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Chapter 37 Orthopaedic Trauma
Unit Summary
Upon completion of this chapter and related course assignments, students will be able to recognize, assess, and manage open and closed fractures, as well as understand the pathophysiology associated with each type. They will be able to identify, assess, and manage disolocations, as well as other ligament and tendon injuries. Students will understand the pathophysiology of pelvic fractures, be able to stabilize the injury, and provide treatment to prevent shock. They will be able to identify pediatric-specific considerations for musculoskeletal trauma and how to apply those when managing these patients. Students will be able to describe the procedure for reduction of shoulder, finger, or ankle dislocations and fractures. They will be able to identify the need for rapid intervention and transport when dealing with musculoskeletal trauma, formulate a field impression, and implement a comprehensive treatment plan for these patients. Students will be able to describe the anatomy, pathophysiology, and management of common or major nontraumatic musculoskeletal disorders. They will be able to identify when and demonstrate how to perform a motor and sensory exam as well how to properly splint an injured extremity.
National EMS Education Standard Competencies
Trauma
Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression to implement a comprehensive treatment/disposition plan for an acutely injured patient.
Orthopaedic Trauma
Recognition and management of
- Open fractures (pp 1764-1766)
- Closed fractures (pp 1764-1766)
- Dislocations (pp 1766-1768)
- Amputations (p 1769)
Pathophysiology, assessment, and management of
- Upper and lower extremity orthopaedic trauma ( p 1754)
- Open fractures (pp 1764-1766; 1782-1789)
- Closed fractures (pp 1764-1766; 1782-1789)
- Dislocations (pp 1766-1768; 1789-1792)
- Sprains/strains (p 1768)
- Pelvic fractures (pp 1784-1786)
- Amputations/replantation (p 1769)
- Compartment syndrome (pp 1780-1781)
- Pediatric fractures (p 1779)
- Tendon laceration/transection/rupture (Achilles and patellar) (pp 1768; 1792)
Medicine
Integrates assessment findings with principles of epidemiology and pathophysiology to formulate a field impression and implement a comprehensive treatment/disposition plan for a patient with a medical complaint.
Nontraumatic Musculoskeletal Disorders
Anatomy, physiology, pathophysiology, assessment, and management of
- Nontraumatic fractures (pp 1792-1795)
Anatomy, physiology, epidemiology, pathophysiology, psychosocial impact, presentations, prognosis, and management of common or major nontraumatic musculoskeletal disorders
- Disorders of the spine (p 1793)
- Joint abnormalities (pp 1793-1794)
- Muscle abnormalities (p 1794)
- Overuse syndromes (pp 1794-1795)
Knowledge Objectives
- Describe the incidence, morbidity, and mortality of musculoskeletal injuries. (p 1754)
- Discuss the anatomy and physiology of the musculoskeletal system. (pp 1754-1763)
- Predict injuries based on the mechanism of injury, including: a. Direct (pp 1763-1764) b. Indirect (p 1764) c. Pathologic (pp 1763-1764)
- Describe age-associated changes in the bones. (p 1758)
- Discuss the general pathophysiology of musculoskeletal injuries, including fractures, ligament injuries, dislocations, muscle injuries, tendon injuries, and injuries that may signify fractures. (pp 1764-1769)
- Discuss fracture classifications, including linear, transverse, oblique, spiral, impacted, comminuted, segmental, complete, incomplete, nondisplaced, and displaced. (pp 1765-
- Discuss the pathophysiology of open versus closed fractures. (p 1765)
- Discuss the signs and symptoms of a fracture. (pp 1765-1766)
- Describe the process of assessing a patient with a musculoskeletal injury. (pp 1769-
- Discuss the assessment findings associated with musculoskeletal injuries. (pp 1769-
- List the six “P”s of musculoskeletal injury assessment. (p 1771)
- List the primary signs and symptoms that can indicate less obvious extremity injury. (pp 1769-1774)
- List the other signs and symptoms that can indicate less obvious extremity injury. (pp 1769-1774)
- Discuss the need for assessment of pulses, motor, and sensation before and after splinting. (pp 1775-1779)
- Identify the need for rapid intervention and transport when dealing with musculoskeletal injuries. (p 1770)
- Discuss the general emergency care principles used in managing musculoskeletal injuries. (pp 1774-1779)
- Discuss the relationship between volume of hemorrhage and open or closed fractures. (p
- Discuss methods of pain control for a patient with a musculoskeletal injury. (pp 1774-
Support Materials
- Lecture PowerPoint presentation
- Case Study PowerPoint presentation
- Skill Drill PowerPoint presentations
- Skill Drill 37-1, Performing a Motor Function and Sensory Exam
- Skill Evaluation Sheets
- Skill Drill 37-1, Performing a Motor Function and Sensory Exam
- Use a full-size skeleton model, various muscle and bone anatomic models, and musculoskeletal charts to reinforce material during class lectures and exercises.
- Prepare immobilization devices for use during skill practice for splinting of injured extremities. Confirm that course equipment is consistent with equipment found at EMS agencies where students may complete clinical rotations or field internships.
Enhancements
- Direct students to visit the companion website to Nancy Caroline’s Emergency Care in the Streets , Seventh Edition, at http://www.paramedic.emszone.com for online activities.
- Contact a local orthopedic practice to identify a guest speaker for discussion of stabilization and management of orthopedic injuries in the prehospital setting.
- Contact a local sports medicine practice to identify a guest speaker for discussion of sports- related orthopedic injuries seen in the prehospital setting.
- Contact a local radiologist to identify a guest speaker that may be able to present radiological images of orthopedic injuries for students with explanations of pathophysiological and anatomical changes.
Content connections: Orthopaedic trauma has the potential to be life threatening depending on the type and extent of injury. Students should be encouraged to review signs and symptoms related to blood volume loss and risk of shock.
Pharmacology should be reviewed for those medications appropriate to manage pain in the orthopaedic injury patient.
Students should consider the pharmacokinetics of medications as they relate to the geriatric patient, patients with renal insufficiency/failure, patients with impaired liver function, and patients that may have used or consumed alcohol and/or drugs.
Cultural considerations: Students should be reminded of the need to consider how age-related changes may affect normal anatomy and physiology, as well as range of motion and function of the musculoskeletal system in the geriatric patient.
Students will need to consider how comorbid factors can influence the ability of the geriatric patient to feel pain and how this may impede their ability to conduct a motor and sensory exam.
Students should be reminded of the need to consider how pain medication may affect the geriatric patient and whether there is potential for medication interactions with undesirable or dangerous side effects.
The pediatric patient with musculoskeletal trauma should be assessed for consistency between the stated cause of injury with the mechanism and assessed injury with consideration of the age of the patient. Old musculoskeletal injuries should be noted as well.
Teaching Tips
- Use a skeleton model as you cover the section of the chapter on anatomy and physiology of the musculoskeletal system. Having visual aids will help students comprehend how the bones and joints are formed and identify potential injuries based on normal function.
- Many of the splints used to treat orthopaedic injuries may not be routinely used by students. A refresher in how to apply splints and which injuries each is appropriate for may assist students who have not applied these as an EMT.
- Incorporate use of the pictures in the text and additional images available to assist students with recognizing presentation of the various musculoskeletal injuries.
- When performing skill practice, incorporating moulaged patients may assist students with identifying the type of injury and how to select the most appropriate device for splinting.
Unit Activities
Writing activities: Assign students the topic of the use of physical therapy for treatment of nontraumatic musculoskeletal disorders. You may want to assign different disorders for students to research. Ask that they submit their findings in a short paper.
Student presentations: Assign students various musculoskeletal injuries. Have them research pictures to share with the class of their injury. Using the skeleton model, ask that they identify common locations of these injuries, as well as causes.
Group activities: Divide the class into groups of four to five students. Establish stations for practicing application of various splints. Have the groups rotate through each station to demonstrate proper use of the splints.
Visual thinking: Label a skeleton with numbers on various bones. Have students review these and record the correct medical name of the bone on an answer sheet. Alternate: Develop a handout of a skeleton and identify the bones you have selected with numbers. Have students correctly record the medical name of the bones identified.
Medical terminology: Locate or create a puzzle such as a crossword or word search that requires students to identify the proper medical terms for bones, joints, disorders of the musculoskeletal system, and movements of the musculoskeletal system.
Pre-Lecture
You are the Medic
“You are the Medic” is a progressive case study that encourages critical-thinking skills.
Instructor Directions
Direct students to read the “You are the Medic” scenario found throughout Chapter 37.
- You may wish to assign students to a partner or a group. Direct them to review the discussion questions at the end of the scenario and prepare a response to each question. Facilitate a class dialogue centered on the discussion questions and the Patient Care Report.
- You may also use this as an individual activity and ask students to turn in their comments on a separate piece of paper.
Lecture
I. Introduction
A. Musculoskeletal injuries are one of the most common reasons for seeking
medication attention.
- These injuries are usually easily identifiable because of associated pain, swelling, and deformity.
- They are rarely fatal, but may result in short- or long-term disability.
- Regardless of the appearance of the injury, always check for life-threatening issues first.
(a) Serves as the pivot around which the radius turns at the wrist to rotate the palm upward (supination) or downward (pronation) d. The hand consists of three sets of bones: i. Wrist bones (carpals) ii. Hand bones (metacarpals) iii. Finger bones (phalanges)
- Pelvis and lower extremities a. The pelvic girdle is three separate bones fused together i. Ischium ii. Ilium iii. Pubis b. The two iliac bones are joined posteriorly to the sacrum at the sacroiliac joints c. The two pubic bones are connected anteriorly to one another at the pubic symphysis. d. The lower extremity comprises the bones of the thigh, leg, and foot. i. Femur: Thighbone, extends from pelvis to knee ii. Acetabulum: Cup-shaped cavity in which the rounded edge of the femur rotates iii. Fibula: Smaller of the two bones of the lower leg iv. Tibia: Forms the interior component on the knee joint v. Patella: Knee cap, extends knee joint e. The foot has three classes of bones. i. Ankle bones (tarsals) (a) Largest is the calcaneus ii. Foot bones (metatarsals) iii. Toes bones (phalanges)
C. Characteristics and composition of bone
- Bones shapes a. Long bones are longer than they are wide. i. Femur ii. Humerus iii. Tibia iv. Fibula v. Radius vi. Ulna b. Short bones are nearly as wide as they are long. i. Phalanges ii. Metacarpals iii. Metatarsals c. Flat bones are thin and broad. i. Sternum ii. Ribs iii. Scapulae iv. Skull d. Irregular bones have a shape that is designed to serve a certain function. i. Bones of the vertebral column ii. Mandible e. Round bones are found in proximity to a joint and help with movement.
i. Patella
- Typical long bone architecture a. The growth plate (physis) allows bones to grow to long lengths. i. Closes when a child becomes an adult and bones mature b. There are three regions of the long bone: i. Diaphysis ii. Epiphysis iii. Metaphysis c. Articular surfaces of the long bone join other bones, forming articulations (joints). i. These regions are covered by cartilage that protects them from wear and tear. ii. Bone not covered by cartilage is protected by the periosteum. (a) Dense membrane containing important capillaries and cells for bone repair and maintenance
- Age-associated changes in bone a. Bones decrease in density after age 35 years, leading to: i. Loss of height ii. Changes in facial structure b. Osteoporosis is a significant decrease in bone density i. Accelerated by menopause in women ii. Associated with a high risk of fracture c. Muscles, cartilage, and other connective tissues age along with bone. i. Increased risk of disk herniation and arthritis
D. Joints
- Formed when two bones come together a. Some are fused and allow for no motion. b. Others allow for motion by permitting movement between the two bones. i. Flexion ii. Extension iii. Abduction iv. Adduction v. Rotation vi. Circumduction vii. Pronation viii. Supination
- Types of joints a. Fibrous (synarthroses or fused) joints contain dense fibrous tissue that doesn’t allow for movement. i. Skull bones ii. Distal tibiofibular joint b. Cartilaginous (amphiarthroses) joints allow for very minimal movement between bones. i. Pubic symphysis ii. Joints connecting ribs to sternum c. Synovial (diarthroses) joints are the most mobile. i. Surrounded by the joint capsule
a. Motor units—composed of neurons and muscles—respond by either contracting as forcefully as possible or not at all. b. Recruitment is a process by which multiple neurons can come together to create a more forceful contraction.
- Innervation of the upper extremities arises from the brachial plexus. a. A network of nerves originating from the spinal cord at the C5-T1 levels b. After these nerves form a network with one another, five distinct nerves are formed: i. Axillary ii. Radial iii. Musculocutaneous iv. Ulnar v. Median
- Innervation of the lower extremities arises from the lumbar and lumbrosacral plexuses. a. A network of nerves originating from L1-S b. Leads to the formation of multiple distinct nerves, including: i. Sciatic nerve ii. Femoral nerve
H. Musculoskeletal bloody supply
- The upper extremity’s blood supply comes from the subclavian artery. a. When the subclavian artery reaches the axilla, it is referred to as the axillary artery. b. After supplying blood to the shoulder region, the artery leaves the axilla and becomes the brachial artery. c. The brachial artery passes through the elbow, dividing into the radial artery and the ulnar artery. d. The radial and ulnar arteries branch out into the hand, forming digital arteries in the fingers.
- The lower extremity’s blood supply comes from the external iliac artery. a. When the external iliac artery reaches the leg it becomes the femoral artery. b. At the knee the femoral artery is referred to as the popliteal artery. c. The popliteal artery divides into the anterior tibial artery and posterior tibial artery. d. The anterior and posterior tibial arteries run along the surface of the ankle and eventually travel to the foot. e. Within the foot, arteries give off branches that form the digital arteries of the toes.
III. Patterns and Mechanisms of Musculoskeletal Injury
A. A pathologic fracture is produced by a force that generally would not cause
harm to a healthy bone.
B. Injury forces and motions
- Direct force a. Fractures occur when the force of an impact is too great to be absorbed by the soft tissue. b. With high-velocity penetrating injuries, the speed of impact matters more than the size of the penetrating object. c. Impalement injuries cause soft-tissue damage that is similar to a low-velocity injury. i. If the object hits bone, a fracture may occur.
- Indirect force a. Indirect injuries occur when the force applied to one part of the body is transmitted to a structurally weaker area. i. Force can be transmitted along the length of a bone or through several bones in a series, causing injury anywhere along the way. b. Twisting injuries occur when an extremity twists around a planted foot or hand i. Common in sports ii. Causes tearing of tendons and ligaments c. Fatigue (march) fractures are caused by repetitive stress. i. Occur after prolonged walking d. Pathologic fractures may occur in patients with diseases that weaken areas of bone. e. Some injuries are commonly encountered together.
IV. Pathophysiology
A. Fracture: A break in the continuity of a bone
- Occurs when the amount of force applied to a bone overcomes the strength of the bone a. Strength is affected by: i. Age ii. Osteoporosis iii. Nutritional status iv. Diseases processes
- Fracture classification a. A fracture can be classified based on: i. Direction of the fracture line through the bone ii. Number of fractures on the bone iii. Number of cortices (layers) involved b. Fractures may be classified based on type of displacement i. Angulation: Each end of the fracture is not aligned in a straight line; an angle has formed. (a) May occur in frontal plane, sagittal plane, or both. c. Fractures may be classified as open or closed. i. Open (compound) fracture: Break in overlying skin allows the fracture to make contact with the outside world. (a) High risk of infection and blood loss due to: (1) More soft-tissue damage is involved. (2) Less interstitial pressure causes larger hematoma. ii. Closed fracture: Skin over the fracture remains intact. d. Signs and symptoms of a fracture i. Pain close to the fracture site ii. Deformity (a) Compare to extremity on the other side iii. Shortening (a) Occurs when the broken ends of a bone override each other (b) Characteristic of femur fractures iv. Swelling v. Guarding/loss of use vi. Tender to palpation
- Amputation: Separation of a limb or other body part from the rest of the body a. May be complete (full separation of the body part) or incomplete (leaving some tissue) b. Hemorrhage can be severe and life threatening. c. Fractures may be present.
- Laceration: Smooth or jagged cut caused by a sharp object or a blunt force that tears tissue a. The depth of the injury can vary. b. Lacerations involving damaged arteries or veins result in severe bleeding. c. Deep lacerations may cause nerve injury. i. Evaluate distal PMS functions.
V. Patient Assessment
A. When assessing an injured patient, do not be distracted by visually impressive
injuries!
- Complete the primary assessment before focusing on the extremities.
- Patients may be classified based on the presence or absence of associated injuries: a. Life- or limb-threatening injury or condition b. Life-threatening injuries and simple musculoskeletal trauma c. Life- or limb-threatening musculoskeletal trauma and no other life-threatening injuries d. Isolated, non-life- or non-limb-threatening injuries
B. Scene size-up
- Focus on safety and standard precautions.
- Consider the mechanism of injury (MOI). a. Will spinal stabilization be needed? b. Don appropriate PPE such as a mask, gown, or eye protection.
- Request additional resources as needed.
C. Primary assessment
- Focus on mental status, ABCs, and priority. a. If there are no immediately life-threatening conditions, continue with history taking and a secondary assessment. b. If there is a significant MOI, do a rapid exam at the scene and perform the full-body exam en route to the hospital. c. Priorities of musculoskeletal injuries should include: i. Identifying the injuries ii. Preventing further harm or damage to the injured structures and surrounding tissues iii. Supporting the injured area iv. Administering pain medication if necessary.
- Form a general impression. a. Evaluate level of consciousness using the AVPU scale. i. For conscious patients, assess mental status by asking questions about chief complaint.
ii. For less alert or unconscious patients, administer high-flow oxygen and expedite transport. b. If there was significant trauma and multiple body systems are affected, the musculoskeletal injuries may be a lower priority. i. Do not waste scene time on prolonged assessment or splinting. ii. Use a long backboard as a “full-body” splint and complete additional assessment during transport.
- Airway and breathing a. Very little else matters if the patient’s airway and breathing are inadequate. i. Injuries to the head or spine, intoxication, or other injuries may cause inadequate breathing. b. Evaluate the chief complaint and MOI to help determine if the patient has an open airway. c. If a spinal injury is suspected, prepare for stabilization.
- Circulation a. Determine whether the patient: i. Has a pulse ii. Has adequate perfusion iii. Is bleeding b. Hypoperfusion is a primary concern. i. Treat the patient for shock immediately if the skin is pale, cool, or clammy and capillary refill time is slow. (a) Maintain a normal body temperature. (b) Stabilize musculoskeletal injuries in the extremities prior to moving. ii. Assess for pulses proximal to the injury, and note any circulatory changes c. Check for external bleeding from open fractures. i. Bandages should be secure enough to control bleeding without restricting circulation. ii. Swelling from fractures and internal injuries may cause bandages to become too tight. iii. Apply a tourniquet if bleeding cannot be controlled.
- Transport decision a. Rapid transport should be provided for: i. Patients with airway or breathing problems ii. Patients with significant bleeding iii. Patients with a significant MOI (even if condition appears stable) b. For rapid transport, use a backboard as a splinting device for the whole body instead of taking the time to splint individual body parts. i. Individual splints should be applied en route if the ABCs are stable. c. Patients with simple MOIs may be stabilized on the scene prior to transport. i. Handle fractures carefully to prevent sharp bone ends from breaking through the skin or damaging nerves and blood vessels.
D. History taking
- Obtain the patient’s medical history using the standard SAMPLE format. a. Identify any preexisting musculoskeletal disorders, and attempt to learn more about the injury.
- Inspection
a. Evaluate the joint above and below the site of injury. b. Compare the injured side to the uninjured side. c. Check for the following signs: i. Deformity (a) Asymmetry (b) Angulation (c) Shortening (d) Rotation ii. Skin changes (a) Contusions (b) Abrasions (c) Avulsions (d) Punctures (e) Burns (f) Lacerations (g) Bone ends iii. Swelling iv. Muscle spasms v. Abnormal limb positioning vi. Increased or decreased ROM vii. Color changes (a) Pallor (b) Cyanosis viii. Bleeding
- Palpation
a. Check for point tenderness (where the patient feels pain) at the site of injury and above and below. i. Note that point tenderness will be absent in intoxicated patients and patients with spinal injury. b. Attempt to identify instability, deformity, abnormal joint or bone continuity, and displaced bones. c. Feel for crepitus at the site of fracture. d. Palpate distal pulses, comparing strength at the site of an injured extremity to a normal one. i. Signs of an arterial injury include: (a) Pulsatile expanding hematoma (b) Diminished distal pulses (c) Palpable thrill (vibration) over injury site that correlates with heartbeat (d) Difficult-to-control bleeding ii. Palpate the pelvis. (a) Apply pressure over the pubic symphysis. (b) Press the iliac wings toward the midline and then posteriorly. (c) Do not repeatedly examine if instability is found. iii. Palpate upper and lower extremities (a) Place your hand around an extremity and squeeze, repeating this every few centimeters. (b) When evaluating upper extremities, check the shoulder and cervical spine. (c) When evaluating the lower extremities, check the pelvis and hip.
- Motor function and sensory exam
a. A motor function exam should be performed whenever a patient has an injury to an extremity. i. First check that the patient does not have a life-threatening injury. ii. Consider the preinjury level of function; deficits may be due to prior injuries or medical problems. iii. Carry out each test with and without resistance and on both sides of the body so extremities can be compared. b. A sensory exam should also be performed on all patients who have an injury to an extremity. i. First check that the patient does not have a life-threatening injury. ii. Identify preexisting conditions that cause changes in sensation, such as diabetes and nerve disorders. iii. Ask the patient if he or she feels any abnormal sensations such as numbness or tingling. iv. Lightly touch the injured extremity and the unaffected side simultaneously. c. To properly perform a motor function and sensory exam, refer to Skill Drill 37-.
F. Reassessment
- The overall goal is to identify the type and extent of the injury and to provide treatment that maximizes the normal healing process. a. Treatment begins in the field.
VI. Emergency Medical Care
A. General treatment of fractures
- Control external bleeding.
- Prevent infection in open fractures.
- Manage internal bleeding (shock considerations).
- Immobilize the limb.
B. General treatment of sprains
- Immobilize.
- Chill.
- Elevate.
- Splint with an elastic bandage.
- Reduce weight bearing.
- Manage pain.
C. Volume deficit due to musculoskeletal injuries
- Fractures can lead to significant blood loss when blood vessels are damaged. a. Prevent hypotension and an unstable condition by: i. Applying direct pressure ii. Splinting iii. Administering IV fluids
D. Pain control
- Orthopaedic injuries are extremely painful. a. Assess the patient’s pain level.
i. If a long bone fracture is severely angulated, use longitudinal traction to realign the bone and improve circulation. i. Avoid straightening or manipulating joints unless there is no distal pulse. j. Splint knees straight (unless angulated) and elbows at a right angle. k. Discontinue traction if the patient reports severe pain. l. Splint firmly. m. Avoid covering fingers and toes to allow for monitoring of skin. n. Apply cold packs and elevate the limb. o. In the case of life-threatening injuries, splinting should not delay transport.
- Types of splints
a. Rigid splint i. Inflexible device that can be attached to a limb for stability ii. Examples include: (a) Padded board (b) Piece of heavy cardboard (c) Aluminum “ladder” or SAM splint molded to fit an extremity iii. Must be generously padded to ensure even pressure along extremity iv. Must be long enough to be secured above and below the fracture site v. Use two providers to apply a rigid splint: one maintains traction while the other wraps the limb. b. Sling and swathe i. Slings are useful in stabilizing shoulder or other upper extremity injuries. ii. To apply a sling: (a) Place the splinted extremity in a comfortable position across the chest. (b) Lay the long edge of a triangular bandage along the patient’s side opposite the injury. (c) Bring the bottom of the bandage up and over the forearm, tying it at the neck and elbow to form a cradle. (d) Secure so the hand is higher than the elbow. (e) Cushion with gauze pads to increase patient comfort. iii. A swathe can add further stabilization for injuries to the clavicle or anterior dislocations of the shoulder. iv. Do not use a sling if the patient has a neck injury. c. Pneumatic splints (air or inflatable splints) i. Stabilize fractures to the lower leg or forearm. ii. Should not be used for angulated fractures, fractures that involve a joint, or open fractures iii. Two distinct advantages: (a) Slow bleeding (b) Minimize swelling iv. To apply an air splint without a zipper: (a) Grasp the patient’s hand or foot and slide the splint over your hand and onto the extremity. (b) Instruct your assistant to inflate the splint. v. To apply an air splint with a zipper: (a) Apply it to the injured area while an assistant maintains traction. (b) Zip it up and inflate. vi. Ensure that the splint does not lose pressure or become overinflated. vii. If a patient has injuries to the lower extremities or pelvis, you may be able to use a pneumatic antishock garment (PASG).
(a) Be sure to check with medical control. (b) Do not use if any of the following exist: (1) Pregnancy (2) Pulmonary edema (3) Acute heart failure (4) Penetrating chest injuries (5) Groin injuries (6) Major head injuries (7) Transport time of less than 30 minutes (c) Carefully inflate the device in increments, with the legs before the abdominal portion. (d) Document injuries and deformities before applying (e) Do not remove in the field. d. Vacuum splints i. Sealed mattresses filled with air and plastic beads that can be placed on a stretcher to make the patient more comfortable (a) Air is suctioned out, compressing the beads so the splint becomes rigid like a plaster cast ii. Disadvantages: (a) Bulky (b) Requires mechanical suction pump iii. Smaller versions are available for stabilizing individual limbs e. Pillow splints i. Used to stabilize an injured foot or ankle. ii. Mold the pillow around the injury, and secure in place with cravats. f. Traction splints i. Used to stabilize femur fractures ii. The splint pulls on the femur. (a) Prevents broken bone ends from overriding as a result of unopposed muscle contraction (b) Maintain alignment of the fracture pieces. (c) Provide effective stabilization of the fracture site. (d) Reduce blood loss. iii. Do not use when there is an: (a) Additional fracture below the knee on the same extremity (b) Open femur fractures iv. To apply: (a) Assess the extremity for distal PMS functions. (b) Place the splint next to the leg to determine the proper length. (c) Stabilize the leg while your partner applies the splint. v. Reassess PMS functions after applying. g. Buddy splinting i. Used for injuries to the fingers and toes ii. An adjacent finger or toe acts as a splint to the injured one iii. Tape the injured digit to the uninjured one, placing gauze between. iv. Avoid taping over joints. v. Make sure the tape doesn’t cut off circulation.
VII. Pathophysiology, Assessment, and Management of
Pediatric Fractures
