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| Tuesday, September 26, 2006 |
| FRACTURES & DISLOCATIONS. |
FRACTURES & DISLOCATIONS.
Fractures & Dislocations.
There are different kinds of broken bones.
Simple or closed fractures:
v The broken bone is not visible through the skin nor is there a skin wound near the fracture site. An example of this is a greenstick fracture. It is called this because the x-ray shows a barely visible fracture and it resembles the pattern of a very young splintered twig.
Compound or open fracture:
v A bone may separate partially or completely from the other half and a skin wound is also present. The bone can protrude through the skin or the skin has been cut due to the injury.
Bones can break in more than one place.
Bones in children are more pliable and may resist breakage more than bones in adults.
Broken bones need treatment right away.
They may cause future deformities and limited movement if not properly cared for. They are also very painful.
Type of Fractures & Dislocations
1. Hip fracture:
v Hip fractures are most common in elderly women and usually are caused by simple falls. Hip fractures also occur in motor vehicle accidents and other sudden deceleration incidents.
v Blood loss can be moderate to severe. The affected extremity may appear to be shorter than the other extremity. Discoloration and swelling may be present over the fracture site.
v A hip fracture is a serious injury that must be evaluated by an orthopedist.
2. Humerus fracture:
v The humerus is the longest and strongest bone in the upper extremity, and substantial force is required to fracture it; blood loss can be heavy. Neurovascular compromise may develop. This is a serious injury that requires evaluation by an orthopedist.
3. Wrist fracture:
v Wrist fractures often occur when persons fall on their outstretched hands or when they throw up their hands to protect themselves against hitting the interior of the vehicle in a motor vehicle accident.
4. Ankle fracture:
v The bones of the lower legs often are fractured in sports accidents, motor vehicle accidents, and falls.
v If the injury was caused by rapid vertical deceleration (a fall), suspect spinal and heel injuries as well, because the energy would have been directed up the body on impact.
v Obvious deformity may be present, or the only indication of trauma may be swelling and pain.
5. Dislocations:
v Any dislocation of a joint can be serious.
v Disruption of the blood supply and nerves in the area can result in loss of the limb or permanent disability. Even if the dislocated joint slips back into place, the patient still must be evaluated by an orthopedist.
v Hip dislocation.
A hip dislocation is a serious orthopedic emergency.
The blood supply to the head or top of the hip may be impaired, causing necrosis and necessitating replacement with an artificial joint in the future. Pressure on the sciatic nerve can result in permanent disability.
Hip dislocation often occurs in motor vehicle accidents when a person's knees strike the dashboard, and the energy then is directed back to the hips. Pain is often severe, and the leg may rest in an abnormal position.
6. Knee dislocation.
v When the bones forming the knee are dislocated or fractured, serious injury to the popliteal artery may occur. Therefore, arteriograms are obtained in the hospital whenever a patient has a dislocated knee.
v Serious knee injuries may necessitate amputation of the leg; consequently, knee dislocation is an orthopedic emergency.
7. Impalement:
v Penetrating trauma may result in foreign bodies or objects impaling bones, muscles, or tendons. Disability or loss of the extremity may occur.
8. Lacerations:
v Although simple lacerations often heal with only simple suturing, lacerations that penetrate the tendons and ligaments in the hands and feet can result in permanent disability if not thoroughly irrigated and repaired.
9. Traumatic Amputations:
v Often sustained in industrial and recreation accidents, traumatic amputations are serious emergencies. Depending on the circumstances, the amputated parts can sometimes be replanted, so the parts should always accompany the patient to the hospital.
v Blood loss may be significant, and some disability and disfigurement are to be expected.
10. Sprain:
v Tearing of a ligament that connects one bone to the other commonly is due to twisting forces and results in a sprain. Although sprains are not usually serious, the patient should be evaluated by a physician.
11. Strain:
v Overstretching or overexerting a muscle, as in sports activities, can cause a strain of that muscle, which is associated with pain. The strain is generally in the area of the tendon, where the muscle attaches to the bone.
TREATMENTS
v Don’t put ice directly on the injured area without cover
v Don’t elevate the injured part if there’re any symptoms of internal bleeding
v If the site of injury is bleeding then treat the wounds and cuts accordingly, but do not try to reset/reshape the bone or joint.
v Also look for signs of shock.
v If the joint or bone needs to be repositioned, do not give the person anything to eat or drink as it will put off medical treatment.
v If there is bleeding do not give aspirin because aspirin is a mild blood thinner and will delay clotting.
Strain Sign & Symptoms
Sudden pain on the injured area
Can cause cramp or immobility
Swollen on the affected area.
Sprain Sign &; Symptoms
Pain on the injured joint
Pain increased when joint were move
Swollen and bruise
Inability to move and bear weight
Any discoloration ( bluish, reddish)
Dislocate happen when the bone and joint are overstressed, contact sports, rheumatoid arthritis, sudden jerking of arm or hand of a small child..
Sign & Symptoms
The injured area look abnormal
Injured body part cannot be moved or painful when moved
Swollen and bruise
A misshapen appearance
Inability to move and bear weight
1. First Aid Treatment for Strain, Sprain and Dislocation
if possible make a splint to help immobilize the affected area.
Do not try to reposition the bone/joint while making the splint.
Apply the RICE method
v Rest : Avoid movement of the injured area and avoid participation in activities that can to re-injure until after the wound had had plenty of time to heal.
v Ice :Use ice to minimize swelling. If no ice is available, a bag of frozen veggies is a good substitute.
v Compression : an elastic or fabric bandage may help decrease swelling and ease the pain. Make sure the bandage is not wrapped to tightly.
v Elevation : If possible raise the injured limb up above the heart. Support the elevated limb in a sling or under a pillow or folded blanket.
v Get help if needed
Muscle Cramps
Discomforts on the body muscle.
Sign &; Symptoms:
v A sharp sudden painful spasm, or tightening of a muscle, (especially common in the legs).
v Muscle hardness
v Twitching of the muscle
v Persistent cramping pains in lower abdominal muscles
v Muscle contracts with great intensity and stays contracted, refusing to stretch out again.
Causes
v Imbalances in certain minerals, body fluids, hormones, and chemicals
v Malfunctions in the nervous system
v Excessive physical activity and hormonal imbalances causes heavy sweating.
First Aid Treatment
v Try to stretch the muscle and massage out the cramp using medicated ointment.
v Muscle cramps can also be caused by a lack of potassium and vitamin E, so eating something like bananas or pineapple can help to replenish the minerals you’ve lost.
Caution
v If suffer from frequent or severe cramps, see doctor especially if severe cramps in chest, shoulders, or arms which, can be symptoms of a heart attack; call immediately for medical help.
v Muscle cramp lasts more than an hour.
v Cramp is in your chest or arms.
2. Fracture Treatment: Immobilization
Defination
Immobilization refers to the process of immobilizing or fixating the position of a joint, bone, extremity, or torso with a splint, cast, or brace.
Purposes of Immobilizing Fractures
To prevent the sharp edges of the bone from moving and cutting tissue, muscle, blood vessels, and nerves. This reduces pain and helps prevent or control shock.
In a closed fracture immobilization keeps bone fragments from causing an open wound and prevents contamination and possible infection.
Purpose
To support and protect broken bones, dislocated joints, and injured soft tissue, such as tendons and ligaments. It can help reduce pain, swelling, and muscle spasms and to prevent an injured area from moving while it heals.
Method of Immobilization
§ Slings.
o A sling is a bandage or a piece of cloth, a belt and so forth suspended from the neck to support an upper extremity. It may be improvised by using the tail of a coat or shirt, and pieces torn from such items as clothing and blankets. The casualty's hand should be higher than his elbow, and the sling should be applied so that the supporting pressure is on the uninjured side.
§ Bandages.
o Bandages may be improvised from belts, rifle slings, bandoliers, kerchiefs, or strips torn from clothing or blankets. Narrow materials such as wire or cord should not be used to secure a splint in place.
§ Splints.
o Improvised from items such as boards, poles, sticks, tree limbs, rolled magazines, rolled newspapers, or cardboard.
o If nothing is available for a splint, the chest wall can be used to immobilize a fractured arm and the uninjured leg can be used to immobilize (to some extent) the fractured leg.
§ Padding.
o Padding may be improvised from such items as a jacket, blanket, poncho, shelter half, or leafy vegetation.
Basic Splinting Principle : immobilize the joints above and below any fracture.
>>figure
Fractures & Dislocations.
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Procedures for Splinting Suspected Fractures
v Gather whatever splinting materials are available such as splints, like wooden boards, branches, or poles. Other splinting materials include padding, improvised cravats, and/or bandages. Ensure that splints are long enough to immobilize the joint above and below the suspected fracture.
v If possible, use at least four ties (two above and two below the fracture) to secure the splints. The ties should be nonslip knots and should be tied away from the body on the splint.
Evaluate the victim.
v Be prepared to perform any necessary lifesaving measures that include clearing the airway, rescue breathing, preventing shock, and/or bleeding control.
WARNING
v Unless there is immediate life-threatening danger, such as a fire or an explosion, DO NOT move the casualty with a suspected back or neck injury. Improper movement may cause permanent paralysis or death.
v In a chemical environment, DO NOT remove any protective clothing. Apply the dressing/splint over the clothing.
Locate the Site of the Suspected Fracture.
v Ask the casualty for the location of the injury. Does he have any pain? Where is it tender? Can he move the extremity? Look for an unnatural position of the extremity. Look for a bone sticking out (protruding).
Prepare the Casualty for Splinting the Suspected Fracture .
v Reassure the casualty.
v Loosen any tight or binding clothing.
v Remove all the jewelry from the casualty and place it in the casualty's pocket. Tell the casualty you are doing this because if the jewelry is not removed at this time and swelling occurs later, further bodily injury can occur.
NOTE: Boots/shoes should not be removed from the casualty unless they are needed to stabilize a neck injury, or there is actual bleeding from the foot.
Gather Splinting Materials
v If standard splinting materials (splints, padding, cravats, and so forth) are not available, gather improvised materials like wooden boards, tree branches, poles, rolled newspapers or magazines.
v Splints should be long enough to reach beyond the joints above and below the suspected fracture site.
v Improvised padding, such as a jacket blanket, poncho, shelter half, or leafy vegetation may be used.
v A cravat can be improvised from a piece of cloth, a large bandage, a shirt, or a towel or parts of the casualty's body may be used. For example, the chest wall may be used to immobilize an arm; and the uninjured leg may be used to immobilize the injured leg.
v If splinting material is not available and suspected fracture CANNOT be splinted, then swathes, or a combination of swathes and slings can be used to immobilize an extremity.
Pad the Splints
v Pad the splints where they touch any bony part of the body, such as the elbow, wrist, knee, ankle, crotch, or armpit. Padding prevents excessive pressure to the area.
Check the Circulation Below the Site of the Injury
v Note any pale, white, or bluish-gray color of the skin which may indicate impaired circulation.
v Circulation can also be checked by depressing the toe/fingernail beds and observing how quickly the color returns. A slower return of pink color to the injured side when compared with the uninjured side indicates a problem with circulation. Depressing the toe/fingernail beds is a method to use to check the circulation in a dark-skinned casualty.
v Check the temperature of the injured extremity. Use your hand to compare the temperature of the injured side with the uninjured side of the body. The body area below the injury may be colder to the touch indicating poor circulation.
v Question the casualty about the presence of numbness, tightness, cold, or tingling sensations.
Casualties with fractures to the extremities may show impaired circulation, such as numbness, tingling, cold and/or pale to blue skin. These casualties should be evacuated by medical personnel and treated as soon as possible. Prompt medical treatment may prevent possible loss of the limb.
WARNING
If it is an open fracture (skin is broken; bone(s) may be sticking out),
DO NOT ATTEMPT TO PUSH BONE(S) BACK UNDER THE SKIN.
Apply the Splint in Place
i. Splint the fracture(s) in the position found. DO NOT attempt to reposition or straighten the injury:-
v If it is an open fracture, stop the bleeding and protect the wound. Cover all wounds with field dressings before applying a splint.
v If bones are protruding (sticking out), DO NOT attempt to push them back under the skin. Apply dressings to protect the area.
ii. Place one splint on each side of the arm or leg. Make sure that the splints reach, if possible, beyond the joints above and below the fracture.
iii. Tie the splints. Secure each splint in place above and below the fracture site with improvised (or actual) cravats. Improvised cravats, such as strips of cloth, belts, or whatever else you have, may be used. With minimal motion to the injured areas, place and tie the splints with the bandages.
v Push cravats through and under the natural body curvatures (spaces), and then gently position improvised cravats and tie in place.
v Use nonslip knots. Tie all knots on the splint away from the casualty (Figure 4-2). DO NOT tie cravats directly over suspected fracture/dislocation site.
Check the Splint for Tightness
v Check to be sure that bandages are tight enough to securely hold splinting materials in place, but not so tight that circulation is impaired.
v Recheck the circulation after application of the splint. Check the skin color and temperature. This is to ensure that the bandages holding the splint in place have not been tied too tightly. A finger tip check can be made by inserting the tip of the finger between the wrapped tails and the skin.
v Make any adjustment without allowing the splint to become ineffective.
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