Musculoskeletal System

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Musculoskeletal System

• Emergencies

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Functions of the Musculoskeletal System

• Gives the body shape
• Protects internal organs
• Provides for movement
• Consists of more than 600 muscles

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Anatomy

• Muscles - provide movement
• generate heat.
• Ligaments - connect bone to bone
• injury sprain
• Tendons - connect bone to muscle
• injury strain
• Bones - protection shape

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The Skeletal System

• Gives form to the body
• Protects vital organs
• Consists of 206 bones
• Acts as a framework for attachment of muscles
• Designed to permit motion of the body

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The Skull
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The Neck
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The Spinal Column
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The Thorax
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The Pelvis
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The Lower Extremity

• Hip
• Thigh
• Knee
• Leg
• Ankle
• Foot

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The Upper Extremity

• Shoulder girdle
• Arm
• Elbow
• Forearm
• Wrist
• Hand

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Joints
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Types of Muscle (1 of 2)

• Skeletal (voluntary) muscle
• Attached to the bones of the body
• Smooth (involuntary) muscle
• Carry out the automatic muscular functions of the
  body

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Types of Muscle (2 of 2)

• Cardiac muscle
• Involuntary muscle
• Has own blood supply and electrical system
• Can tolerate interruptions of blood supply for
  only very short periods

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Injuries

• Sprain
• Strain
• Dislocation
• Closed fracture
• Open fracture

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Sprains Strains

• Sprain
• Joint injury with tearing of ligaments
• Strain
• Stretching or tearing of a muscle

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S/S

• Pain
• Edema and Ecchymosis
• Joint instability
• Treatment - immobilize, ice, elevate if
  possible

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Dislocation

• A disruption of a joint, in which the bone ends
  are no longer in contact and the supporting
  ligaments are torn

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S/S of a Dislocation

• Marked deformity
• Edema
• Pain
• Tenderness on palpation
• Complete loss of joint function
• Distal numbness
• Treatment - immobilize, ice, elevate if possible.

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Fractures

• Closed fracture
• does not break the skin
• Open fracture
• External wound

• Nondisplaced fracture
• Simple crack
• Displaced fracture
• deformity

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Closed fracture

• Signs symptoms
• Pain
• Edema
• Possible deformity
• Contusion
• Loss of motion
• false motion
• Crepitus
• Guarding
• Treatment - immobilize, ice, elevate if possible.

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Open fracture

• Signs symptoms
• Pain
• Deformity
• Break in skin and/or exposed bone
• Treatment - dressing, immobilize, ice, elevate
  if possible

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Old terminology

• Simple compound

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Types of Fractures

• Green stick
• Spiral
• Transverse
• Comminuted
• Pathologic
• Epiphyseal

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complications of fx

• blood vessel nerve damage
• Fat embolus
• disability or deformity

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Bleeding (internal)

• Bones have a blood supply!
• Fractures bleed internally -
• Femur - 1 liter
• Pelvis - 1 liter
• Tibia - 500 cc

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Other considerations

• What is beneath fracture site?
• open fracture
• Joint involved?

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Tips other stuff

• Angulation or angulated extremity
• Depressed skull fracture
• Basilar skull fracture
• Flail Chest

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Hip Injury

• Hip Fracture classic presentation
• Shortened, externally rotated
• Hip Dislocation
• Usually flexed and internally rotated
• Requires significant force

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TX

• draw-sheet method
• Make NO attempt to straighten leg
• Support with rolled blankets
• Prevent hip movement

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Assessment of injured extremities

• PMSC
• Pulse
• Movement
• Sensation
• Capillary refill
• Cold, blue, pulseless extremity has circulation
  problem

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ALWAYS CHECK DISTAL FUNCTION BEFORE AFTER
SPLINTING !!!!!

• AND DOCUMENT WHAT YOU FOUND !!

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Splinting

• Why we splint...
• relieve pain
• reduce tissue/vessel damage during movement

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Types of splints

• Self splinting
• Pillows, blankets, items of clothing
• Sling swath
• Rigid
• Cardboard
• plastic
• ladder
• Air or vacuum
• Traction

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Traction splints

• Closed, mid-shaft femur fracture without hip,
  knee, or ankle injury.

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General Principles of Splinting (1 of 2)

• Remove clothing area
• PMSC
• Dress all wounds
• Do not move the patient before splinting

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General Principles of Splinting (2 of 2)

• Immobilize the joints
• Pad rigid splints
• Maintain manual immobilization.
• Realign angulations PRN
• When in doubt, splint
• Reassess PMSC
• Immobilize all suspected spinal injuries in a
  neutral in-line position
• pain, resistance, crepitus

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Realignment issues

• NEVER REALIGN A JOINT
• NEVER REALIGN A INJURY WITH GOOD DISTAL FUNCTION
• Only pulseless, longbone fractures

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Basic Realignment Steps

• Have all equipment ready in place
• Explain procedure to patient
• In 1 move, with gentle traction, align extremity
  (goal is anatomical position)
• Use the least amount of force necessary.
• If resistance is met or pain increases, splint in
  deformed position.
• Reassess distal function

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Remember

• No matter how bad the fracture our priorities are
  the ABCs

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Hazards of Improper Splinting

• Further damage
• Delay in transport
• Reduction of distal circulation
• Aggravation of the injury
• Injury to tissue, nerves, blood vessels, or muscle

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end

• Questions???