassed (yield
strength) .
• Caused predominantly by slip at micro cracks .
• Permanent deformity can be resulted which can’t be remodeled
well.
• Common at forearm and fibula.
01/11/2024 14
 Plastic deformity

Greenstick fracture

01/11/2024 15
 Class,,,,,,,,,,
Incomplete fractures:
C. Buckle fracture :
 occurs at the metaphyseal locations and resemble the
torus or base of a pillar in architectural terms.
 Common in children between 2 and 12 years at distal
radius ,often at ulna and wrist by falling ,repeated
sports etc.

01/11/2024 16
 Class,,,,,,,,,,
D. Compression fracture:- bone has been
compressed (seen in vertebral fractures)

01/11/2024 17
 Signs and Symptoms

 Pain, swelling, tenderness and difficulty of moving the

injured part.
 Abnormal movement
 Difference in shape and length
 Deformities.
 Discoloration.
 Loss of function
 Crepitus
 Localized Edema and Ecchymosis

01/11/2024 18
 Objectives of the first aid

 To stop bleeding.
 To immobilize the injured part.
 To transport the victim to hospital
 To give care for shock.
 To take measure to relief pain

01/11/2024 19
 First aid principles
 Rescue if necessary and protect against further injury.
 Maintain an open air way and apply AR if indicated.
 Call for an ambulance
 Immobilize injured parts and the adjacent joint.
 Elevate involved extremities if possible without
disturbing the suspected fracture.
 Apply splint to help immobilize

01/11/2024 20
 …Cont.
 Remove or cut away the victims clothing.
 Control hemorrhage by applying direct pressure
 Don't wash, or probe or do not insert your fingers into
the wound.
 If a fragment of bone is protruding, cover the entire
wound with sterile dressing.
 Do not try to replace any bone fragments.

01/11/2024 21
 Splinting
• Splints are metallic, wooden
or other devices applied to the
arms, legs or trunk to
immobilize the injured part.
• Protect against further injury
during transportation

01/11/2024 22
 General principles of splinting

 The splint should be long enough to extend past the

joints on either side of a suspected fracture.
 It should be adequately padded.
 It can be held in place by stripes of clothes and other
available materials.
 In fractures of arms, check for pulse; inspect the fingers
for color and swelling.
01/11/2024 23
 Cont’d,,,,,,,,,,,,
 If there is numbness, tingling sensation loosen ties
immediately

 Inform the victim not to move the part below the

fracture site.

 Never test for fracture by moving the victim’s broken

body part.

 Straighten and splint a deformed limb as necessary.

01/11/2024 24
 Specific fractures
Fracture of the scapula
 Fracture of the scapula (shoulder blade)is generally the
direct result of the impact of a fall or an automobile
collision.
 Dislocations of the shoulder joint, sprains and contusions
are common in this area.
 First aid consists of applying a sling and bandaging the
victim’s upper arm to his/her chest wall
01/11/2024 25
01/11/2024 26
 Fracture of the humorous

FA for a closed humorous fracture

 Place a pad in the victim’s arm pit, apply a splint or
improvised splint tied in place above and below the
break area
 Support the forearm with a sling that doesn’t produce
upward pressure at the fracture site.
 Bind the victim’s upper arm to his/her chest wall

01/11/2024 27
01/11/2024 28
 FA for an open fracture

A. Remove the victim’s cloth

B. Control bleeding by applying direct pressure and
elevating the part
C. Cover the wound with a large sterile or clean
dressing and apply a splint that does not press
against the area of the break.
D. Do not attempt to cleanse the wound and push a
protruding bone back .
E. Arrange for transportation as soon as possible

01/11/2024 29
 Elbow fracture

• Elbow fractures may involve the lower part of the

humerus or the upper bones of the forearm.
First aid measures
• Place the victim’s forearm in a sling and bind it to his/her
body (if the elbow can be bent).

01/11/2024 30
 …cont.
 If the elbow cannot bent, immobilize the fracture at the
upper arm, at the elbow and at the wrist against the
chest , abdomen and at the hip.
 Lie the victim down and elevate the arm.
 If a splint is not available, wrap a pillow about the arm
centering it at the elbow and tie or pin the two sides
together.

01/11/2024 31
 Fracture of forearm and wrist

 The two bones of the fore arm (ulna and radius) may be
fractured individually or together.
First aid measures
 Fractures in the mid portion of the fore arm and wrist are
treated in the same way as fractures of the shaft of the
humerus.

01/11/2024 32
01/11/2024 33
 Fracture of the upper leg
• Fractures of the shaft of the femur usually result from falls or
traffic injuries.

• If the victim is to be transported only for short distance on a

stretcher, place a blanket b/n the legs and bind them together.
• To apply the board splint, assemble needed supplies.

• If you use improvised board splints, it should be well padded and

should reach from the victim’s armpit on the outer side and groin
on the inner side to below his/her heel.

01/11/2024 34
 …Cont.

• The bandages will be tied on the following areas: just

below the arm pit, at the abdomen, at the hip, above and
below the fracture site, at the lower leg and ankle and
foot with figure of eight bandage.

• Don’t try to cleanse open wound (if present).

• If possible apply a traction splint for the fracture of the
shaft of the femur.
01/11/2024 35
 36
01/11/2024
 Fracture of the kneecap (Patella)

 Patella fractured usually by direct injuries sustained

when control of the knee is lost, with the front thigh
muscles pulling violently on the kneecap.

01/11/2024 37
 First aid measures

A. Apply a pillow splint about the

knee or padded splints from below
the victim’s heel to his buttocks
along the back of the leg, with the
leg extended.
B. Raise the leg slightly to prevent
swelling.
C. Send to hospital or a health center.
01/11/2024 38
 Fracture of the lower leg
First Aid for Fractures for lower leg
 Apply well- padded splints on both sides of the leg and
foot from the top of the patient’s thigh to his foot .

 The splint will be secured with a bandage at the thigh, at

the knee, below and above the fracture and at the ankle
and foot with a figure of eight bandage.

01/11/2024 39
 …cont.

 In an emergency, insert blankets or towels between the legs

and tie them to gather.

 Remember to keep the victim’s foot pointing up ward and

check for poor circulation, prevent movement of the broken
bone ends, knees and ankle.

01/11/2024 40
01/11/2024 41
 Fracture of ankle and foot

 The ankle is made up of the lower ends of the tibia and

fibula, and The first bone of the foot (the talus).
 Fractures in this area occur most commonly in active
sports, in falls, and in motor vehicle accident.

01/11/2024 42
 First aid measures
I. Loosen or remove the victim’s shoes,
and hose (socks) and keep him lying
down with his leg elevated.
II. For an open wound apply large bulky
dressings.
III. Splint with a pillow or blanket firmly
applied with out attempting to correct
the deformity.
IV. Send to hospital for definitive care
01/11/2024 43
 First aid measures for different types of fracture

Control bleeding if open fracture.

Immobilize any fractured or injured body parts.
Hold victim gently while moving purposely.
Elevate with out interruption with fracture.
In case of face and jaw bone fracture ,maintain open air way

01/11/2024 44
 Dislocation

 Dislocation is an injury to the ligaments around a joint that

permits a separation of the bone from its normal position in
a joint.
 Signs of a dislocation are similar to those of a fracture, thus
a suspected dislocation should be treated like a fracture.
 Never try to relocate a suspected dislocation.

 immobilize the joint until professional medical help is

available.
01/11/2024 45
 …cont.

 Displacement of a bone end

commonly affects:-
 shoulder, elbow, wrist,
fingers or thumb
 Commonly caused by fall or a
direct blow, sports

01/11/2024 46
 A dislocated joint is:

Misshapen
Very painful
Swollen
Discolored

01/11/2024 47
 S/S of dislocation

 Swelling.
 Obvious deformity.
 Pain
 Tenderness
 Discoloration.

01/11/2024 48
 First aid measures

A. Splint and immobilize the affected joint

B. Apply a sling if appropriate.
C. Elevate the affected part if a limb is involved.
D. Never attempt to reduce a dislocation.
E. Seek medical attention promptly.

01/11/2024 49
 Sprain

 Tearing injury to one or more ligaments of the joint,

which occur when joint is forced beyond the limit of its
normal plane of motion .
 An injury to a joint, muscle and tendon in the region of a
joint.
 The ankles, fingers, wrists and knees are most often
sprained.
01/11/2024 50
 S/S of sprain

 Tenderness
 Swelling
 Bruising (Discoloration)
 Restricted use or loss of use
 Pain upon motion

01/11/2024 51
 Strain
 Tearing injury to muscle fibers resulting from
excessive tension or overuse or over stretching.
 The fibers are stretched and some times partially torn.
 Commonly strains occur on the back muscles, due to
improper lifting technique.

01/11/2024 52
 To avoid back strain

 Place the feet close to the object firmly and apart.

 Squat; do not lean foreword keeping the back as straight as

possible
 Lift slowly, pushing up with the strong thigh and leg muscles
are bearing the weight.
 Do not jerk the object upwards, or twist or turn your body as
lifting takes place.
 To lower a heavy object reverses procedure.
01/11/2024 53
 Strain prevention

01/11/2024 54
 FA for sprain and strain (known as RICE)

Rest the injured part of the body.

Ice: apply ice packs or cold compresses for up to 10 or 15
minutes at a time every few hours for the first 2 days to
prevent swelling.
Compression: wearing an elastic compression bandage
for at least 2 days will reduce swelling.
Elevation: keep the injured part elevated above the level
of the heart to reduce swelling.
01/11/2024 55
01/11/2024 56