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CHAPTER SEVEN
BONE AND JOINT INJURIES
 1. Fracture
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 Fracture – Is a break in the continuity of a bone.

Causes of Fracture;
 Traumatic or accidental causes

-It could be as a result of direct or indirect force application

 Pathologic causes of fracture

 Stress fracture

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 Types of Fractures
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Clinical classification of fracture

 Simple Closed fracture – In which the broken bone doesn’t come out

through the skin.

 Compound open fracture – in which the bone pierces the skin so that

the skin is torn or scraped.

 It is the severe form of fracture as there is;

 A great risk of contamination and development of infection

 Undetermined loss of blood that leads to anemia and hypovolemic
shock.
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 Clinical classification of fracture
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Open fracture Closed fracture

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 Common sites for fractures
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 Which bones commonly break?

 Upper arm (humerus)
 Forearm (radius/ulna)
 Wrist
 Lower leg (tibia/fibula)
 Ankle

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 Signs and symptoms of fracture
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 Pain that is usually severe and gets worse with time and movement
 Local swelling
 Bruising
 A limb or joint that is visibly out of place
 Limitation f movement or inability to bear weight
 Numbness and tingling
 Paleness of the injured area
 Crepitation (feel rubbing of broken bone)

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 First aid measures for fractures
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 Assess and manage ABC.

 Reassure and calm the casuality
 Manage bleeding if any and assess for shock.
 Splinting (immobilizing) the limb above and below the suspected fracture ,assess for
any neurological deficit.
 The injured area should be elevated to reduce swelling and pain
 Expose the injured area and assess unnoticed injuries.
 Provide analgesics ( anti-pain)
 Provide TAT ( tetanus anti toxoid vaccine)
 Provide antibiotics
 Urgent referral
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 Precautions
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 Transport an injured victim as if the victim has a spinal cord injury.

 Do not attempt to reduce a fracture or try to push a protruding bone
end back.
 Do not replace bone fragments
 Never test for fracture by having the victim to move the part or try to
walk on a possibly broken leg.
 Do not allow an accident victim to move his neck.

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 Complication of fracture
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 Blood loss, Resulting in shock

 Injury to vital organs
 Neurological and / or vascular damage
 Infection in open fractures
 Fat embolism
 Compartment syndrome : is the compression of nerves, blood vessels, and
muscle inside a closed space (compartment) within the body.
 This leads to tissue death from lack of oxygenation; the blood vessels being
compressed by the raised pressure within the compartment.
 Involves the forearm and lower leg .
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 2.Strain and Sprain injury
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 Strain
 Sprain

 Grouped under the soft tissue injuries that involve muscles, tendons and

ligaments.
Causes
 Excessively heavy load bearing

 Sudden or violent movements

 Any other actions that pulls the muscles and tendons

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 Sign & Symptoms
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 Localized pain or point tenderness

 Swelling and bruising or ecchymosis
 stiffness
 Discoloration (bruising)
 Distinct gap felt at the site
 Decreased range of movement
 Loss of function or laxity of the joint when there is a complete or
extensive tear of the involved structures.

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 First aid measures
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 RICE is the key :

 Rest the affected area

 Ice-pack

 Compress

 Elevate

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 3.Dislocated joint
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 When a bone is forcibly displaced from its joint the injury is known as
dislocation.
 Cause – Strong force that wrenching the bone in to an abnormal position
- Falls
- Blows

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 Commonly affected joints
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 Shoulder
 Jaw
 Hip
 Joints in the thumbs or fingers

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 Signs and symptoms

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 Disgusting, severe pain and difficulty on moving the area.

 Swelling and bruising around the joint.
 Numbness and tingling
 Injured part is usually stiff and tender at the joint, will help you
distinguish a dislocation from a fracture.

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 Emergency Management
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 Advise the casualty to keep still

 Support the injured part, in a position of maximum comfort for the
casualty, before you immobilize it.
 Immobilize the injured part with -Padding, Bandage and Slings
 For firm support, bandage the injured part to an unaffected part of the
body.
 Treat for shock if necessary
 Arrange to transport the casualty to hospital
 Check the circulation beyond the bandages every 10 minutes. If the
circulation is impaired, loosen the bandages. 03/28/2024
 Caution

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 Don’t try to reposition a dislocated bone in to its socket – Cause

further injury.
 Don’t move casualty until the injured part is secured and supported
 Don’t allow to eat, drink or smoke as a general anesthetic may be
needed.

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 4.Spinal cord injury
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 Spinal cord trauma is damage to the spinal cord that results from direct
injury to the cord itself, or
 From indirect injury from damage to the bones, soft tissues, and blood
vessels surrounding the spinal cord.

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 Causes
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 Falling from a height

 Falling awkwardly while doing gymnastics
 Diving in to a shallow pool and hitting the bottom
 Being thrown from a horse or motor bike
 Being in a collapsed rug by sacrum
 Sudden deceleration in a motor vehicle
 A heavy object falling across the back
 Injury to the head or face

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 Sign and Symptoms
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 Severe acute pain

 Severe shock

 Paralysis

 Weakness

 Breathing difficulties (from paralysis of breathing muscles)

 Spasticity /increased muscle tone

 Sensory changes

 Numbness

 Pain

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 Cont’d…
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 Loss of normal bowel and bladder control

 Constipation
 Incontinence
 Bladder spasms

 Abnormal blood pressure

 B/P fluctuates quickly and through a wide range
 Can be worse with pain or bladder spasm

 Abnormal sweating
 Trouble in maintaining proper temperature
 Sever shock
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 Emergency management
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For a conscious casualty

 Reassure the casualty and advise her not to move

 Call for an ambulance

 Kneel behind the casualty’s head. Grasp the sides of the casualty’s head

firmly with your hands over the ears.

 Steady and support her/his head in the neutral head position, in which

the head, neck and spine are aligned.

 Continue to support the casualty’s head in the neutral position until

emergency medical services take over.

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 For Unconscious causality
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 Kneel behind the casualty’s head.

 Grasp the sides of her head firmly with your hands over the ears.
 Steady and support the head in the neutral head position
 If necessary open the casualty’s air way using the jaw thrust method
 Check the casualty’s breathing. If there is breathing continue to support the
head. Ask a helper to call an ambulance.
 If the casualty is not breathing and there are no signs of circulation. Give
rescue breaths and chest compressions.
 Monitor and record vital signs
-Level of response
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- Pulse and breathing
 Caution
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 Do not move the casualty from the position in which you found him
unless he is in danger.
 If the casualty has to be moved, use the log-roll technique
 Don’t bend or twist the victim’s body
 Don’t move the head forward
 Under any circumstances. Don’t allow the victim to sit up

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 Complications of Spinal cord injury
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 Paralysis - Paraplegia
- Quadriplegia
 Loss of bladder control

 Increased risk of UTI

 Loss of bowel control

 Loss of sexual functioning (Male impotence)

 Paralysis of breathing muscles

 Complication of immobility
 Deep vein thrombosis
 Pulmonary infections
 Skin break down
 Contractures
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Thank You!

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