Injuries To Arms & Legs: Examination & Evaluation

The kid was skating all over the place. Down the stairs, down the rails, over onto the fountain...just everywhere. I'm not surprised that he crashed. He never wanted to wear the protective equipment. I guess that he got what he deserved...one broken wrist...


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The kid was skating all over the place. Down the stairs, down the rails, over onto the fountain...just everywhere. I'm not surprised that he crashed. He never wanted to wear the protective equipment. I guess that he got what he deserved...one broken wrist and a broken arm too."

As a first responder, you will treat many patients who have suffered various types of open or closed painful, swollen or deformed extremities. It is important that you recognize the signs and symptoms of injuries of the musculoskeletal system. Proper care given at the scene can prevent additional injury or disability.

The skeleton has 206 bones and provides support and form for the body. It also protects the body's vital organs. The skull protects the brain, the spinal column protects the spinal cord, the ribs and sternum protect the heart and lungs, and the pelvis protects the organs of the lower abdomen.

The four primary functions of the skeletal system are to provide support, protect the body, assist in body movement and produce red blood cells. Because muscles and bones work together to produce movement, they are often called the musculoskeletal system. This movement occurs at joints, the contact points between bones that are next to one another. The joints are held together by ligaments, thick bands that arise from one bone, span the joint and insert into the adjacent bone.

A vital but often overlooked function of the skeletal system is the production of red blood cells. Red blood cells are made primarily in the spaces inside the bone called the marrow.

There are three major types of musculoskeletal injuries: fractures, dislocations and sprains. It is often difficult to distinguish one type of extremity injury from the other. All three types are serious and all extremity injuries must be identified so they can receive appropriate medical treatment. Since we are often not sure of the type of exact injury, we now are using new terminology to describe an injured extremity as "painful, swollen and deformed."

A fracture is a broken bone. Fractures can be caused by a variety of mechanisms but a significant force is almost always required. Fractures are generally classified as either closed or open. Closed fractures are more common. In the case of a closed fracture, the bone is broken but does not cause a break in the skin.

In an open fracture, the bone is broken and the overlying skin is lacerated. The open wound can be caused by penetrating objects, such as a bullet, or by the fractured bone end protruding through the skin. The open fracture is contaminated by dirt and bacteria; this contamination may lead to infection. Every fracture injures adjacent soft tissues, resulting in bleeding at the fracture site. Fractures also can injure adjacent nerves and blood vessels, causing severe nerve injury and excessive bleeding. Open fractures result in more bleeding than do closed fractures.

A dislocation is a disruption of the joint that tears the supporting ligaments. The bone ends that make up the joint separate completely from each other and lock in one position. Any attempted motion of a dislocated joint is very painful. Because many nerves and blood vessels lie near joints, a dislocation also can damage these structures.

A sprain is a joint injury in which the joint is partially, temporarily dislocated, and some of the supporting ligaments are either stretched or torn. It can be thought of as a partial dislocation. The following are the primary signs and symptoms of extremity injuries:

  • Pain at the injury site.
  • An open wound.
  • Swelling and discoloration (bruising).
  • The patient's inability or unwillingness to move the part.
  • Deformity.
  • Tenderness at the injury site.

There are three essential steps involved in examining all persons with limb injuries:

  1. General overall assessment of the patient.
  2. Examination of the injured part.
  3. Evaluation of the circulation and sensation in the injured limb.
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