EMERGENCY MEDICINES

Muna Abdirahman Yasin

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 Chapter :2 Bone and
Joint Injury

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 BONE AND JOINT INJURIES
Multiple injuries to skeletal system, including, the bones
joints and ligaments, and adjacent soft tissue are common.
It may occur in all types of major accident.
• Fracture is break or crack in bone.

They are two types of fracture.

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 What to look for
It may be difficult to tell if bone is broken when doubt treat
the injury as a fracture.
Use the acronym LAF (look, ask, feel)
• Look: Look at the injury site for swelling or deformity,
compare the injured site to uninjured site
• Ask: Ask the victim to treat the pain. Ask if the victim can
use the injured part
• Feel: Is there tenderness when the injured part is felt?

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 The indicator of broken one
1. Swelling caused by bleeding, it happens rapidly after a
fracture
2. Deformity: Compare the injured part with uninjured
3. Pain and tenderness at the injury site
4. The victim may be unable to point the site of pain. The
useful procedure for detecting fractures is to feel gently
along the bones
5. Inability to use the injured part
6. Treat the victim for shock
7. Gently remove clothing.
Don’t move the injured area unless necessary.
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 8. Use LAF
Look: Look swelling and deformity
Ask: Ask the victim about the pain
Feel: Area tenderness
9. Check circulation and nerves by using
acronym (CSM) (circulation, sensation,
movement)
• Circulation is checked by feeling for pulse or
capillary refill test or colour
• Sensation is checked by lightly touching the
victim’s toes or fingers & asking the victim to
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 10. Stabilize the injured part in place. Most broken
bones are minor and the part usually needs to be
stabilized.
NB:
• Don’t straighten dislocations or fractures involving
the spine, shoulder, elbow, wrist or knee because of
major nerve and arteries near these joints.
• Don’t try to push a bone back under the skin.

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 Reasons of splinting
• Minimize pain
• Prevent further
damage of muscle
nerve and blood vessels
• Prevent closed fracture
• Reduce bleeding and
swelling

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Shoulder
Fracture of the scapula, dislocation of shoulder
joints sprain and contusion are common in this area.
What to do
• 1. Support injured arm slightly away from the chest with
the wrist and hand slightly higher than the elbow
• 2. Apply arm sling through back.
• 3. Check for sign of circulation loss (pulse, finger nail
color)
• Most shoulder dislocation is anterior. The victim will hold
his or her arm in a fixed position away from the chest wall.
• You can also use splinting by placing a pillow or rolled
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Fore Arm
• To stabilize a fore arm fractures
• Use rigid splint from the palm of the
hand to outer part of the elbow one on
the opposite side “Sandwich splint” to
prevent rotation of the fore arm.
• Keep the victim thumb in upright
position
• Prevent two bone touching each other
• Secure the splint by cravat or roller
bandage
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Wrist, hand, and finger
• Stabilize by attaching a rigid splint that extends past the tip
of finger to mid forearm.
• Place the hand into its position of function
• Place a pillow around the hand and fore arm and tying the
pillow in place with cravat.
• Then place in a sling
• Fingers may be taped together gauze is used to separate
the fingers

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Pelvis and hip
• Stabilize the victim as she or he is found
• Treat for shock until EMS system to arrive
• Pillows or soft objects can be placed underneath the
knees.

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Femur bone
• Place a folded blanket or pillow between the victim’s leg for
padding
• Tie the injured leg to the uninjured leg by several cravat or
bandage
• Secure two boards one placed between the victim’s leg
extending from the groin to foot.
• Other placed along the victim’s side extending from the
arm pit to the foot
• Stabilize the hip and knee against movement. Stabilize the
victim against any movement. Tell the victim not to move

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Lower Leg
• Stabilize the lower leg with two boards extending from
the upper thigh to the bottom of the foot or place a
folded blanket between the victims leg.
• Pad and then tie the injured leg to the uninjured leg
with several cravat or bandage.

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Spine
What to look for
• Head injury
• Painful movement of arms and leg numbness
• Loss of bowel or bladder control
• Paralysis to the arms and or leg
• Deformity of the
victim’s head and
neck

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 What to do
• Stabilize the victim in place
• Send urgently to hospital

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Dislocation
• It occurs when joint comes apart and stays apart with the
bones ends no longer in contact.
• It has the same sign and symptoms of fracture.

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 What to do
• 1. Check the CSM (Circulation Sensation and
Movement)
• 2. Stabilize using a splint
• 3. Do not replace the joint since nerves and blood
vessels could be
damaged

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 Sprain
• A sprain is an injury to joint ligament or a muscle.
• It involves the
tearing of these
structures.
• Injury to blood
vessels and
contusion of
surrounding
soft tissue occurs.

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 Strains
• Strain is an injury to a muscle that results from
overstretching.
• It may be associated with sprain or fracture.

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 Mgt of sprain and strain
• R - Rest
• I – Ice for 48 hours. Hot compress after that.
• C – Compression by elastic bandage
• E – Elevation

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Complications of fracture
• Early • Late
• Arterial injury • Osteomyelitis
• Nerve injury • Non-union
• Thromboembolism • Malunion
• Open fracture • Post traumatic arthritis

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THE END

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