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Extremity Trauma
Extremity Trauma
Extremity Trauma - 1
Overview
Major mechanisms, associated trauma,
potential complications, management:
• Pelvis • Clavicle/shoulder
• Femur • Elbow
• Hip • Forearm and wrist
• Knee • Hand or foot
• Tibia/fibula
Extremity Trauma - 2
Extremity Trauma
Distorted or wounded extremities must
not distract from life-threatening injuries.
• Easy to identify
• Disabling but rarely immediately life-threatening
Potential danger:
• Hemorrhagic shock (very few)
• Neurovascular compromise
• Distal PMS
Extremity Trauma - 3
Extremity Trauma
Extremity injuries
• Fractures
• Dislocations
• Amputations
• Open wounds
• Neurovascular injuries
• Impaled objects
• Compartment syndrome Courtesy of Roy Alson, MD
Extremity Trauma - 4
Extremity Injuries
Fractures
• Open (compound)
• Communication to outside
• Danger of contamination
• Blood loss outside body
• Closed (simple)
• No communication to outside
• Danger of contamination
• Blood loss inside body
Extremity Trauma - 5
Fractures
Hemorrhage with fracture
• Closed femur fracture
• Loss of 1 liter of blood
• Two closed femur fractures life-threatening
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Extremity Injuries
Dislocations
• Neurovascular compromise
• True emergency though not life-threatening
• Check PMS distal to major joint dislocations
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Dislocations
Management
• No neurovascular compromise
• Splint in position found
• Neurovascular compromise
• Apply only gentle traction in effort to straighten
• No more than 10 pounds of force
• Often best: pad and splint in most comfortable
position and rapid safe transport
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Extremity Injuries
Amputations
• Disabling and sometimes life-threatening
• Potential for massive hemorrhage
• Most often, bleeding controlled with ordinary pressure
Extremity Trauma - 9
Amputations
Management
• Cover with damp sterile dressing, elastic wrap
• Uniform reasonable pressure across stump
• Tourniquet if bleeding absolutely not controlled
• Rarely needed
• Retrieve amputated part
• In plastic bag, inside ice water
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Extremity Injuries
Open wounds
• Remove contamination
• Gross: remove
• Smaller: irrigate with normal saline
• Sterile dressing and bandage
• Pressure dressing, if necessary
• Pressure point
• Tourniquet rare
• Hemostatic agent Courtesy of Roy Alson, MD
Extremity Trauma - 11
Open Wounds
Obvious
exsanguinating hemorrhage—
only time can change order of
ABC to CAB.
Extremity Trauma - 12
Extremity Injuries
Neurovascular injuries
• Nerves and major vessels
run beside each other in
flexor area of major joints
Distal PMS
• Assess pulse
• Assess motor function
• Assess sensory
Extremity Trauma - 13
Extremity Injuries
Impaled objects
• Do not remove
• Airway obstruction exception
Extremity Trauma - 14
Extremity Injuries
Compartment syndrome
• Forearm and lower leg most common
• Swelling compresses nerves and vessels
Extremity Trauma - 15
Compartment Syndrome
Early symptoms Late symptoms
• Pain • Pain
• Paresthesia • Pallor
• Pulselessness
• Paresthesia
• Paralysis
Extremity Trauma - 16
ITLS Patient Assessment
Mechanism History Common Injury
Falls landing on feet Foot, lumbar spine
Sitting position Knee, hip
Fall onto wrist Wrist, elbow
Fall onto ankle Ankle, proximal fibula
Shoulder involved Shoulder, neck, chest
Pelvis involved Pelvis, shock
Extremity Trauma - 17
Extremity Trauma
ITLS Primary and Secondary Surveys
• Major bleeding
• DCAP-BTLS
• Instability
• Crepitation
• Joint pain
• Joint movement
• Distal PMS
Extremity Trauma - 18
Management
Splinting
• Prevent motion in broken bone ends
• Eliminate further damage
• Decrease pain
Load-and-go patients
• Temporary splinting with long backboard
• Additional splinting during transport
Extremity Trauma - 19
Splinting
Rules
• Adequately visualize
• Distal PMS before and after splinting
• Treat neurovascular compromise
• Cover open wounds with sterile dressing
• Immobilize one joint above and below
• Apply on side away from open wound
• Pad splint well
• Do not attempt to push bone ends under skin
Extremity Trauma - 20
Extremity Trauma
Extremity Trauma - 21
Types of Splints
Extremity Trauma - 22
Extremity Trauma
Spine
Extremity Trauma - 23
Extremity Trauma
Pelvis
Extremity Trauma - 24
Extremity Trauma
Femur
Extremity Trauma - 25
Extremity Trauma
Hip
Extremity Trauma - 26
Extremity Trauma
Knee
Extremity Trauma - 27
Extremity Trauma
Tibula/fibula
Extremity Trauma - 28
Extremity Trauma
Clavicle
Extremity Trauma - 29
Extremity Trauma
Shoulder
Extremity Trauma - 30
Extremity Trauma
Elbow
Extremity Trauma - 31
Extremity Trauma
Forearm and wrist
Extremity Trauma - 32
Extremity Trauma
Hand or foot
Extremity Trauma - 33
Summary
ITLS Primary Survey has priority.
• Extremity trauma not usually life-threatening
• Pelvic, femur fractures can be life-threatening
Extremity Trauma - 34
Discussion