Orthopedic Trauma

Andrea L. Williams, PhD, RN

Emergency Education & Trauma Program
Specialist
Associate Clinical Professor
UWHC & UW-SON

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Name that Injury!

Associated Conditions
Hemorrhage Shock (~2L pelvis, 1L thigh
& 500 ml tibia)
Instability
Loss of tissue
Laceration with contamination
Interrupted blood supply Ischemia
Nerve damage
Long-term Disability

Sprains
Partial tear of a ligament by twisting & stretching
of a joint beyond normal ROM
1st Degree Sprain No instability, few fibers torn.
Minimal hemorrhage & swelling
2nd Degree Sprain No instability, ligaments partally
torn, swelling and hemorrhage
3rd Degree Sprain Unstable, ligaments completely,
with significant swelling & hemorrhage.

Sprained Knee

Strains & Ruptures

Strain - Injury to a muscle or tendon from
overexertion (back, arms, calf)
Severe strains can cause bone avulsion

Joint Dislocations
Dislocation Articulating surfaces of 2 bones
are displaced

Luxation Complete dislocation

Subluxation Incomplete dislocation
Rotator Cuff injuries Usually deltoid
Common sites
Shoulders, elbows, fingers, knees, & ankles

Complications
Posterior popliteal injury

Principles of Splinting (p. 1238)

Splint joints and fractures above & below injuries
Cover open fractures
Document pulses, sensation, motor function
before & after splinting
Stabilize the limb with gentle in-line traction to a
position of normal alignment
Immobilize dislocations in a position of comfort
with
Ice, cold compresses
Elevation to or just below level of heart

Shoulder Injuries
Dislocations
Subluxations
Rotator cuff tendon
injuries
Sternoclavicular strain
Treatment
Neurovascular status
Splint in position found
or
Sling & secure to body
Ice or cold compresses

Elbow Injuries
Falling on an outstretched arm or
flexed elbow
Pulled elbow Nursemaids elbow
from a sudden lateral force
Athletic injury
Complications
Volkmanns contracture Claw-like
contraction of hand & arm deformity
from ischemia
Laceration of brachial artery
Ulnar nerve damage

Treatment
Check neurovascular status
Splint in position found
Ice or cold compresses

Radial, Ulnar, Wrist Injuries

Check neurovascular
status
Splint in position found
(rigid or formable
Ice & elevation

Hand Injury
Boxers fracture 5th
metatarsal bone
Treatment
Check neurovascular
status
Splint (rigid or
semiformable) in
position of function
Ice & elevation

Finger Injuries
Assess neurovascular status
Splint in foam filled aluminum
splint, with tongue blades, or
tape to adjacent finger
Ice & elevation

Pelvic Injuries

Signs & Symptoms

Pain
Hypovolemic shock
Shortening or abnormal
rotation of affected
extremity
Associated with injuries
to the bladder, urethra,
reproductive organs &
sacral nerves

Pelvic Injuries
Treatment of Pelvic Fractures/Ring Injuries
Open book Vacuum mattress, Pelvic Binder, or sheet
Control hemorrhage Direct pressure or close pelvic
ring
Fluid volume replacement Normal Saline
(ED - PRBC, FFP, Platelets., Factor VII A &/or
embolization)
External fixation/ORIF

Classification of Long Bone

Injuries
Fractures

Complete or incomplete
Open or closed
Epiphyseal Cause bending or deformity
Comminuted Several breaks in the bone
Greenstick - Break in periosteum w/i
bowing or buckling
Spiral Twisted or circular break. child
abuse
Oblique Diagonal, slanting break
Transverse Right angle fracture
Pathological

Long Bone Fractures

Pathophysiology
Femur fractures result from major force
Long bone fractures from falls, MVC,
MCC
Femur neck fractures common in
elderly
Blood loss into a femur
1,000-1,500 ml

Long Bone Fractures

Signs & Symptoms

Pain
Ecchymosis & edema of the
site
Deformity at the site
Shortening of affected
extremity
Internal or external rotation
Hypovolemia or
hypovolemic shock

Long Bone Fractures

Assessment
Circulation Hemorrhage or ischemia
Neurovascular status
Pulses

Deformity Edema, hematoma, wounds

Compartment Syndrome
6 Ps Pain, Pallor, Parasthesia, Pulses,
Paralysis, Pressure

Long Bone Fractures

Treatment

Immobilize
Splint
Control pain
Realign In ED
Skeletal traction (In ED)
Usually temporary. Weights
must hang free, meticulous skin
care
External fixators
ORIF

Splinting
Types of splints
Rigid splint body part fit to splint
design
Soft or formable splint molded to
shape or configuration of the body part
Traction splint (Femur fractures)
traction to stabilize and align

Open Fractures

Signs & Symptoms

Evidence of skin disruption over a
fracture
Protrusion of bone through an open
wound
Pain
Neurovascular compromise
Bleeding

Open Fractures

Treatment
Cover the wound
Splint
ED or OR Wound
cleansing & debridement
Realignment
Splint/Cast
External fixation
ORIF
Complications osteomyelitis, cellulitis

Techniques for Realignment

Finger realignment
Shouldar realignment
Hip realignment
Knee realignment
Ankle realignment

Jumper Syndrome
Vertical deceleration
Forces transmitted upwards from lower
extremities, pelvis, spine, chest
Lower extremity fractures & spinal cord
injuries
Retroperitoneal hemorrhage is the most
common cause of shock

Amputations

Classification
Partial
Complete
Usually involves digits,
foot, lower leg, hand or
forearm
Life over limb
considerations

Amputations
Classification

Partial
Complete
Usually involves digits, foot, lower leg,
hand or forearm
Life over limb considerations
Re-implantation (Favorable in Peds &
with guillotine-type amputations)

Amputations

Signs & Symptoms

Obvious tissue loss
Pain
Bleeding
Hypovolemic shock

Amputations

Treatment
Reattachment
Amputation
Rehabilitation
Prosthesis Clinic
Assessment & Care
Keep body part
bagged not directly
on ice

Compartment Syndrome

Signs & Symptoms

Pain disproportionate to injury
Sensory deficit
Progressive muscle weakness
Tense swollen area
Elevated compartment
pressures
Loss of pulses

Compartment Syndrome
Treatment
Elevation of limb not above heart level
Placement of an intracompartmental
monitor
<20 = normal
>20 = ischemia
> 30 = necrosis

Fasciotomies to release the pressure