Musculoskeletal injuries and wound management

DR. Emil Fazliq2nd February 2009

PHASE I

MUSCULOSKELETAL INJURIES

• Injury of the bone, joint and muscles• Fracture - broken bones, a break in a

bone• People don’t usually die of broken

bone but airway obstruction, blood loss, brain injury

• Fracture- painful, debilitating, life-long disability and deformity

Classification• Open or closed• Transverse• Oblique• spiral• impacted• Greenstick• Comminuted• Impacted

SIGNS AND SYMPTOMS OF FRACTURE

• Pain• Deformity• Open wound• Swelling• Dysfunction• Crepitus• History of injury

WHAT TO DO• ABC…..• Remove clothing/constricted item• Examine the injured area• Check blood flow and

neurology(circulation, sensation,movement)

• Splint the fracture/Arrest bleeding• Appropriate referral

JOINT INJURY• Place two or more bone become

together• Dislocation - When joint become

totally apart and no longer in contact• Subluxation- When joint become

partially apart

Signs and symptoms• Deformity(compare with the contra

lateral joint)• Severe pain • Swelling• Inability to move the joint

What to do• ABC…• CSM(Circulation, sensation, motion)• Splint the joint• Symptomatic treatment• Reduce (If you know how)• Appropriate referral

SPRAIN• Ligament and tendon injury during

joint movement or twisting violently• Ligament - Connect bone to bone• Tendon - Connect muscle to bone

Signs and symptoms• Similar to fracture• Difficult to distinguish• Bluish discoloration or hematoma

formation around the joint

What to do…?• RICE (Rest, ice, compression,

elevation)

Strains• Muscle pull/injury• Occur to untrained muscle when it is

stretched beyond its normal range of motion

• Eg . Sudden sprint• Area become inflammed causing

pain and stiffness

What to look for….?• Sharp pain at the affected area• Extreme tenderness• Cavity,indentation or bump• Weakness and loss of function• Stiffness and pain

What to do• RICE

Cramps• Muscle goes into uncontrolled spasm

and contraction• Causing severe pain and loss of

motion• No definitive cause identified so far• A/w diabetes and atherosclerosis• Night cramps and heat cramps which

related to dehydration and electrolyte imbalance

What to do…..• Gently stretch the affected muscle• Relax the muscle• Apply ice to the cramped muscle• Drink salted cool water or sports

drink

Donts• Give salt tablet to patient• Massage or rub the affected

muscle( may cause more pain and does not relieve cramping)

wound

• Break in the skin surface• May allow micro-organism to enter the

body,causing an infection.• A few types

Types of wound• Abrasion- top layer of skin is loss with little or

blood loss• Laceration- cut skin with jagged and irregular

edges,usually caused by a forceful tearing away of skin tissue

• Incisions- smooth-edged,resembling a surgical or like a paper-cut,

• Puncture- deep, narrow wounds in the skin and underlying organs such as stab wound from a nail or knife

• Avulsion - piece of skin is torn loose and is either hanging from the body or completely removed, bleeds lots

What to do…..?• Protect yourself

– Use glove– Several layers of gauze pads or plastic wrap– Ask the patient to use his/her own hand to

pressure the wound– Use your bare hand as LAST RESORT

Cont.

• Exposed the wound to find the source of bleeding

• Attempt to control bleeding

Cleaning the wound• To prevent infection• Scrub and clean your hand vigorously with so.• .• .• .• ap and water• Wear gloves• Expose the wound• Clean the woun.• .• .• .• .• .• .• .• d,irrigate thoroughly,remove foreign body

Wound coverage• Use sterile dressing• Don’t use tape• Cover the wound with a thin layer of

antibiotic ointment• Change the dressing if soaked• Dressing- cover the wound• Bandage - holds the dressing in place

Wound infection• Once infected……disaster• Damage is extensive• So..prevent infection

Signs and symptoms of infected wound

• Inflammed• Pus discharged• Fever• Lymphadenopathy

Predisposing factor• Dirty and foreign material• Rugged or crushed tissue• Bite woundsWound that is not cleaned thouroughlyInjury to underlying bone, joint or tendon

Infected wound-treatment• Keep the wound clean• Dressing.• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• .• the wound• Antibiotic• Removed the predisposing factor