Premergency First Aid, CPR and AED Manual

8 Muscle, Bone and Joint Injuries

Fractures A fracture can be either open or closed. During assessment of a patient with possible fractures or dislocations, first see if the skin over the injury is damaged. If the skin isn’t broken, the patient has a closed fracture. An open fracture has an external wound, either caused by the blow itself or by the broken bone ends cutting the skin. The wound can vary in size from a small puncture to a large tear that exposes bone and tissue. A small crack, or break, in the bone can be difficult to assess from a sprain or bruising. Larger breaks can displace the bone ends, causing obvious deformity including shortening of the limb, rotation, or angulation. Often the deformity is obvious but not in every case. Always compare the injured limb to the uninjured side in a patient with a suspected fracture.

The wrist may fracture from the direct blow, but the rest of the bones and joints in the arm and shoulder may be injured from the energy traveling up the arm. When caring for a fall injury, you must identify the point of impact and the MOI to determine any associated injury. Twisting forces are common causes of musculoskeletal injury and frequently affect the ligaments of the knee. An example of a twisting force type of injury is a skiing accident, where a ski gets caught and twists the leg, stretching and tearing the ligaments. High energy forces, such as those associated with vehicle crashes, falls from height, and gunshots, cause severe damage to bones, surrounding tissue and internal organs. A patient can have multiple injuries to many parts of the body including more than one fracture in a single limb.

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