Chapter 14

Bone, Joint, and Muscle Injuries

Bone Injuries

• Associated with a forceful cause of injury

• May present with obvious disfigurement

• The real problems associated with

fractures are the potential injury to the vital

organs next to them.

Fractures

• Fracture and broken bone both mean a

break or crack in a bone.

• Two categories

− Closed—skin is intact.

− Open—skin has been

broken.

© Jones & Bartlett Learning.

Types of Fractures

• Greenstick—incomplete fracture

• Traverse—cut across bone at right angles

• Oblique—cross bone in a slanting direction

© Jones & Bartlett Learning.

Types of Fractures

• Comminuted—bone is fragmented into

more than two pieces

• Impacted—broken ends are jammed

together

• Spiral—results from a twisting injury

Fractures: What to Look For

• Use DOTS to assess

for injury:

− Deformity

− Open wounds

− Tenderness

− Swelling

© E. M. Singletary, M.D. Used with permission.

Fractures: What to Look For

• Loss of function

• Guarding

• Crepitus—grating sensation

• History of injury that includes a serious

incident

Fractures: What to Do

• Check for life-threatening conditions first.

• Gently remove clothing covering the area.

• Look and feel for DOTS.

Fractures: What to Do

• Check pulse and

nerves using the

mnemonic CSM.

− C—Circulation

• For arm injury, feel

for radial pulse.

• For leg injury, feel

for posterior tibial

pulse.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Use CSM (cont’d)

− Sensation

• Lightly touch or

squeeze one of the

person’s toes or

fingers while his or

her eyes are

closed.

• Ask which finger or

toe he or she feels.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Use CSM (cont’d)

− M—Movement

• Have the person

wiggle his or her

toes and fingers. © Jones & Bartlett Learning. Courtesy of MIEMSS.

© Jones & Bartlett Learning. Courtesy of MIEMSS.

Fractures: What to Do

• Stabilize part.

• For open fracture:

− Do not push on

protruding bones.

− Cover wound with

a dressing.

• Seek medical care.

© American Academy of Orthopaedic Surgeons.

Joint Injuries

• A joint is where two or more bones come

together.

Dislocations

• A dislocation occurs when a joint comes

apart and stays apart with the bone ends

no longer in contact.

© American Academy of Orthopaedic Surgeons.

Dislocations: What to Look For

• Deformity (main sign)

• Tenderness, severe pain

• Swelling

• Inability to move injured part

• Numbness or impaired circulation of

extremity

Dislocations: What to Do

• Call 9-1-1 if:

− Extremity looks blue or extremely pale

− Transport of the person would be difficult or

might aggravate the injury

• Check the CSM.

Dislocations: What to Do

• If EMS will arrive soon, hold injured part to

stabilize until they arrive.

• If EMS will be delayed or you are

transporting to distant medical care, use

the RICE procedure.

• Do not try to reduce a dislocation.

Sprains

• Occurs when a

joint is twisted or

stretched beyond

its normal range of

motion

− Results in partially

or completely torn

ligaments

© Sean Gladwell/Dreamstime.com.

Sprains: What to Look For

• Similar signs and symptoms to a fracture

− Severe pain

− Swelling

− Discolored skin around the joint

Sprains: What to Do

• Use the RICE procedure.

− Rest.

− Ice. Apply for 20 minutes.

− Compression. Apply for 3 to 4 hours.

• Repeat the cycle of ice and compression.

− Elevate. Raise the injured part.

Muscle Injuries

• Muscle injuries pose no real emergency.

Strains

• Occurs when a muscle is stretched

beyond its normal range of motion

• Inflammation begins immediately.

− Can take 24 to 72 hours for pain and stiffness

to begin

Strains: What to Look For

• Occurs during physical activity

• Sharp pain

• Extreme tenderness

• Inability to use injured part

• Stiffness and pain when muscle is used

Strains: What to Do

• Use the RICE procedure.

Cramps

• Occurs when a muscle goes into an

uncontrolled spasm and contraction

• Associated with diabetes, atherosclerosis,

and physical activity

• Two categories

− Night cramps

− Heat cramps

Cramps: What to Look For

• Sudden, severe muscle pain

• A muscle, often calf muscle, that feels

hard because of muscle contraction

• Residual discomfort, may last for a few

hours

Cramps: What to Do

• Gently stretch the muscle.

• Relax the muscle.

• Apply an ice pack.

• For heat cramps:

− Drink lightly salted cool water.

− Drink a commercial sports drink.

Muscle Contusion

• A muscle contusion or bruise results from

a blow to the muscle.

Contusions: What to Look For

• Person reports blow to a muscle

• Swelling

• Pain and tenderness

• Black and blue mark appearing hours later

Contusions: What to Do

• Use the RICE procedure.

• Seek medical care for any contusion larger

than the person’s palm.