Lesson 9:Lesson 9:Bone & Joint Injuries Bone & Joint Injuries

Emergency Reference Guide p. 33-43Emergency Reference Guide p. 33-43

ObjectivesObjectives

• Define strain, sprain, fracture and dislocation

• List Signs & Symptoms of strain, sprain, fracture & dislocation

• Demonstrate field assessment

• Define RICE (Rest, Immobilization, Cold, Elevation)

• Describe use of RICE

ObjectivesObjectives (cont’d.)(cont’d.)

• Demonstrate & describe the emergency treatment for:– Strains & sprains– Fractures– Dislocations, including re-alignment

• Describe treatment for:– Angulated fractures– Open fractures

• Describe long term care for injuries to bones & joints

• Describe when to evacuate

Bone & Joint Injury OverviewBone & Joint Injury Overview

• Injuries to musculoskeletal system are among most common wilderness injuries

• Care is same, regardless of exact diagnosis

• Strains are overstretched muscles or tendons

• Sprains are injuries to ligaments (e.g. holding bones to bones)

Bone & Joint Injury Overview Bone & Joint Injury Overview (cont’d.)(cont’d.)

• A fracture is a bone break, chip or crack– Open fracture: open wound in skin over

fracture– Closed fracture: no break in the skin– Closed fractures more common…open ones

more dangerous

• Dislocation: movement of bone or joint away from normal position, often includes tearing of ligaments.

FractureFracture

Fracture TypesFracture Types

Guidelines for Preventing Bone Guidelines for Preventing Bone & Joint Injuries& Joint Injuries

• Pay attention to safety

• Wear adequate footwear

• Engage in pre-trip physical conditioning

• Set up camp or home so there are few trip hazards

Checking for Strains, Sprains & Checking for Strains, Sprains & FracturesFractures

• Signs & Symptoms:– Deformity, Open injuries, Tenderness & Swelling

(DOTS)– Moderate to severe pain or discomfort– Bruising (may take hours to appear)– Inability to move or use affected area– Broken bone or fragments sticking out– Bones grating or sounds of grating– Feeling or hearing snap or pop– Loss of Circulation, Sensation, Motion– MOI such as fall, suggests injury may be severe

Checking for Possible Bone or Checking for Possible Bone or Joint InjuryJoint Injury

• Have patient rest in comfortable position

• Remove clothing as necessary to check injured area

• Ask how injury happened & what areas hurt (MOI)

• Visually inspect entire body. Compare both sides of body to look for differences. Feel for DOTS

Checking for Possible Strain or Checking for Possible Strain or SprainSprain

• Have patient actively move joint & evaluate pain involved

• Manipulate joint with your hands & evaluate pain

• If joint appears usable, have patient test it with his/her weight

Checking for Possible FractureChecking for Possible Fracture

• Determine whether injured part looks broken (deformed). Compare to uninjured side

• Ask patient whether he/she thinks it is broken • Gently touch injured area look for:

– Patients reaction to touch

– Muscles appear to be in spasm

– Injured area seems unstable

– One spot hurts noticeably more than the rest

– Check CSM beyond site of injury

Caring for Strains, Sprains & Caring for Strains, Sprains & FracturesFractures

• Whether usable or not, general care is RICE– Rest: don’t allow injured area to be used for at least ½

hour– Immobilization: prevent further injury by keeping

injured area still– Cold: ice works best, avoid direct contact with the skin– Elevation: Keep injury higher than patient’s heart– 20-30 min of cold followed by 10-15 min of warming– Repeat RICE cycle 3-4 times a day, if possible

RICERICE

RestImmobilization

ColdElevation

SplintingSplinting• In remote areas, patients will likely need to be moved• The splint should restrict movement to prevent further

injury & increase comfort• The splint must be made of something to pad injury &

rigid enough to provide support• Padding should fill in all spaces to help prevent

movement• Possible splint materials include branches, hiking poles,

SAM splints, magazines, etc.• Use triangular bandages, tape, elastic wraps, etc. to

secure splints

Improvised Splinting MaterialImprovised Splinting Material

• What items can be used for splinting?– Sticks– Tent poles– Oars/paddles– Ski/trekking poles– SAM Splints– Internal Pack frames

Improvised Splinting Material Improvised Splinting Material (cont’d.)(cont’d.)

• Padding:– Sleeping bags– Foamlite pads– Extra clothing– Soft debris from forest floor– Rolls of sterile dressing

SplintingSplinting• Prepare splinting material before starting trip• Splints must be able to hold injury in natural,

neutral position:– Spine inline, pad the small of the back– Legs almost straight, pad behind knees– Feet 90 degrees to legs– Arms flexed to cross the heart– Hands in functional curve with padding on palms– Leave shoe on foot, it can act as splint. Remove, if

circulation is an issue– Remove rings, bracelets, watches…may restrict flow

Splinting TypesSplinting Types

• Hard Splint: splinting material is rigid (i.e. poles, sticks, etc)

• Soft Splints: splinting material is soft & bulky (i.e. newspaper, sleeping pad, sweatshirt, etc)

• Anatomical: splint material is another body part (i.e. fingers taped together, legs splinted & tied together)

Hard SplintHard Splint

Soft SplintSoft Splint

Preparing for Leg SplintPreparing for Leg Splint

Hard Splint - LegHard Splint - Leg

Anatomical Splint - LegAnatomical Splint - Leg

Applying a Sling & SwatheApplying a Sling & Swathe

• Support injured arm above & below site of injury• Place triangular bandage under arm & over

uninjured shoulder.• Wrap outside of bandage around other side of

neck. Tie on side of neck add padding• Bind arm to torso with folded bandage• Check CSM below in hand

Arm SlingArm Sling

Arm SlingArm Sling

Splinting Skills SessionSplinting Skills Session

• Form pairs or groups of 3:

• Splint lower leg with rigid material

• Splint legs anatomically

• Splint Forearm with soft material (using a sling & swath)

Splinting Specific FracturesSplinting Specific Fractures

• Jaw: hold jaw in place, wide wrap around head Make sure can be removed (in case of vomiting)

• Collarbone: Secure collarbone with sling & swathe

• Fingers and toes: Bind to adjacent finger/toe• Ribs: support arm on injured side with sling &

swathe…make sure patient breathes deeply• Hip/pelvis: secure legs together…watch for

shock/internal bleeding

Caring for Complicated Caring for Complicated FracturesFractures

• Angulated fractures leave bones distorted, open fractures expose body to infection

• Irrigate open fracture, dress appropriately• If bone ends sticks out & help is more than 4

hours away:– Control bleeding– Clean wound & bones ends (do not touch)– Apply gentle inline traction– Dress wound

Caring for Complicated Caring for Complicated Fractures Fractures (cont’d.)(cont’d.)

• Splint the fracture, infection likely, but bones survive better in body

• With angulated fracture, bones must be straightened w/ in-line traction:– Pull in direction in which bones are pointed

– Slowly & gently move broken bone back to place

– Do not force

– Do not continue, if increasing pain

– Splint limb once aligned

DislocationsDislocations

Checking and Caring for Checking and Caring for DislocationsDislocations

• Dislocation will produce pain in joint & loss of normal motion

• Joint “Looks wrong”

• Many dislocations can only be splinted in the field

• Some can be put back by realignment through process called “reduction”

Dislocation ReductionDislocation Reduction

• Work quickly, but calmly. The sooner reduction is done, the better

• Encourage patient to relax, particularly when a joint is injured

• Stop, if pain increases dramatically

• Splint joint after it is back in place

Shoulder ReductionShoulder Reduction

• Anterior Shoulder dislocations most common:– Position patient face down on rock/log, injured

arm dangling down– Tie something 10-15 lbs in weight to dangling

wrist…patient does not hold weight– Wait…process takes 20-30 min. to work– Key is for patient to be relaxed & allow gentle

pull to ease joint back in place

Shoulder Reduction Shoulder Reduction (cont’d.)(cont’d.)

• Injured patients can do this on themselves, as well

• The sooner the better, waiting may cause chest muscles to tighten & spasm

• As soon as process completed, put arm in sling & swathe to secure it

Toe/Finger RelocationToe/Finger Relocation

• Keep injured finger partially bent

• Pull on end with one hand, press gently back in place with other

• Place gauze pad between injured finger & the finger next to it

• Tape in place

• Do not tape over injured joint

Kneecap DislocationKneecap Dislocation• Apply gentle traction to the leg to

straighten it

• Kneecap may pop in place with just traction

• Massage thigh & use hand to push kneecap gently back in place

• Apply a splint that does not put pressure on the kneecap.

• Patient may be able to walk

Guidelines for EvacuationGuidelines for Evacuation

• If injured body part is usable, level of pain determines whether evacuation is needed

• Evacuate anyone with un-usable body part & first time dislocations

• GO FAST with angulated fractures, open fractures, fractures of pelvis, hip, femur (thigh), more than one long bone or decrease in CSM below injury

ScenarioScenario

• During a trail restoration, an adult leader falls on downed branch & down a 5 foot embankment. You can call the ranger station, but help is at least 1 hour away

• Break into groups of 4, 1 victim and 3 rescuers.

Questions???Questions???

What else could you add to your What else could you add to your First Aid Kit?First Aid Kit?