TRAUMA – Musculoskeletal Injuries

FRACTURES
Fractures are usually caused when there is a history of trauma or impact to the body. Fractures might be recognised by: pain at the site of injury, bruising &/or swelling, loss of function and possibly deformity. Fractures can be simply described as closed / open / complicated.
Closed fractures – the skin is intact – no external bone protrusion or external bleeding
Open fractures – the skin is damaged and the bone protrudes through the skin, often causing bleeding
Complicated fractures – there is damage to large blood vessels, nerves, organs or the bone is severely damaged. Complicated fractures can pose a threat to a person’s life and should always be treated urgently.
The management of fractures involves 2 key actions: IMMOBILISE AND SUPPORT.
We need to keep the injured part from moving and help the casualty support it. This can be achieved by using splints and slings or even simple techniques such as tying the injured limb to the body (body splint) or resting the broken limb against a supportive object or surface. Never attempt to re-align or straighten a deformed limb. The casualty is likely to be in shock and so rest and reassurance is required.
The management of open fractures involves the added difficulty of bleeding control. If the bleeding is serious, indirect pressure can be applied around the protruding bone, e.g. donut bandage.

DISLOCATIONS
A dislocation is a separation of bones at a joint. A dislocation may recognised by severe pain, swelling, bruising, unnatural movement and deformity at the joint. Common areas of dislocations are shoulders, fingers and knees.
The management of a dislocation is very similar to that of a fracture and involves immobilization and support of the injured part. This could involve the use of slings or simple support measures. In the case of a dislocation we apply ice or a cold compress to the injured part to help reduce pain and swelling. If it is impossible to tell whether the injured joint is a dislocation or a fracture, then we treat it as a fracture and avoid applying ice to the affected area.

SPRAINS & STRAINS
A sprain is an over-stretching or tearing of ligaments at a joint and a strain is an over-stretching or tearing of muscles or tendons. The sprain is most common in the wrists and ankles. To recognise a sprain we look for: pain, swelling, bruising & partial loss of function in the joint. For both the sprain and the strain we apply the RICER principle REST, ICE, COMPRESSION, ELEVATION, REFERRAL. Rest the casualty, raise the injured part, apply a compression bandage to the injured joint and then apply an ice pack to the area. Ice should be applied for 20 minutes (in 2 x 10 minute intervals) every 2 hours. The casualty should then seek medical advice.

SPINAL INJURY
A spinal injury should always be suspected if a casualty has suffered a physically traumatic event such as being struck by a car, thrown from a motorbike/car, fallen from a height etc.
If the conscious casualty has pain in the neck or back, any strange tingling sensations in any part of their body or is unable to move any part of their body, then they should remain still and comforted whilst awaiting an ambulance. If the casualty is unconscious on their back, then protecting the airway will take priority and the casualty will need to be rolled very carefully into the recovery position, avoiding any forward or twisting motion of the neck and spine. If you are trained or have help, adopting a spinal roll to move the casualty into the recovery position would be preferable.
CRUSH INJURY
You should attempt to free a person who has a crushing force lying across their body as soon as possible if it is safe for you to do so. Prolonged crushing forces on large limbs can cause serious harm and potentially death. When the crushing force has been removed, be prepared to treat for bone and tissue damage and potentially serious bleeding.
If you are not sure how long a crush force has been in place, it is best to get the approval of emergency services prior to removal as this prolonged (30 minutes to 1 hour) of the force may create dangerous toxins in the affected limb which may be released into the body when the force is removed.