The mechanism of injury to bones and joints can be caused by direct forces, indirect forces, and twisting forces:
A direct force causes injury at the point of impact.
An indirect force causes injury at a site other than the point of impact.
A twisting force causes one part of an extremity to remain in place while the rest twists. Twisting injuries commonly affect the joints, such as ankles, knees, and wrists. Twisting forces cause ligaments to stretch and tear.
Injuries to bones and joints may be open or closed:
In an open injury, the skin surface is broken. An open injury increases the risk of contamination and infection. These injuries can also result in serious blood loss.
In closed injuries of bones and joints, the skin surface is not broken. The injury is often painful, swollen, and deformed.
A fracture is a break in a bone. If a bone is broken, chipped, cracked, or splintered, it is said to be fractured.
A dislocation occurs when the ends of bones are forced from their normal positions in a joint.
A subluxation, which is a partial dislocation, means the bone is partially out of the joint. A complete dislocation means it is all the way out. Dislocations and subluxations usually result in temporary deformity of the joint and may result in sudden and severe pain.
A sprain is a stretching or tearing of a ligament, the connective tissue that joins the end of one bone with another. Sprains are classified as mild, moderate, or severe.
A strain is a twisting, pulling, or tearing of a muscle. A muscle strain usually occurs when a muscle is stretched beyond its limit. A strain often occurs near the point where the muscle joins the tough connective tissue of the tendon.
Most sprains and strains can be treated with the RICE technique:
Rest
Ice
Compression
Elevation
In treating musculoskeletal injuries, DOTS is a useful tool to remember what to look and feel for:
Deformities
Open injuries
Tenderness
Swelling
In assessing extremity injuries, check the pulse, movement, and sensation (PMS) in each extremity.
A splint is a device used to limit the movement of (immobilize) an injured arm or leg to reduce pain and further injury.
In some situations, the patient will have already splinted the injury by holding the injured part close to his or her body in a comfortable position. The body used as a splint is called a self-splint or an anatomic splint.
Before splinting an injured hand or foot, place it in the position of function. The natural position of the hand at rest looks as if you were gently grasping a small object, such as a baseball.
Rigid splints are made of hard material, such as wood, strong cardboard, or plastic. This type of splint is useful for immobilizing injuries that occur to the middle portion (midshaft) of a bone. Some rigid splints are padded, but others must be padded before they are applied to the patient.
Semi-rigid (flexible) splints are very useful for immobilizing joint injuries. These splints can be molded to the shape of the extremity. Examples include the SAM® Splint and aluminum ladder splints. Semi-rigid splints can be used in combination with other splints.
Soft splints are flexible and useful for immobilizing injuries of the lower leg or forearm. Examples of soft splints include a sling and swathe, blanket rolls, pillows, and towels.
A sling and swathe is used to immobilize injuries to the shoulder, collarbone, or upper arm bone. A triangular bandage is often used to make a sling. A swathe is a piece of soft material used to secure the injured extremity to the body.
A traction splint is a device used to immobilize a closed fracture of the thighbone. This type of splint maintains a constant, steady pull on the bone. A traction splint keeps broken bone ends in a near-normal position.
A unipolar traction splint has one pole that provides external support for the injured leg.
A bipolar traction splint uses two external poles, one on each side of the injured leg, to provide external support
A pneumatic splint requires air to be pumped into or suctioned out of it. An air splint, a vacuum splint, and a pneumatic antishock garment (PASG) are examples of pneumatic splints. A pneumatic splint is placed around the injured area and is inflated (air splint or PASG) or deflated (vacuum splint) until it becomes firm.
Most spinal injuries occur to the cervical spine. The next most commonly injured areas are the thoracic and lumbar spine. A spinal column injury (bony injury) can occur with or without a spinal cord injury. A spinal cord injury can also occur with or without an injury to the spinal column. The spinal cord does not have to be severed for a loss of function to occur.
Compression fractures of the spine result in weakened vertebrae. A compression fracture can occur with or without a spinal cord injury.
Distraction occurs when the spine is pulled apart. When the spine is distracted, ligaments and muscles are overstretched or torn and the vertebrae are pulled apart.
An injury to the spinal cord may be complete or incomplete:
A complete spinal cord injury occurs when the spinal cord is severed. The patient has no voluntary movement or sensation below the level of the injury. Both sides of the body are equally affected.
Paraplegia is the loss of movement and sensation in the body from the waist down. Paraplegia results from a spinal cord injury at the level of the thoracic or lumbar vertebrae.
Quadriplegia (also called tetraplegia) is a loss of movement and sensation in both arms, both legs, and the parts of the body below an area of injury to the spinal cord. Quadriplegia results from a spinal cord injury at the level of the cervical vertebrae.
With an incomplete spinal cord injury, some parts of the spinal cord remain intact. The patient has some function below the level of the injury. With this type of injury, there is a potential for recovery, because function may be lost only temporarily.
The signs and symptoms of a possible spinal injury include the following:
Tenderness in the injured area
Pain associated with movement (do not ask the patient to move to see if he or she has pain; do not move the patient to test for a pain response)
Pain independent of movement or palpation along the spinal column
Pain down the lower legs or into the rib cage
Pain that comes and goes, usually along the spine and/or the lower legs
Soft-tissue injuries associated with trauma to the head and neck (cuts, bruises)
Numbness, weakness, or tingling in the extremities
A loss of sensation or paralysis below the site of injury
A loss of sensation or paralysis in the upper or lower extremities
Difficulty breathing
A loss of bladder or bowel control
An inability to walk, move extremities, or feel sensation
Deformity or muscle spasm along the spinal column
Manual stabilization of the head and neck is also called in-line stabilization. Manual stabilization of the head and neck helps prevent further injury to the spine.
As an Emergency Medical Responder, you may need to apply a rigid cervical collar (also called a c-collar) in treating a spinal injury. You should use a c-collar only if the equipment is available and you have been trained to use it. When used alone, a rigid cervical collar does not immobilize. For effective immobilization, a rigid collar must be used with manual stabilization or a spinal immobilization device, such as a backboard.
A log roll is a technique used to move a patient from a face-down to a face-up position while maintaining the head and neck in line with the rest of the body. This technique is also used to place a patient with a suspected spinal injury on a backboard.
A long backboard helps stabilize the head, neck and torso, pelvis, and extremities. It is used to immobilize patients found in a lying, standing, or sitting position.
A short backboard helps immobilize a patient's head, neck, and torso. It can also be used as a long backboard for a small child. Examples include vest-type devices and rigid short backboards.
An injury to the scalp may occur because of blunt or penetrating trauma. When injured, the scalp may bleed heavily. In children, the amount of blood loss from a scalp wound may be enough to produce shock.
The skull protects the brain from injury. However, damage to the skull can cause damage to the brain. Skull injuries may occur from blunt or penetrating trauma. Significant force, such as a severe impact or blow, can result in a skull fracture.
A head injury may be open or closed:
In an open head injury, the scalp is not intact and the risk of infection is increased. Broken bones or foreign objects forced through the skull can cut, tear, or bruise the brain tissue itself.
In a closed head injury, the skull remains intact. However, the brain can still be injured by forces or objects that strike the skull. The forces that impact the skull cause the brain to move within the skull. The brain strikes the inside of the skull, which causes injuries to the brain tissue.
A concussion is a traumatic brain injury that results in a temporary loss of function in part or all of the brain. A concussion occurs when the head strikes an object or is struck by an object. The injury may or may not cause a loss of consciousness. A headache, loss of appetite, vomiting, and pale skin are common soon after the injury.
An altered or a decreasing mental status is the best indicator of a brain injury.
To treat a patient with a head injury, use the following steps:
Conduct a scene size-up, ensure safety, and put on appropriate PPE. Evaluate the mechanism of injury.
Form a general impression.
Perform an initial assessment.
Ask an assistant to manually stabilize the patient's head and neck while you continue your exam.
Closely monitor the patient's airway, breathing, pulse, and mental status.
