Approach to the Patient with

Musculoskeletal Injuries

Osman Mert TOPKAR, M.D.

Marmara University School of Medicine

Department of Orthopaedics and Traumatology
 Learning Objectives

• General introduction to musculoskeletal system (bones,

joints, and muscles)
• Nomenclature of musculoskeletal injury
• Simple approach to musculoskeletal injury
• Dressings and bandages

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 First Aid

• Aims;
– To preserve life
– To limit worsening of the condition
– To promote recovery

3
 Bone, Joint, and Muscle Injuries

• The body is built on a framework of bones –the

skeleton- that
supports;
– Muscles
– Blood vessels
– Nerves
protects;
– Organs (such as the heart)

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 Bone, Joint, and Muscle Injuries
• Movement is made
possible by muscles
attached to the bones
and by movable
joints where the
bones meet
 Types of Injury

• Muscles and the

tendons
– Strain (Muscles)
– Sprain (Tendons)
– Tear (Muscles and
tendons)

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 Types of Injury
• Bones
– Broken Þ fracture
– Displaced at a joint
• Þ dislocation
– Both
• Fracture with
disolcation
 Sign and Symptoms
• Pain
• Bruising:
– discoloration
• Swelling
• Deformity
• Exposed bone
• ….
 Fractures

• Fracture: a break or crack in a bone

• Generally, considerable force is required to break a

bone, unless it is diseased or old (Pathological
fracture)

• Conversely, young bones that are still growing are

elastic and may split, bend, or crack just like a
young sapling (greenstick fracture)

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 Fractures

• Simple fracture
– A clean break or a crack in
the bone

• Comminuted fracture
– Produces multiple bone
fragments

• Greenstick fracture
– Split in a young, immature
bone; common in children

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 Fractures

Ø Open fracture
– Close to the fracture, the skin is
broken through which the bone
may or may not protrude

Ø Closed fracture
– The surrounding skin is unbroken;
but internal injury to surrounding
tissues may cause local swelling

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 Soft Tissue Injuries-Ligaments

• Injuries that affect the ligaments and muscles

• A sprain is an injury to a ligament at or near a joint
• Overstretched and torn by violent or sudden
movement

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 Soft Tissue Injuries-Muscles and Tendons

• Muscles and their tendons may be overstretched and

torn by violent or sudden movement

• Damage to muscle tissue can occur in one of three

ways;

Ø Strain

Ø Rupture

Ø Deep bruising

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• Strain
– Overstretching of the muscle ® partial
tearing or pull
– Often occurs at the junction of the muscle
and the tendon that joints it to a bone

• Rupture
– Complete tear of the muscle
– Occurs in the fleshy part or in the tendon

• Deep bruising
– May be extensive in parts of the body
where there is a large bulky of muscle
– Usually accompanied by bleeding into the
damaged area, which can lead to pain,
swelling, and bruising

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 General Approach
• Check ABC
– Open airway, check breating and circulation
• Check skin for
– Open wounds
– Piercing
• Immobilize the area below and above
the injured area
• Prevent shock
• Get medical help
 Treatment for Open Fractures
• Aims
– To prevent blood loss, movement, and infection at the
site of injury
– To arrange transportation to the hospital, with
comfortable support during transport

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 Treatment for Soft Tissue Injuries

• Aims
– To reduce swelling and pain
– To obtain medical aid if necessary

• The “PRICE” procedure

P: Protect (stabilization)
R: Rest the injured part
I: Apply Ice or a cold drink
C: Compress the injury
E: Elevate the injured part

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 Joint Sprain
• Assess the severity of injury for suspected
fracture (deformity, malfunction…)
• Remove any clothing from the joint
• Apply cold
• Elevation
• Anti-inflamatory medication
 Sprained Ankle

• If the ankle is broken,

treat it as a fracture of
the lower leg;
• a sprain (usually caused
by a wrench) can be
treated by the PRICE
Protocol

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 P.R.I.C.E.
1. Protection by splint or bracing
2. Rest, steady, and support the ankle in the most
comfortable position
3. Apply an ice pack or a cold compress to a recent
injury to reduce swelling
4. Wrap the ankle in a thick layer of padding and
bandage firmly
5. Raise and support the injured limb to reduce swelling
6. Advise resting the ankle

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 Treatment of Sprained Ankle
• Aims
– To relieve pain and swelling
– To seek medical aid if necessary

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 Dressings and Bandages

• Dressings
– Sterile dressings
– Gauze dressings
– Improvised dressings
– Adhesive dressings

• Cold compresses

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 Dressings and Bandages

• Bandages
– Roller bandages
– Tubular gauze
– Triangular bandages
– Hand and foot cover bandage
– Scalp bandage
– Slings
– Improvised slings

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• Inflatable splint
 Splinting and sling for upper
extremity fracture
1. Provide what you need
2. Stabilize the extremity
3. Stay in front of the patient
4. Support the arm
5. Place the sling
6. Release the arm
7. Tie the bandage
8. Provide the right posture
9. Check the circulation