EXTREMITY TRAUMA

Instructor Name:
Title:
Unit:
 OVERVIEW
Relationship of extremity trauma to
assessment of life-threatening injury
Types of extremity injuries
Assessment & management
General
Estimation of blood loss
Splinting
Specific injuries
 FRACTURE PRIORITIES
Fractures rarely life-threatening
Perform BTLS Primary Survey to find life-
threatening injuries
Do not be distracted by obvious but not life-
threatening extremity injuries
Be alert to major bleeding from extremity
injuries
TYPES OF FRACTURES
Open
Bone ends protrude through the wound
High risk of infection
Closed
No opening through the skin
Fractures may
Damage adjacent nerves and vessels
Produce severe bleeding
Blood loss may be internal
 DISLOCATIONS
Joint deformity may be fracture or
dislocation
Can cause neurovascular
compromise of distal extremity
Always assess
Distal sensation
Distal motor function
Distal pulses and skin color
 AMPUTATIONS

Control bleeding by direct pressure

Tourniquets rarely needed
Locate amputated part
Do not place amputated part directly
in ice or water
Place part in plastic bag
Place bag in ice-water mixture
 SPRAINS & STRAINS
Signs similar to fractures
X-rays needed to distinguish from fractures
Treat as if fractured

If an extremity hurts, immobilize

it
 OPEN WOUNDS
Control bleeding with
pressure
Tourniquets rarely
needed
Check distal PMS
Pulse
Motor COURTESY ROY ALSON M.D.

Sensory
Applying Tourniquet
IMPALED OBJECTS

Stabilize in position found

Removal may cause uncontrollable
bleeding
Exceptions
Object in cheek
Cannot control major bleeding with
object in place
COMPARTMENT SYNDROME

Pathophysiology
Signs
and
symptoms
Early Late
Pain Pallor
Paresthesias Pulselessness
Paralysis
 SIGNS & SYMPTOMS OF
EXTREMITY INJURY

Pain
Deformity
Swelling
Loss of
movement
Crepitus
COURTESY ROY ALSON,
M.D.
 ASSESSMENT
Scene Size-Up
Clues to specific injuries
BTLS Primary Survey
Pelvic fractures or bilateral femur fractures are
Load & Go
Control major bleeding
History may suggest other injuries
BLOOD LOSS FROM
FRACTURES
Pelvis - 500cc for each break
May lacerate major vessels causing
major internal bleeding
Femur - 1000cc
Multiple fractures can produce life-
threatening hemorrhage
May all be internal
 DETAILED EXAM
CHECK EXTREMITIES FOR

Deformities Burns
Contusions Tenderness
Abrasions Lacerations
Penetrations Swelling

ALSO CHECK FOR PMS

 MANAGEMENT
SPLINTING
Decreases pain
Prevents further
injury
Decreases blood
loss
COURTESY DAVID EFFRON, M.D.
 GENERAL RULES OF
SPLINTING
Visualize injured part
Check and record PMS before and after
splinting
May apply gentle in-line traction
Cover open wounds with sterile dressings
Pad the splint
Immobilize one joint above and below
the site of the injury
GENERAL RULES OF
SPLINTING
Do not push bone ends back under
the skin
May apply splints en route to the
hospital
If in doubt, splint
Never delay transport of critical
patient to perform splinting of
minor fractures
 MANAGEMENT
LOAD & GO PATIENTS

Spinal immobilization
Long backboard
C-collar
Head immobilizer
Limit splinting until en route
Backboard acts as whole body
splint
 MANAGEMENT
SPECIFIC INJURIES
CLAVICLE
FRACTURES
Common injury
Apply sling &
swathe
 SHOULDER INJURIES
AC separation
Sling & swathe
Shoulder
dislocation
Use pillow with
sling & swathe
Fracture
Use sling & swathe
 ELBOW INJURY
Fracture or dislocation
may cause
neurovascular injury
Splint in position
found
Transport promptly
FOREARM/WRIST INJURY
Rigid splint
Keep hand in
position of
function
Air splint
May be difficult
to reassess
circulation
Pillow
 FEMUR FRACTURES
High force injury
High potential for
shock
May use traction splint
PASG or air splint
may give adequate
stabilization
COURTESY OF ROY ALSON M.D.
 KNEE FRACTURE
OR DISLOCATION
Orthopedic emergency
Frequently causes
vascular injury
Dislocation associated
with high incidence of
leg amputation
 MANAGEMENT KNEE
DISLOCATION
Obvious dislocation without distal pulse
Apply gentle in-line traction
If gentle traction does not restore the pulse
Splint in place
Prompt transport
TIBIA-FIBULA FRACTURES

Frequently open fractures

Significant hemorrhage
possible
Dress open wounds
Depending on level of
fracture
Upper - Rigid splint COURTESY OF ROY ALSON M.D.

Lower - Air splint or pillow

 FOOT OR HAND
INJURIES
Common industrial injury
Often disabling
Rarely life-threatening
Splint foot with pillow
Splint hand in position of
function
 SUMMARY

Note mechanism of injury

Remember priorities
ABCs first
Be prepared for shock
Record PMS
 SUMMARY

Critical patients
Do not waste time on minor splinting
Immobilize spine
Apply other splints en route
Immobilize one joint above and
below
If in doubt, splint
QUESTIONS?