SlideShare ist ein Scribd-Unternehmen logo
1 von 64
Downloaden Sie, um offline zu lesen
INSTITUTE OF HEALTH SCIENCES
SCHOOL OF MIDWIFERY AND NURSING
DEPARTMENT OF ADULT HEALTH NURSING
AND MIDWIFERY
PREPARED BY:- KIDANE DINKU.
INITIAL EVALUATION AND MANAGEMENT
OF ORTHOPEDIC INJURIES
Presentation
2/7/2023
1
Outline presentation
2/7/2023
 Objective
 Introduction
 Fracture, Flail Chest
 Dislocation, Sprain And Strain.
 Principles for bone and joint injuries.
 Splint specific fractures.
 Management for dislocation.
 Management for sprain and strains
2
Objectives
2/7/2023
After studying this chapter, the student will be able to:
 Define fracture, dislocation, sprain and strain.
 Recognize f/a principles for bone and joint injuries.
 Demonstrate how to splint specific fractures.
 Demonstrate first aid management for dislocation.
 Apply first aid management for sprain and strain.
3
Introduction
 Musculoskeletal trauma involves injury to one or more of the
following structures:
Bone: A unit of the skeleton composed of the hardest variety of
connective tissue.
 Bones give shape and support to the body.
 In addition to surrounding and protecting vital organs, they serve as
points of attachment for the muscles of the limbs, making movement
possible.
2/7/2023
4
Cont…
Joint: The area where two or more bones articulate with one
another.
 Joints are usually classified in terms of the amount of motion
permitted at the articulation.
 Most joints of the extremities are synovial joints, which allow
the greatest amount of motion.
2/7/2023
5
Cont…
Ligament: A bundle of connective tissue forming part of the
fibrous capsule surrounding a joint and attached to it.
 Every joint of the extremities is reinforced by two or more
ligaments
Tendon: The fibrous structure connecting a voluntary muscle to
bone, cartilage, or ligaments.
 Tendons enable muscles to effect motion in the joint or body
area to which they are attached
2/7/2023
6
Orthopedic injuries to these structures include the
following:
 Fracture -is a complete or incomplete break in the continuity of bones.
 Fracture -is a complete or incomplete break in the continuity of
bones.
 Dislocation -is complete or Partial separation of the joint
 Sprain- is a joint injury caused by excessive stretching of the
supporting ligaments.
 Strains- are caused by stretching or tearing of a muscle.
 Subluxation -Partial disruption of a joint, in which some degree of
contact between the articular surfaces remains
2/7/2023
7
Cont…
2/7/2023
Fracture-dislocation or fracture-subluxation
 Disruption of a joint combined with fracture of at least one of
the bones involved in the articulation.
Diastasis:
 A separation of the interosseous membrane connecting two
syndesmotic joints as seen between the radius and ulna and
tibia and fibula.
8
Mechanism of injury
2/7/2023
By. Kidane D ( Bsc in Emergency and Critical Care Nurse )
 Motor vehicle accident
 Industrial accident (machine)
 Gunshot injury
 Fall from a height, trivial
 Fighting injury
 Pathologic fractures
 Stress fractures
9
Patient’s History
2/7/2023
 The value of the history in cases of orthopedic trauma is often
underestimated.
 Knowing the precise mechanism of injury may be the key to
diagnosing some fractures or dislocations.
 For example, a history of shoulder injury combined with the
complaint of dysphagia may be the only clue to the existence
of posterior sternoclavicular dislocation.
10
Cont..
2/7/2023
 History taking should not necessarily be limited to orthopedic
issues.
 Depending on the situation, a general medical history should be
obtained because it may have implications for further workup.
 Relevant issues may include a history of cancer, heart disease or
neurologic disease, taking anticoagulant medication.
11
Initial evaluation of orthopedic injuries
2/7/2023
 Essential components of Initial evaluation of orthopedic injuries
 General patient assessment
 Examination of the injured limb
 Evaluation of circulation, sensation, and movement
12
2/7/2023
13
I. General patient assessment
2/7/2023
 Associated life threatening injuries may be missed if evaluation
of the patient is not systematic.
 Limb injuries are not life threatening unless there is excessive
bleeding from an open wound
Note: Fx to pelvic = 3L bleeds ,
Fx to femoral =1-1.5 bleeds,
Fx to tibia = 0.5-1 L bleeds.
 Fx to each ribs bleeds 150ml,
Fx to humerus =0.5-1L bleeds,
14
ll. Examination of the injured limb
2/7/2023
1. Inspect the injured limb and compare it with the opposite, uninjured
limb.
2. Gently and carefully cut away any clothing covering the wound, if
necessary.
3. When you examine the limb, you may find any one of the following:
a. Open wound
b. Deformity
c. Swelling
d. Bruising
15
Cont …
2/7/2023
4. Gently feel the injured limb for points of tenderness- is the
best indicator of an underlying fracture, dislocation, or sprain.
5. To detect limb injury, start at the top of each limb and using
both hands, squeeze the entire limb in a systematic, firm
manner, moving down the limb and away from the body.
6. As you conduct the hands-on examination, ask the patient
where it hurts most.
16
III. Evaluation of circulation, sensation, and movement.
2/7/2023
1. Once you suspect limb injury, you must evaluate the circulation and
sensation in that limb.
2. Any injury may have associated blood vessel or nerve damage.
3. It is essential to check circulation and sensation after any movement
of the limb.
S/S
 tingling or numbness in the extremity;
 nerve damage or lack of circulation.
17
Cont …
 After you have made a careful visual and hands-on
examination, and if the patient shows no sign of injury, ask the
patient to move the limb carefully.
 If there is an injury, the patient will report pain and refuse to
move the limb.
2/7/2023
18
Imaging
2/7/2023
 The joints above and below a fracture should generally be imaged
because injury at the proximal or distal joint may coexist with long
bone fractures.
 Injuries that may require special views or advanced
imaging modalities in order to be visualized include
acromioclavicular separation, fracture of the scaphoid, posterior
shoulder dislocation, and sternoclavicular dislocation.
 Plain radiographs are still the mainstay for fracture diagnosis
19
Fracture
2/7/2023
Types of Fracture
1. Closed fractures- closed (simple)
fractures are those not associated with
open wounds on the surface of the
body.
2. Open fractures – open (compound)
fractures are those associated directly
with open wounds.
20
Signs and symptoms of fracture
2/7/2023
 History of trauma
 Pain, Swelling,
 Inability to use the injured body part
 Tenderness and bruising
 Deformity, abnormal movement (sure signs of fracture).
 Altered neurovascular status
21
Initial management /First aid measures
2/7/2023
Objectives of first aid
 To prevent blood lose
 To keep the broken bone joints from moving.
 To give care for shock.
 To relief pain
 To transport the victim to hospital
22
Fracture of the scapula
2/7/2023
 Fracture of the scapula (shoulder blade) is
generally the direct result of the impact of
a fall or an automobile collision.
 Dislocations of the shoulder joint, sprains
and contusions are common in this area.
 First aid consists of applying a sling and
bandaging the victim’s upper arm to his
chest wall
Consists of applying a sling to
elevate and immobilize the arm
and shoulder blade.
23
Fracture of the humerus (The bone of the upper
arm)
2/7/2023
First aid for a closed humerus fracture
Place a pad in the victim’s arm pit, apply a splint or improvised
splint tied in place above and below the break area .
Support the forearm with a sling that doesn’t produce upward
pressure at the fracture site.
Bind the victim’s upper arm to his chest wall
24
Cont…
2/7/2023
25
Fracture of fore arm and wrist
2/7/2023
 The two bones of the fore arm (ulna and radius) may be
fractured individually or together.

26
First aid measures
2/7/2023
 Fractures in the mid portion of the fore arm and wrist are
treated in the same way as fractures of the shaft of the
humerus.
27
Flail Chest
28
 Flail Chest
 Direct injury to the chest resulting in an
unstable segment of the chest wall that
moves separately from remainder of
thoracic cage
 Typically results from two or more
fractures on 2 or more ribs
 Typically accompanied by a pulmonary
contusion
 Physical exam = paradoxical movement of
chest segment
 Treatment = improve abnormalities in gas
exchange
 Early intubation for patients with
respiratory distress
 Avoidance of overaggressive fluid
resuscitation
CONT…
 Segment of chest wall that don’t have bony continuity with
the rest of thoracic cage .
 Associated multiple rib fracture
Clinical manifestation
 Disrupts normal chest movement .
 Paradoxical chest movement during breathing and pulmonary
contusion are common.
CONT.
 Palpation- creptus (rib/cartilage fracture) , uncoordinated
respiratory motion
 Diagnosis :- CXR- multiple rib fracture
- ABG- respiratory failure with hypoxia
 Management – Initial – adequate ventilation
-administration of humidified air
 -fluid resuscitation for
hypotension(careful monitoring of fluid is mandatory-CVP)
Bulky Dressing for splint of Flail Chest
 Use Trauma bandage and Triangular
Bandages to splint ribs.
 Can also place a bag of D5W on area
and tape down
Fracture of the upper leg
2/7/2023
 Fractures of the shaft of the femur usually result from falls or
traffic injuries.
 The victim is in severe pain and shock and markedly disabled.
 The foot is characteristically turned outward and the limb
shortened owing to overlapping of the bone ends due to muscular
spasm.
32
2/7/2023
33
First aid measures
2/7/2023
 If the victim is to be transported only for short distance on a
stretcher, place a blanket between the legs and bind them together.
 To apply the board splint, assemble needed supplies.
 If you use improvised board splints, they should be well padded
and should reach from the victim’s armpit on the outer side and
groin or the inner side to below his heel
34
Cont…
2/7/2023
 The bandages will be tied on the following areas: just below the arm
pit, at the abdomen, at the hip, above and below the fracture site, at
the lower leg and ankle and foot with figure of eight bandage
 Don’t try to cleanse open wound (if present).
 If possible apply a traction splint for the fracture of the shaft of the
femur.
35
Fracture of the kneecap (Patella
2/7/2023
 The patella is in front of the knee Joint.
 It is fractured usually by direct injuries sustained when control of
the knee is lost, with the front thigh muscles pulling violently on
the kneecap.
36
First aid measures
2/7/2023
Apply a pillow splint about the knee or padded splints from
below the victim’s heel to his buttocks along the back of the leg,
with the leg extended.
Raise the leg slightly to prevent swelling.
Send to hospital or a health center.
37
Fracture of the lower leg
2/7/2023
 The bones of the lower leg are the tibia (shinbone), which
supports the weight of the body and the fibula, which forms the
outside wall of the ankle and is on the outer side of the leg.
38
Fracture of ankle and foot
2/7/2023
 The ankle is made up of the lower ends of the tibia and fibula
and the first bone of the foot (the talus). Fractures in this area
occur most commonly in active sports, in falls, and in motor
vehicle accident.
39
First aid measures
2/7/2023
Loosen or remove the victim’s shoes, and hose (socks) and
keep him lying down with his leg elevated.
 For an open wound apply large bulky dressings.
40
2/7/2023
41
General Rx cont’d…
2/7/2023
All limb injuries are treated in the same way in the field.
A..Fix ABC problems first; Administer anti pain
B. Cover open wounds with dry, sterile dressings.
C. Apply firm but gentle pressure to control bleeding, if
necessary.
D. Apply a cold pack to painful, swollen, or deformed
extremities.
E. Splint the injured limb and immobilize it.
F. Immoblization prevents displacement of reduced Fx, reduce
pain.
42
Splinting
2/7/2023
 All limb injuries should be splinted before the
patient is moved, unless the environment prevents
effective splinting or threatens the pt’s life.
Purpose:
 prevents the movement of broken bone ends, a
dislocated joint, or damaged soft tissues, thereby
reducing pain.
 Controls bleeding and decreases the risk of
additional damage.
 Prevents closed fractures from becoming open
fractures during movement or transport.
43
General principles of splinting
2/7/2023
1. Note and record PMS distal to the point of injury, both before and after
splinting.
2. Cover all open wounds with a dry, sterile dressing before applying the
splint.
3. Do not move the patient before splinting, unless there is an immediate
danger to the patient or the EMR.
4. Immobilize the joint above and the joint below the injury site
5. Splint the limb without moving it unnecessarily.
6. When in doubt, splint.
44
Materials used for splinting
1. Rigid splints
 Are made from firm material ; are applied to the sides, front, or
back of an injured extremity.
 Common types of rigid splints include:
Padded board splints, Molded plastic or aluminum splints
.Padded wire ladder splints, Folded cardboard splints
2. Air splint
 After it is applied, the splint is inflated.
 comfortable for the patient and provides uniform pressure to a
bleeding wound.
3. Iprovised
2/7/2023
45
Open or compound fracture
2/7/2023
- This is a fracture in which the fracture hematoma
communicates with skin or mucous membrane.
- Infection is the most feared complication.
- may cause delayed healing, non union, sepsis or even death.
- It is a surgical emergency.
46
Open or compound fracture…..
2/7/2023
Principles of management:
1. Early wound debridement & thorough irrigation with saline.
2. Broad Antibiotics & Tetanus prophylaxis
3. Rigid immobilization with access to the wound
4. Delayed wound closure! Never close a compound fracture
immediately in an attempt to convert it to a closed one.
You’ll cause a severe anaerobic infection!
47
Orthopedic consultation in the ED
2/7/2023
 In many cases, such as fracture of the hip, the need for
hospital admission and/or orthopedic consultation in the ED.
 In some situations, however, differences of opinion may exist
regarding whether the patient needs to be seen by an
orthopedist in the ED.
 Even patients with injuries that ultimately may require
surgical repair, such as an unstable ankle fracture, sometimes
may be immobilized and discharged with a referral for prompt
orthopedic follow-up.
48
Complications of Fractures
2/7/2023
I- Soft tissue Injuries
 Arteries, Nerves and Viscera may be injured
II- Compartment syndrome
 Is a dangerously increased pressure within the enclosed fascial
compartments of extremities.
49
Complications of Fractures…
2/7/2023
III- Infection
- Usually complicates open fractures
- Chronic osteomyelitis may be resulted.
- Cleaning and adequate debridement is the most critical
factor in preventing infection.
50
Cont…
2/7/2023
 The high compartmental pressure causes Ischemia and
necrosis of soft tissues in the compartment.
 Common to especially fore arm and leg.
 Severe pain, especially with passive flexion of fingers is the
earliest indicator.
 4Ps - Paresthesia, Paralysis, Pallor or Pulselessness may
develop later.
51
Dislocation
2/7/2023
 A dislocation is a displacement of a bone end
from the joint particularly at the shoulder, elbow,
fingers or thumb usually as a result of a fall or a
direct blow.
 Unless proper care is given, a
dislocation may occur repeatedly.
52
Signs and symptoms of dislocation
2/7/2023
 Swelling.
 Obvious deformity.
 Pain upon movement.
 Tenderness to touch.
 Discoloration.
53
First aid measures
2/7/2023
 First aid should be essentially the same as for closed fractures.
 Splint and immobilize the affected joint in the position in which it
was found.
 Apply a sling if appropriate.
 Elevate the affected part if a limb is involved.
 Seek medical attention promptly.
 Never attempt to reduce a dislocation.
54
Sprain
2/7/2023
 A sprain is an injury to a joint, ligament or muscle and tendon in
the region of a joint.
 It occurs usually as result of forcing a limb beyond
the normal range of movement.
The ankles, fingers, wrists and knees are most often sprained.
55
Signs and symptoms of sprain
2/7/2023
 Swelling
 Tenderness
 Pain upon motion
 Discoloration
 It might be difficult to differentiate a sprain from a closed
fracture
with out an X-ray.
56
First aid measures
2/7/2023
 If the victim’s ankle or knee is affected, do not allow him to walk.
 Loosen or remove the victim’s shoes, apply a pillow or blanket, splint
and elevate the victim’s leg to prevent swelling .
 Keep the injured part raised for at least 24 hours.
 Apply cold wet pad or place a small bag of crushed ice on the
affected area over a towel intermittently, to protect the victim’s skin.
 If swelling and pain persist, seek medical attention.
57
Strain
2/7/2023
 Strains are injuries to muscle resulting from over stretching.
 Commonly strains occur on the back muscles, due to improper lifting
technique.
 To avoid back strain when a heavy object must be lifted, observe the
following precaution.
 Place the feet close to the object firmly and apart.
 Lift slowly, pushing up with the strong thigh and leg muscles are bearing
the weight.

58
First aid measures
2/7/2023
 Bed rest, heat and use of a board under the mattress for firm
support are recommended for person with a strained back
 Cool the area by applying an ice pack or cold compress for the
first 24 hours.
 After 24 hours, apply heat, warm, wet and rest care.
 Seek medical care; (severe back strains should be seen by a
physician).
59
Prevention of accidents resulting in skeletal and muscular
injuries
2/7/2023
The following discussion on prevention will limit it self to additional
consideration regarding motor vehicle accidents:
 Motor vehicle accident prevention
 What follows is intended to provide a basis for discussion of the
over all high way accident.
 Driving skill, judgment and condition of driver
 Vehicle condition
 Environmental conditions and Pedestrian safety
60
Falling accidents
2/7/2023
Falls are the second leading cause of accidental death.
 Ranking behind motor vehicle fatalities and a head of fire and burn
fatalities.
 The reader should further develop his/ her understanding regarding
the following types of accidents by referring standard references.
 Slipping and Tripping (Slight Walking) Hazards
 Climbing and Reaching
 Special Precautions
 Joint and Muscle Tissue Injury Prevention
61
Summary
2/7/2023
 Evaluation of orthopedic injuries is the cornerstone of the patients
that used to identifying and treating orthopedic urgencies and
emergencies.
 Initial evaluation is crucial and critical to minimizing morbidity
and mortality.
 Immobilization is necessary for an orthopedic injury to heal
properly. Injured bones, ligaments, tendons, and more will incur
further damage if the affected areas aren't immobilized.
 Keeping the area from moving also helps reduce pain.
62
References
2/7/2023
1.Tintinalli’s Emergency Medicine, A Comprehensive Study
Guide Ninth Edition page number 1767.
2.Annual Update in Intensive Care and Emergency Medicine
ISBN 9783030060664 ISBN 9783030060671 (eBook)
https://doi.org/10.1007/9783030060671
3. Advanced Trauma Life Support ATLS Ninth Edition
63
2/7/2023
64

Weitere ähnliche Inhalte

Ähnlich wie initial ppt.pptx

fractureofneckofthefemur-121016113941-phpapp02.pdf
fractureofneckofthefemur-121016113941-phpapp02.pdffractureofneckofthefemur-121016113941-phpapp02.pdf
fractureofneckofthefemur-121016113941-phpapp02.pdfSbusisomtungwa
 
Care of patient with fracture (1)
Care of patient with fracture (1)Care of patient with fracture (1)
Care of patient with fracture (1)Krishna Gandhi
 
FRACTURE AND ITS CARE.pptx
FRACTURE AND ITS CARE.pptxFRACTURE AND ITS CARE.pptx
FRACTURE AND ITS CARE.pptxKrishna Gandhi
 
PT Management of Fractures of Condyles of Femur
PT Management of Fractures of Condyles of FemurPT Management of Fractures of Condyles of Femur
PT Management of Fractures of Condyles of FemurNavKalsi1
 
chapter-29-Part-A.pptx
chapter-29-Part-A.pptxchapter-29-Part-A.pptx
chapter-29-Part-A.pptxTrisCho
 
39. tibial plafond (pilon) fractures
39. tibial plafond (pilon) fractures39. tibial plafond (pilon) fractures
39. tibial plafond (pilon) fracturesMuhammad Abdelghani
 
Clavicle fractures-Management
Clavicle fractures-ManagementClavicle fractures-Management
Clavicle fractures-ManagementFelix Emerson
 
principle of fracture managment-1-app6892.pdf
principle of fracture managment-1-app6892.pdfprinciple of fracture managment-1-app6892.pdf
principle of fracture managment-1-app6892.pdfANDREWODHIAMBO12
 
Fracture neck of femur
Fracture neck of  femurFracture neck of  femur
Fracture neck of femurPrateek Singh
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fractureHarshita89
 
Fractures of Pelvic
Fractures of PelvicFractures of Pelvic
Fractures of PelvicEneutron
 
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)College of Medicine, Sulaymaniyah
 

Ähnlich wie initial ppt.pptx (20)

fractureofneckofthefemur-121016113941-phpapp02.pdf
fractureofneckofthefemur-121016113941-phpapp02.pdffractureofneckofthefemur-121016113941-phpapp02.pdf
fractureofneckofthefemur-121016113941-phpapp02.pdf
 
Care of patient with fracture (1)
Care of patient with fracture (1)Care of patient with fracture (1)
Care of patient with fracture (1)
 
FRACTURE AND ITS CARE.pptx
FRACTURE AND ITS CARE.pptxFRACTURE AND ITS CARE.pptx
FRACTURE AND ITS CARE.pptx
 
Orthopedics 5th year, 1st lecture (Dr. Ali A.Nabi)
Orthopedics 5th year, 1st lecture (Dr. Ali A.Nabi)Orthopedics 5th year, 1st lecture (Dr. Ali A.Nabi)
Orthopedics 5th year, 1st lecture (Dr. Ali A.Nabi)
 
Pelvic fractures
Pelvic fracturesPelvic fractures
Pelvic fractures
 
PT Management of Fractures of Condyles of Femur
PT Management of Fractures of Condyles of FemurPT Management of Fractures of Condyles of Femur
PT Management of Fractures of Condyles of Femur
 
chapter-29-Part-A.pptx
chapter-29-Part-A.pptxchapter-29-Part-A.pptx
chapter-29-Part-A.pptx
 
39. tibial plafond (pilon) fractures
39. tibial plafond (pilon) fractures39. tibial plafond (pilon) fractures
39. tibial plafond (pilon) fractures
 
Clavicle fractures-Management
Clavicle fractures-ManagementClavicle fractures-Management
Clavicle fractures-Management
 
principle of fracture managment-1-app6892.pdf
principle of fracture managment-1-app6892.pdfprinciple of fracture managment-1-app6892.pdf
principle of fracture managment-1-app6892.pdf
 
Principle of fracture managment
Principle of fracture managmentPrinciple of fracture managment
Principle of fracture managment
 
G04602048057
G04602048057G04602048057
G04602048057
 
Spinal orthosis
Spinal orthosisSpinal orthosis
Spinal orthosis
 
Treatment of fracture
Treatment of fractureTreatment of fracture
Treatment of fracture
 
Fracture neck of femur
Fracture neck of  femurFracture neck of  femur
Fracture neck of femur
 
orthopaedics surgery by dr shubham patel
orthopaedics surgery by dr shubham patelorthopaedics surgery by dr shubham patel
orthopaedics surgery by dr shubham patel
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fracture
 
Fractures of Pelvic
Fractures of PelvicFractures of Pelvic
Fractures of Pelvic
 
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)
Orthopedics 5th year, 6th/part two & 7th/part one lectures (Dr. Ali A.Nabi)
 
Pelvic ring for md1
Pelvic ring for md1Pelvic ring for md1
Pelvic ring for md1
 

Mehr von MohammedAbdela7

Introduction to Pathology.pptx
Introduction to Pathology.pptxIntroduction to Pathology.pptx
Introduction to Pathology.pptxMohammedAbdela7
 
Hypersensitivity reactions BY GROUP 1.pptx
Hypersensitivity reactions BY GROUP 1.pptxHypersensitivity reactions BY GROUP 1.pptx
Hypersensitivity reactions BY GROUP 1.pptxMohammedAbdela7
 
Cellular Reactions to Injury.pptx
Cellular  Reactions  to Injury.pptxCellular  Reactions  to Injury.pptx
Cellular Reactions to Injury.pptxMohammedAbdela7
 
by Group 8 PID & EP edited.pptx
by Group 8 PID & EP edited.pptxby Group 8 PID & EP edited.pptx
by Group 8 PID & EP edited.pptxMohammedAbdela7
 
Autoimmunity group 2.ppt
Autoimmunity group 2.pptAutoimmunity group 2.ppt
Autoimmunity group 2.pptMohammedAbdela7
 
infection prevention.pptx
infection prevention.pptxinfection prevention.pptx
infection prevention.pptxMohammedAbdela7
 
Medication and fluid therapy.pptx
Medication and fluid therapy.pptxMedication and fluid therapy.pptx
Medication and fluid therapy.pptxMohammedAbdela7
 
Endocrine System Disorder.pptx
Endocrine System Disorder.pptxEndocrine System Disorder.pptx
Endocrine System Disorder.pptxMohammedAbdela7
 
2 Assessment of patient with respiratory disorder.pptx
2 Assessment of patient with respiratory disorder.pptx2 Assessment of patient with respiratory disorder.pptx
2 Assessment of patient with respiratory disorder.pptxMohammedAbdela7
 

Mehr von MohammedAbdela7 (20)

Chap.VII.pptx
Chap.VII.pptxChap.VII.pptx
Chap.VII.pptx
 
Introduction to Pathology.pptx
Introduction to Pathology.pptxIntroduction to Pathology.pptx
Introduction to Pathology.pptx
 
preeclampsia.pptx
preeclampsia.pptxpreeclampsia.pptx
preeclampsia.pptx
 
Hypersensitivity reactions BY GROUP 1.pptx
Hypersensitivity reactions BY GROUP 1.pptxHypersensitivity reactions BY GROUP 1.pptx
Hypersensitivity reactions BY GROUP 1.pptx
 
inflammaton.pptx
inflammaton.pptxinflammaton.pptx
inflammaton.pptx
 
FINALLLL HMD.pptx
FINALLLL HMD.pptxFINALLLL HMD.pptx
FINALLLL HMD.pptx
 
Chap.-II.pptx
Chap.-II.pptxChap.-II.pptx
Chap.-II.pptx
 
Cellular Reactions to Injury.pptx
Cellular  Reactions  to Injury.pptxCellular  Reactions  to Injury.pptx
Cellular Reactions to Injury.pptx
 
by Group 8 PID & EP edited.pptx
by Group 8 PID & EP edited.pptxby Group 8 PID & EP edited.pptx
by Group 8 PID & EP edited.pptx
 
ACID-BASE BALANCE.pptx
ACID-BASE BALANCE.pptxACID-BASE BALANCE.pptx
ACID-BASE BALANCE.pptx
 
Autoimmunity group 2.ppt
Autoimmunity group 2.pptAutoimmunity group 2.ppt
Autoimmunity group 2.ppt
 
infection prevention.pptx
infection prevention.pptxinfection prevention.pptx
infection prevention.pptx
 
integumentery.pptx
integumentery.pptxintegumentery.pptx
integumentery.pptx
 
Medication and fluid therapy.pptx
Medication and fluid therapy.pptxMedication and fluid therapy.pptx
Medication and fluid therapy.pptx
 
Endocrine System Disorder.pptx
Endocrine System Disorder.pptxEndocrine System Disorder.pptx
Endocrine System Disorder.pptx
 
CVS and abdomen.pptx
CVS and abdomen.pptxCVS and abdomen.pptx
CVS and abdomen.pptx
 
Endocrine DOs.pptx
Endocrine DOs.pptxEndocrine DOs.pptx
Endocrine DOs.pptx
 
badnews.pptx
badnews.pptxbadnews.pptx
badnews.pptx
 
2 Assessment of patient with respiratory disorder.pptx
2 Assessment of patient with respiratory disorder.pptx2 Assessment of patient with respiratory disorder.pptx
2 Assessment of patient with respiratory disorder.pptx
 
Adult health.pptx
Adult health.pptxAdult health.pptx
Adult health.pptx
 

Kürzlich hochgeladen

The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptxTina Purnat
 
Nutrition of OCD for my Nutritional Neuroscience Class
Nutrition of OCD for my Nutritional Neuroscience ClassNutrition of OCD for my Nutritional Neuroscience Class
Nutrition of OCD for my Nutritional Neuroscience Classmanuelazg2001
 
Rapid Release Granulation Technology ppt
Rapid Release Granulation Technology pptRapid Release Granulation Technology ppt
Rapid Release Granulation Technology pptHasnat Tariq
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSapna Thakur
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfSasikiranMarri
 
Heme synthesis for medical And Nursing studentspptx
Heme synthesis for medical And Nursing studentspptxHeme synthesis for medical And Nursing studentspptx
Heme synthesis for medical And Nursing studentspptxRajendra Dev Bhatt
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurNavdeep Kaur
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxpdamico1
 
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptx
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptxL1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptx
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptxDr Bilal Natiq
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfHongBiThi1
 
CPCSEA guidelines and IAEC committee.pptx
CPCSEA guidelines and IAEC committee.pptxCPCSEA guidelines and IAEC committee.pptx
CPCSEA guidelines and IAEC committee.pptxMs. Kiran Divekar
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Badalona Serveis Assistencials
 
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and Oculomics
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and OculomicsNext Gen Ophthalmic Imaging for Neurodegenerative Diseases and Oculomics
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and OculomicsPetteriTeikariPhD
 
Presentation on Non Steroidal Anti-inflammatory Agents
Presentation on Non Steroidal Anti-inflammatory AgentsPresentation on Non Steroidal Anti-inflammatory Agents
Presentation on Non Steroidal Anti-inflammatory AgentsPrerana Jadhav
 
ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamAkebom Gebremichael
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.pptraviapr7
 
Hip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsHip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsRishiRajgude
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfDivya Kanojiya
 
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Dr. Dheeraj Kumar
 

Kürzlich hochgeladen (20)

The next social challenge to public health: the information environment.pptx
The next social challenge to public health:  the information environment.pptxThe next social challenge to public health:  the information environment.pptx
The next social challenge to public health: the information environment.pptx
 
Nutrition of OCD for my Nutritional Neuroscience Class
Nutrition of OCD for my Nutritional Neuroscience ClassNutrition of OCD for my Nutritional Neuroscience Class
Nutrition of OCD for my Nutritional Neuroscience Class
 
Rapid Release Granulation Technology ppt
Rapid Release Granulation Technology pptRapid Release Granulation Technology ppt
Rapid Release Granulation Technology ppt
 
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna ThakurSCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
SCHOOL HEALTH SERVICES.pptx made by Sapna Thakur
 
History and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdfHistory and Development of Pharmacovigilence.pdf
History and Development of Pharmacovigilence.pdf
 
Heme synthesis for medical And Nursing studentspptx
Heme synthesis for medical And Nursing studentspptxHeme synthesis for medical And Nursing studentspptx
Heme synthesis for medical And Nursing studentspptx
 
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaurMETHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
METHODS OF ACQUIRING KNOWLEDGE IN NURSING.pptx by navdeep kaur
 
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptxPresentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
Presentation for Bella Mahl 2024-03-28-24-MW-Overview-Bella.pptx
 
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptx
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptxL1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptx
L1.INTRODUCTION to ENDOCRINOLOGY MEDICINE.pptx
 
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
Navigating Advances in Alzheimer’s Disease: An Expert Consult on Integrating ...
 
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdfSGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
SGK HÓA SINH ENZYM 2006 CHỊ THU RẤT HAY.pdf
 
CPCSEA guidelines and IAEC committee.pptx
CPCSEA guidelines and IAEC committee.pptxCPCSEA guidelines and IAEC committee.pptx
CPCSEA guidelines and IAEC committee.pptx
 
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
Presentació "Real-Life VR Integration for Mild Cognitive Impairment Rehabilit...
 
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and Oculomics
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and OculomicsNext Gen Ophthalmic Imaging for Neurodegenerative Diseases and Oculomics
Next Gen Ophthalmic Imaging for Neurodegenerative Diseases and Oculomics
 
Presentation on Non Steroidal Anti-inflammatory Agents
Presentation on Non Steroidal Anti-inflammatory AgentsPresentation on Non Steroidal Anti-inflammatory Agents
Presentation on Non Steroidal Anti-inflammatory Agents
 
ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom KidanemariamANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
ANEMIA IN PREGNANCY by Dr. Akebom Kidanemariam
 
Systemic Lupus Erythematosus -SLE PT2.ppt
Systemic  Lupus  Erythematosus -SLE PT2.pptSystemic  Lupus  Erythematosus -SLE PT2.ppt
Systemic Lupus Erythematosus -SLE PT2.ppt
 
Hip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and KinematicsHip Joint Biomechanics & its Kinetics and Kinematics
Hip Joint Biomechanics & its Kinetics and Kinematics
 
Plant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdfPlant Fibres used as Surgical Dressings PDF.pdf
Plant Fibres used as Surgical Dressings PDF.pdf
 
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
Units of Radiation Measurements, Quality Specification, Half-Value Thickness,...
 

initial ppt.pptx

  • 1. INSTITUTE OF HEALTH SCIENCES SCHOOL OF MIDWIFERY AND NURSING DEPARTMENT OF ADULT HEALTH NURSING AND MIDWIFERY PREPARED BY:- KIDANE DINKU. INITIAL EVALUATION AND MANAGEMENT OF ORTHOPEDIC INJURIES Presentation 2/7/2023 1
  • 2. Outline presentation 2/7/2023  Objective  Introduction  Fracture, Flail Chest  Dislocation, Sprain And Strain.  Principles for bone and joint injuries.  Splint specific fractures.  Management for dislocation.  Management for sprain and strains 2
  • 3. Objectives 2/7/2023 After studying this chapter, the student will be able to:  Define fracture, dislocation, sprain and strain.  Recognize f/a principles for bone and joint injuries.  Demonstrate how to splint specific fractures.  Demonstrate first aid management for dislocation.  Apply first aid management for sprain and strain. 3
  • 4. Introduction  Musculoskeletal trauma involves injury to one or more of the following structures: Bone: A unit of the skeleton composed of the hardest variety of connective tissue.  Bones give shape and support to the body.  In addition to surrounding and protecting vital organs, they serve as points of attachment for the muscles of the limbs, making movement possible. 2/7/2023 4
  • 5. Cont… Joint: The area where two or more bones articulate with one another.  Joints are usually classified in terms of the amount of motion permitted at the articulation.  Most joints of the extremities are synovial joints, which allow the greatest amount of motion. 2/7/2023 5
  • 6. Cont… Ligament: A bundle of connective tissue forming part of the fibrous capsule surrounding a joint and attached to it.  Every joint of the extremities is reinforced by two or more ligaments Tendon: The fibrous structure connecting a voluntary muscle to bone, cartilage, or ligaments.  Tendons enable muscles to effect motion in the joint or body area to which they are attached 2/7/2023 6
  • 7. Orthopedic injuries to these structures include the following:  Fracture -is a complete or incomplete break in the continuity of bones.  Fracture -is a complete or incomplete break in the continuity of bones.  Dislocation -is complete or Partial separation of the joint  Sprain- is a joint injury caused by excessive stretching of the supporting ligaments.  Strains- are caused by stretching or tearing of a muscle.  Subluxation -Partial disruption of a joint, in which some degree of contact between the articular surfaces remains 2/7/2023 7
  • 8. Cont… 2/7/2023 Fracture-dislocation or fracture-subluxation  Disruption of a joint combined with fracture of at least one of the bones involved in the articulation. Diastasis:  A separation of the interosseous membrane connecting two syndesmotic joints as seen between the radius and ulna and tibia and fibula. 8
  • 9. Mechanism of injury 2/7/2023 By. Kidane D ( Bsc in Emergency and Critical Care Nurse )  Motor vehicle accident  Industrial accident (machine)  Gunshot injury  Fall from a height, trivial  Fighting injury  Pathologic fractures  Stress fractures 9
  • 10. Patient’s History 2/7/2023  The value of the history in cases of orthopedic trauma is often underestimated.  Knowing the precise mechanism of injury may be the key to diagnosing some fractures or dislocations.  For example, a history of shoulder injury combined with the complaint of dysphagia may be the only clue to the existence of posterior sternoclavicular dislocation. 10
  • 11. Cont.. 2/7/2023  History taking should not necessarily be limited to orthopedic issues.  Depending on the situation, a general medical history should be obtained because it may have implications for further workup.  Relevant issues may include a history of cancer, heart disease or neurologic disease, taking anticoagulant medication. 11
  • 12. Initial evaluation of orthopedic injuries 2/7/2023  Essential components of Initial evaluation of orthopedic injuries  General patient assessment  Examination of the injured limb  Evaluation of circulation, sensation, and movement 12
  • 14. I. General patient assessment 2/7/2023  Associated life threatening injuries may be missed if evaluation of the patient is not systematic.  Limb injuries are not life threatening unless there is excessive bleeding from an open wound Note: Fx to pelvic = 3L bleeds , Fx to femoral =1-1.5 bleeds, Fx to tibia = 0.5-1 L bleeds.  Fx to each ribs bleeds 150ml, Fx to humerus =0.5-1L bleeds, 14
  • 15. ll. Examination of the injured limb 2/7/2023 1. Inspect the injured limb and compare it with the opposite, uninjured limb. 2. Gently and carefully cut away any clothing covering the wound, if necessary. 3. When you examine the limb, you may find any one of the following: a. Open wound b. Deformity c. Swelling d. Bruising 15
  • 16. Cont … 2/7/2023 4. Gently feel the injured limb for points of tenderness- is the best indicator of an underlying fracture, dislocation, or sprain. 5. To detect limb injury, start at the top of each limb and using both hands, squeeze the entire limb in a systematic, firm manner, moving down the limb and away from the body. 6. As you conduct the hands-on examination, ask the patient where it hurts most. 16
  • 17. III. Evaluation of circulation, sensation, and movement. 2/7/2023 1. Once you suspect limb injury, you must evaluate the circulation and sensation in that limb. 2. Any injury may have associated blood vessel or nerve damage. 3. It is essential to check circulation and sensation after any movement of the limb. S/S  tingling or numbness in the extremity;  nerve damage or lack of circulation. 17
  • 18. Cont …  After you have made a careful visual and hands-on examination, and if the patient shows no sign of injury, ask the patient to move the limb carefully.  If there is an injury, the patient will report pain and refuse to move the limb. 2/7/2023 18
  • 19. Imaging 2/7/2023  The joints above and below a fracture should generally be imaged because injury at the proximal or distal joint may coexist with long bone fractures.  Injuries that may require special views or advanced imaging modalities in order to be visualized include acromioclavicular separation, fracture of the scaphoid, posterior shoulder dislocation, and sternoclavicular dislocation.  Plain radiographs are still the mainstay for fracture diagnosis 19
  • 20. Fracture 2/7/2023 Types of Fracture 1. Closed fractures- closed (simple) fractures are those not associated with open wounds on the surface of the body. 2. Open fractures – open (compound) fractures are those associated directly with open wounds. 20
  • 21. Signs and symptoms of fracture 2/7/2023  History of trauma  Pain, Swelling,  Inability to use the injured body part  Tenderness and bruising  Deformity, abnormal movement (sure signs of fracture).  Altered neurovascular status 21
  • 22. Initial management /First aid measures 2/7/2023 Objectives of first aid  To prevent blood lose  To keep the broken bone joints from moving.  To give care for shock.  To relief pain  To transport the victim to hospital 22
  • 23. Fracture of the scapula 2/7/2023  Fracture of the scapula (shoulder blade) is generally the direct result of the impact of a fall or an automobile collision.  Dislocations of the shoulder joint, sprains and contusions are common in this area.  First aid consists of applying a sling and bandaging the victim’s upper arm to his chest wall Consists of applying a sling to elevate and immobilize the arm and shoulder blade. 23
  • 24. Fracture of the humerus (The bone of the upper arm) 2/7/2023 First aid for a closed humerus fracture Place a pad in the victim’s arm pit, apply a splint or improvised splint tied in place above and below the break area . Support the forearm with a sling that doesn’t produce upward pressure at the fracture site. Bind the victim’s upper arm to his chest wall 24
  • 26. Fracture of fore arm and wrist 2/7/2023  The two bones of the fore arm (ulna and radius) may be fractured individually or together.  26
  • 27. First aid measures 2/7/2023  Fractures in the mid portion of the fore arm and wrist are treated in the same way as fractures of the shaft of the humerus. 27
  • 28. Flail Chest 28  Flail Chest  Direct injury to the chest resulting in an unstable segment of the chest wall that moves separately from remainder of thoracic cage  Typically results from two or more fractures on 2 or more ribs  Typically accompanied by a pulmonary contusion  Physical exam = paradoxical movement of chest segment  Treatment = improve abnormalities in gas exchange  Early intubation for patients with respiratory distress  Avoidance of overaggressive fluid resuscitation
  • 29. CONT…  Segment of chest wall that don’t have bony continuity with the rest of thoracic cage .  Associated multiple rib fracture Clinical manifestation  Disrupts normal chest movement .  Paradoxical chest movement during breathing and pulmonary contusion are common.
  • 30. CONT.  Palpation- creptus (rib/cartilage fracture) , uncoordinated respiratory motion  Diagnosis :- CXR- multiple rib fracture - ABG- respiratory failure with hypoxia  Management – Initial – adequate ventilation -administration of humidified air  -fluid resuscitation for hypotension(careful monitoring of fluid is mandatory-CVP)
  • 31. Bulky Dressing for splint of Flail Chest  Use Trauma bandage and Triangular Bandages to splint ribs.  Can also place a bag of D5W on area and tape down
  • 32. Fracture of the upper leg 2/7/2023  Fractures of the shaft of the femur usually result from falls or traffic injuries.  The victim is in severe pain and shock and markedly disabled.  The foot is characteristically turned outward and the limb shortened owing to overlapping of the bone ends due to muscular spasm. 32
  • 34. First aid measures 2/7/2023  If the victim is to be transported only for short distance on a stretcher, place a blanket between the legs and bind them together.  To apply the board splint, assemble needed supplies.  If you use improvised board splints, they should be well padded and should reach from the victim’s armpit on the outer side and groin or the inner side to below his heel 34
  • 35. Cont… 2/7/2023  The bandages will be tied on the following areas: just below the arm pit, at the abdomen, at the hip, above and below the fracture site, at the lower leg and ankle and foot with figure of eight bandage  Don’t try to cleanse open wound (if present).  If possible apply a traction splint for the fracture of the shaft of the femur. 35
  • 36. Fracture of the kneecap (Patella 2/7/2023  The patella is in front of the knee Joint.  It is fractured usually by direct injuries sustained when control of the knee is lost, with the front thigh muscles pulling violently on the kneecap. 36
  • 37. First aid measures 2/7/2023 Apply a pillow splint about the knee or padded splints from below the victim’s heel to his buttocks along the back of the leg, with the leg extended. Raise the leg slightly to prevent swelling. Send to hospital or a health center. 37
  • 38. Fracture of the lower leg 2/7/2023  The bones of the lower leg are the tibia (shinbone), which supports the weight of the body and the fibula, which forms the outside wall of the ankle and is on the outer side of the leg. 38
  • 39. Fracture of ankle and foot 2/7/2023  The ankle is made up of the lower ends of the tibia and fibula and the first bone of the foot (the talus). Fractures in this area occur most commonly in active sports, in falls, and in motor vehicle accident. 39
  • 40. First aid measures 2/7/2023 Loosen or remove the victim’s shoes, and hose (socks) and keep him lying down with his leg elevated.  For an open wound apply large bulky dressings. 40
  • 42. General Rx cont’d… 2/7/2023 All limb injuries are treated in the same way in the field. A..Fix ABC problems first; Administer anti pain B. Cover open wounds with dry, sterile dressings. C. Apply firm but gentle pressure to control bleeding, if necessary. D. Apply a cold pack to painful, swollen, or deformed extremities. E. Splint the injured limb and immobilize it. F. Immoblization prevents displacement of reduced Fx, reduce pain. 42
  • 43. Splinting 2/7/2023  All limb injuries should be splinted before the patient is moved, unless the environment prevents effective splinting or threatens the pt’s life. Purpose:  prevents the movement of broken bone ends, a dislocated joint, or damaged soft tissues, thereby reducing pain.  Controls bleeding and decreases the risk of additional damage.  Prevents closed fractures from becoming open fractures during movement or transport. 43
  • 44. General principles of splinting 2/7/2023 1. Note and record PMS distal to the point of injury, both before and after splinting. 2. Cover all open wounds with a dry, sterile dressing before applying the splint. 3. Do not move the patient before splinting, unless there is an immediate danger to the patient or the EMR. 4. Immobilize the joint above and the joint below the injury site 5. Splint the limb without moving it unnecessarily. 6. When in doubt, splint. 44
  • 45. Materials used for splinting 1. Rigid splints  Are made from firm material ; are applied to the sides, front, or back of an injured extremity.  Common types of rigid splints include: Padded board splints, Molded plastic or aluminum splints .Padded wire ladder splints, Folded cardboard splints 2. Air splint  After it is applied, the splint is inflated.  comfortable for the patient and provides uniform pressure to a bleeding wound. 3. Iprovised 2/7/2023 45
  • 46. Open or compound fracture 2/7/2023 - This is a fracture in which the fracture hematoma communicates with skin or mucous membrane. - Infection is the most feared complication. - may cause delayed healing, non union, sepsis or even death. - It is a surgical emergency. 46
  • 47. Open or compound fracture….. 2/7/2023 Principles of management: 1. Early wound debridement & thorough irrigation with saline. 2. Broad Antibiotics & Tetanus prophylaxis 3. Rigid immobilization with access to the wound 4. Delayed wound closure! Never close a compound fracture immediately in an attempt to convert it to a closed one. You’ll cause a severe anaerobic infection! 47
  • 48. Orthopedic consultation in the ED 2/7/2023  In many cases, such as fracture of the hip, the need for hospital admission and/or orthopedic consultation in the ED.  In some situations, however, differences of opinion may exist regarding whether the patient needs to be seen by an orthopedist in the ED.  Even patients with injuries that ultimately may require surgical repair, such as an unstable ankle fracture, sometimes may be immobilized and discharged with a referral for prompt orthopedic follow-up. 48
  • 49. Complications of Fractures 2/7/2023 I- Soft tissue Injuries  Arteries, Nerves and Viscera may be injured II- Compartment syndrome  Is a dangerously increased pressure within the enclosed fascial compartments of extremities. 49
  • 50. Complications of Fractures… 2/7/2023 III- Infection - Usually complicates open fractures - Chronic osteomyelitis may be resulted. - Cleaning and adequate debridement is the most critical factor in preventing infection. 50
  • 51. Cont… 2/7/2023  The high compartmental pressure causes Ischemia and necrosis of soft tissues in the compartment.  Common to especially fore arm and leg.  Severe pain, especially with passive flexion of fingers is the earliest indicator.  4Ps - Paresthesia, Paralysis, Pallor or Pulselessness may develop later. 51
  • 52. Dislocation 2/7/2023  A dislocation is a displacement of a bone end from the joint particularly at the shoulder, elbow, fingers or thumb usually as a result of a fall or a direct blow.  Unless proper care is given, a dislocation may occur repeatedly. 52
  • 53. Signs and symptoms of dislocation 2/7/2023  Swelling.  Obvious deformity.  Pain upon movement.  Tenderness to touch.  Discoloration. 53
  • 54. First aid measures 2/7/2023  First aid should be essentially the same as for closed fractures.  Splint and immobilize the affected joint in the position in which it was found.  Apply a sling if appropriate.  Elevate the affected part if a limb is involved.  Seek medical attention promptly.  Never attempt to reduce a dislocation. 54
  • 55. Sprain 2/7/2023  A sprain is an injury to a joint, ligament or muscle and tendon in the region of a joint.  It occurs usually as result of forcing a limb beyond the normal range of movement. The ankles, fingers, wrists and knees are most often sprained. 55
  • 56. Signs and symptoms of sprain 2/7/2023  Swelling  Tenderness  Pain upon motion  Discoloration  It might be difficult to differentiate a sprain from a closed fracture with out an X-ray. 56
  • 57. First aid measures 2/7/2023  If the victim’s ankle or knee is affected, do not allow him to walk.  Loosen or remove the victim’s shoes, apply a pillow or blanket, splint and elevate the victim’s leg to prevent swelling .  Keep the injured part raised for at least 24 hours.  Apply cold wet pad or place a small bag of crushed ice on the affected area over a towel intermittently, to protect the victim’s skin.  If swelling and pain persist, seek medical attention. 57
  • 58. Strain 2/7/2023  Strains are injuries to muscle resulting from over stretching.  Commonly strains occur on the back muscles, due to improper lifting technique.  To avoid back strain when a heavy object must be lifted, observe the following precaution.  Place the feet close to the object firmly and apart.  Lift slowly, pushing up with the strong thigh and leg muscles are bearing the weight.  58
  • 59. First aid measures 2/7/2023  Bed rest, heat and use of a board under the mattress for firm support are recommended for person with a strained back  Cool the area by applying an ice pack or cold compress for the first 24 hours.  After 24 hours, apply heat, warm, wet and rest care.  Seek medical care; (severe back strains should be seen by a physician). 59
  • 60. Prevention of accidents resulting in skeletal and muscular injuries 2/7/2023 The following discussion on prevention will limit it self to additional consideration regarding motor vehicle accidents:  Motor vehicle accident prevention  What follows is intended to provide a basis for discussion of the over all high way accident.  Driving skill, judgment and condition of driver  Vehicle condition  Environmental conditions and Pedestrian safety 60
  • 61. Falling accidents 2/7/2023 Falls are the second leading cause of accidental death.  Ranking behind motor vehicle fatalities and a head of fire and burn fatalities.  The reader should further develop his/ her understanding regarding the following types of accidents by referring standard references.  Slipping and Tripping (Slight Walking) Hazards  Climbing and Reaching  Special Precautions  Joint and Muscle Tissue Injury Prevention 61
  • 62. Summary 2/7/2023  Evaluation of orthopedic injuries is the cornerstone of the patients that used to identifying and treating orthopedic urgencies and emergencies.  Initial evaluation is crucial and critical to minimizing morbidity and mortality.  Immobilization is necessary for an orthopedic injury to heal properly. Injured bones, ligaments, tendons, and more will incur further damage if the affected areas aren't immobilized.  Keeping the area from moving also helps reduce pain. 62
  • 63. References 2/7/2023 1.Tintinalli’s Emergency Medicine, A Comprehensive Study Guide Ninth Edition page number 1767. 2.Annual Update in Intensive Care and Emergency Medicine ISBN 9783030060664 ISBN 9783030060671 (eBook) https://doi.org/10.1007/9783030060671 3. Advanced Trauma Life Support ATLS Ninth Edition 63