Bone & Joint Injuries  Signs & Symptoms:

 Deformity, Open injuries, Tenderness & Swelling

(DOTS)
Objectives
 Moderate to severe pain or discomfort
 Define strain, sprain, fracture and dislocation
 Bruising (may take hours to appear)
 List Signs & Symptoms of strain, sprain, fracture & dislocation
 Inability to move or use affected area
 Demonstrate field assessment
 Broken bone or fragments sticking out
 Define RICE (Rest, Immobilization, Cold, Elevation)
 Bones grating or sounds of grating
 Describe use of RICE
 Feeling or hearing snap or pop
 Demonstrate & describe the emergency treatment for:
 Loss of Circulation, Sensation, Motion
 Strains & sprains
 MOI such as fall, suggests injury may be severe
 Fractures

 Dislocations, including re-alignment

Checking for Possible Bone or Joint Injury
 Describe treatment for:

 Angulated fractures
 Have patient rest in comfortable position
 Open fractures
 Remove clothing as necessary to check injured area
 Describe long term care for injuries to bones & joints
 Ask how injury happened & what areas hurt (MOI)
 Describe when to evacuate
 Visually inspect entire body. Compare both sides of body to look
for differences. Feel for DOTS

Bone & Joint Injury Overview Checking for Possible Strain or Sprain
 Injuries to musculoskeletal system are among most common  Have patient actively move joint & evaluate pain involved
wilderness injuries
 Manipulate joint with your hands & evaluate pain
 Care is same, regardless of exact diagnosis
 If joint appears usable, have patient test it with his/her weight
 Strains are overstretched muscles or tendons

 Sprains are injuries to ligaments (e.g. holding bones to bones)

 A fracture is a bone break, chip or crack

Checking for Possible Fracture
 Open fracture: open wound in skin over fracture
 Determine whether injured part looks broken (deformed).
 Closed fracture: no break in the skin Compare to uninjured side
 Closed fractures more common…open ones more dangerous  Ask patient whether he/she thinks it is broken
 Dislocation: movement of bone or joint away from normal  Gently touch injured area look for:
position, often includes tearing of ligaments.
 Patients reaction to touch

 Muscles appear to be in spasm

Guidelines for Preventing Bone & Joint Injuries
 Injured area seems unstable
 Pay attention to safety
 One spot hurts noticeably more than the rest
 Wear adequate footwear
 Check CSM beyond site of injury
 Engage in pre-trip physical conditioning
Caring for Strains, Sprains & Fractures
 Set up camp or home so there are few trip hazards
 Whether usable or not, general care is RICE

 Rest: don’t allow injured area to be used for at least ½

Checking for Strains, Sprains & Fractures hour
  Immobilization: prevent further injury by keeping  Remove rings, bracelets, watches…may restrict flow
injured area still

 Cold: ice works best, avoid direct contact with the skin
Splinting Types
 Elevation: Keep injury higher than patient’s heart
 Hard Splint: splinting material is rigid (i.e. poles, sticks, etc)
 20-30 min of cold followed by 10-15 min of warming
 Soft Splints: splinting material is soft & bulky (i.e. newspaper,
 Repeat RICE cycle 3-4 times a day, if possible sleeping pad, sweatshirt, etc)

Splinting  Anatomical: splint material is another body part (i.e. fingers taped
together, legs splinted & tied together)
 In remote areas, patients will likely need to be moved

 The splint should restrict movement to prevent further injury &

increase comfort

 The splint must be made of something to pad injury & rigid
enough to provide support
 Padding should fill in all spaces to help prevent movement
 Possible splint materials include branches, hiking poles, SAM
splints, magazines, etc.
 Use triangular bandages, tape, elastic wraps, etc. to secure splints
Applying a Sling & Swathe
 Support injured arm above & below site of injury
 Place triangular bandage under arm & over uninjured shoulder.
 Wrap outside of bandage around other side of neck. Tie on side of
neck add padding
 Bind arm to torso with folded bandage

 Check CSM below in hand

Improvised Splinting Material

 What items can be used for splinting?

Splinting Skills Session
 Sticks
 Form pairs or groups of 3:
 Tent poles
 Splint lower leg with rigid material
 Oars/paddles
 Splint legs anatomically
 Ski/trekking poles
 Splint Forearm with soft material (using a sling & swath)
 SAM Splints

 Internal Pack frames

Splinting Specific Fractures
 Padding:
 Jaw: hold jaw in place, wide wrap around head Make sure can be
 Sleeping bags removed (in case of vomiting)

 Foamlite pads  Collarbone: Secure collarbone with sling & swathe

 Extra clothing  Fingers and toes: Bind to adjacent finger/toe

 Soft debris from forest floor  Ribs: support arm on injured side with sling & swathe…make sure
patient breathes deeply
 Rolls of sterile dressing
 Hip/pelvis: secure legs together…watch for shock/internal
Splinting bleeding
 Prepare splinting material before starting trip

 Splints must be able to hold injury in natural, neutral position:
 Spine inline, pad the small of the back
 Legs almost straight, pad behind knees
 Feet 90 degrees to legs
 Arms flexed to cross the heart
 Hands in functional curve with padding on palms
 Leave shoe on foot, it can act as splint. Remove, if
circulation is an issue
Caring for Complicated Fractures
 Angulated fractures leave bones distorted, open fractures expose
body to infection
 Irrigate open fracture, dress appropriately
 If bone ends sticks out & help is more than 4 hours away:
 Control bleeding
 Clean wound & bones ends (do not touch)
 Apply gentle inline traction
  Dress wound  Key is for patient to be relaxed & allow gentle pull to
ease joint back in place
 Splint the fracture, infection likely, but bones survive
better in body  Injured patients can do this on themselves, as well

 With angulated fracture, bones must be straightened w/  The sooner the better, waiting may cause chest
in-line traction: muscles to tighten & spasm

 Pull in direction in which bones are pointed  As soon as process completed, put arm in sling &
swathe to secure it
 Slowly & gently move broken bone back to place

 Do not force
Toe/Finger Relocation
 Do not continue, if increasing pain
 Keep injured finger partially bent
 Splint limb once aligned
 Pull on end with one hand, press gently back in place with other

 Place gauze pad between injured finger & the finger next to it
Dislocations
 Tape in place
 Are serious injuries that require prompt attention, characterized
by:  Do not tape over injured joint

>Marked deformity

>Swelling Kneecap Dislocation

>Pain aggravated by movement.  Apply gentle traction to the leg to straighten it

>loss of normal motion  Kneecap may pop in place with just traction

>Numbness  Massage thigh & use hand to push kneecap gently back in place

>Impaired circulation to limb  Apply a splint that does not put pressure on the kneecap.

 Patient may be able to walk

Checking and Caring for Dislocations

 Dislocation will produce pain in joint & loss of normal motion

 Joint “Looks wrong” Guidelines for Evacuation

 Many dislocations can only be splinted in the field

 Some can be put back by realignment through process called  If injured body part is usable, level of pain determines whether
“reduction” evacuation is needed

 Evacuate anyone with un-usable body part & first time

dislocations
Dislocation Reduction
 GO FAST with angulated fractures, open fractures, fractures of
 Work quickly, but calmly. The sooner reduction is done, the better pelvis, hip, femur (thigh), more than one long bone or decrease in
CSM below injury
 Encourage patient to relax, particularly when a joint is injured

 Stop, if pain increases dramatically

 Splint joint after it is back in place

Shoulder Reduction

 Anterior Shoulder dislocations most common:

 Position patient face down on rock/log, injured arm

dangling down

 Tie something 10-15 lbs in weight to dangling

wrist…patient does not hold weight

 Wait…process takes 20-30 min. to work