Strains, Sprains, Fractures and Dislocations

Strains, sprains, fractures and dislocations
Name London District 14 February LINKS2007 Autumn 2008
What well be covering What are strains, sprains, fractures and dislocations, and why do they happen? How to recognise them on duty How to treat them What to do and what not to do Practical skills bandaging people with these problems
Strains, sprains, fractures and dislocations London District LINKS
The skeleton
Your body is held together by bones Together, bones form the skeleton The skeleton is very strong all your organs and muscles are attached to it somehow How many bones does an average adult have?
The skeleton The average adult has 206 bones The heaviest is the femur in the thigh The smallest is the stapes in the ear
Any bone in the body can be broken if things go wrong
Joints
Bones meet at joints Joints allow the body to move However they are weaker than bone, and this makes them vulnerable to injury Joints contain several important parts
A simplified joint
Bone
Cartilage lines the bone surfaces

Fluid fills the joint space Ligaments cover the outside of the joint
Mechanisms of injury Strains, sprains, fractures and dislocations are caused by abnormal forces on joints and bones These can include:
- impacts - twisting movements - compression or stretching - over-bending of joints
Mechanisms of injury What sort of duty situations might these problems occur in?
- Sports matches - Running events - Ice skating - Car or cycle races - Crushing in heavy crowds - Diving into deep water
Strains
What is a strain? Muscles attach to bones via tendons You can see tendons on the back of your hand If a muscle is pulled too hard, the tendon becomes damaged a strain Pain occurs whilst the tendon heals
Common sites for strains Strains often occur around:

- Neck - Ribs - Upper arm - Fingers - Groin!
Why are these strains common?
Recognising a strain How would you recognise a strain?

- History of injury e.g. casualty slipped over - Pain and tenderness - Swelling usually not much - Reddening of the skin - Reduced movement due to the pain - Location often away from a joint unlike a sprain
How to treat a strain The treatment is RICE
How to treat a strain RICE is a key first aid acronym:
R I C E
- Rest the affected area - Ice-pack the affected area
- Compress the affected area

- Elevate the affected area
How to treat a strain Advise the casualty they can buy simple painkillers from a pharmacy Strains can take a few days to a week to get better (if RICE is followed)
If it doesnt get better they can see their GP or go to A&E
Sprains
What is a sprain?
Remember the joint? A sprain occurs when the ligament around a joint is damaged The joint fluid can leak out This causes pain and swelling
Common sites for sprains What joints are commonly sprained?

- Ankle - Knee - Elbow - Wrist - Finger joints
Tends to be joints in arms and legs that sprain the most why?
Recognising a sprain How would you recognise a sprain?

- History of injury e.g. fell awkwardly - Pain and tenderness - Swelling more than in a strain
- Reddening of the skin

- Reduced movement due to the pain - Location around a joint, by definition
How to treat a sprain RICE is the key again:
R I C E
- Rest the affected area - Ice-pack the affected area
- Compress the affected area

- Elevate the affected area
How to treat a sprain Again the casualty can buy simple painkillers Sprains often take longer to heal up to two weeks
Resting the joint is most important

Again they should see their GP or A&E if things dont get better
Fractures
What is a fracture?
A fracture is a broken bone This includes chips and cracks in bones as well as full snaps Bones usually fracture in their shafts A strong force is usually required
Types of fractures Doctors like to classify fractures There are only 2 classes you need to know about
- Closed fracture where the broken ends of the bones are in their normal place - Open fracture where the ends of the bones have moved e.g. sticking out of skin
Why is this important?

Types of fractures
Closed fracture
Open fracture
Common sites for fractures Which bones commonly break?

- Upper arm (humerus) - Forearm (radius/ulna) - Wrist - Lower leg (tibia/fibula) - Ankle
Why are these fractures common?

Recognising a fracture How would you recognise a fracture?

- History of injury e.g. fell onto arm - Snapping or cracking noise heard - Lots of pain - Swelling of the area - Obvious deformity e.g. bone looks bent - Inability to move the area - Bone sticking out or a wound if open fracture
Recognising a fracture You should be more suspicious of a fracture in people with weaker bones:
- children - older people - people with bone disease e.g. osteoporosis (thinning of the bones) - people taking steroids for a long time
How to treat a fracture Try to move the area as little as possible Support the area:
- Arm sling for an arm or wrist fracture - Elevation sling for a collar bone fracture - Blanket padding for a leg fracture
Dress any wounds that are present Cover any bone ends with dressings soaked in sterile saline
How to treat a fracture The casualty needs to go to hospital as soon as possible Dont let the casualty eat or drink, smoke or walk around
Treat for shock if necessary
Further treatment
The ambulance crew may use a splint to hold the bones in place They may give the casualty painkillers:
- gas and air (Entonox) - into the bloodstream e.g. morphine
Further treatment
Many fractures can be treated with a plaster cast Others need operations and metalwork to hold the bones in place This is a tibia fracture
Dislocations
What is a dislocation?
Remember the joint? A dislocation occurs when the two bone ends come apart This stops the joint from moving It is usually due to an impact to the joint
Common sites for dislocations Which joints commonly dislocate?

- Shoulder - Finger joints - Hip (often hip replacements) - Kneecap - Ankle
Due to the forces involved, fractures may occur with dislocations

Recognising a dislocation How would you recognise a dislocation?

- History of injury impact to a joint - Crunching noise heard - Deformity of the joint - Swelling and redness - Lots of pain - Inability to move the joint - Signs of a nearby fracture
How to treat a dislocation Keep the joint still and supported use a sling or padding if necessary Never try to put the bones back into the normal position:
- Without x-ray cant be sure its a dislocation - May cause more damage - Its cruel without painkillers!
How to treat a dislocation The casualty needs to go to hospital as soon as possible Dont let the casualty eat or drink, smoke or walk about
Treat for shock if necessary
Further treatment Sometimes the ambulance crew may move the bones position if they are worried about nerve or artery damage Otherwise the dislocation will be moved in hospital after an x-ray The casualty will need painkillers and sedation its very painful!
Any questions?
Practical skills Well now teach you how to:

- Apply an arm sling useful for arm fractures - Apply an elevation sling useful for collar bone fractures - Apply padding and bandages to a leg to support a leg fracture
Quiz
Question 1 A sprain is where:

A. The ligaments around a joint have been damaged B. The bones in a joint have become displaced C. A muscle and its tendon have been damaged D. The soft tissues around a bone have been bruised
Question 1 A sprain is where:

A. The ligaments around a joint have been damaged B. The bones in a joint have become displaced C. A muscle and its tendon have been damaged D. The soft tissues around a bone have been bruised
Question 2 How long does a strain take to heal, if RICE is followed?

A. A few hours B. A few days to a week
C. Up to two weeks
D. Up to a month
Question 2 How long does a strain take to heal, if RICE is followed?

A. A few hours B. A few days to a week
C. Up to two weeks
D. Up to a month
Question 3 The C in RICE stands for:

A. Calm the patient B. Circulation C. Call for medical help D. Compress the injury
Question 3 The C in RICE stands for:

A. Calm the patient B. Circulation C. Call for medical help D. Compress the injury
Question 4 The most important risk with an open fracture is that:

A. The bones might erode each other as they rub together B. Infection can enter the body C. The doctor might scratch himself on the protruding bone D. There might be lots of bleeding
Question 4 The most important risk with an open fracture is that:

A. The bones might erode each other as they rub together B. Infection can enter the body C. The doctor might scratch himself on the protruding bone D. There might be lots of bleeding
Question 5 Which of these joints is not commonly dislocated?

A. Wrist B. Ankle
C. Shoulder
D. Finger
Question 5 Which of these joints is not commonly dislocated?

A. Wrist B. Ankle
C. Shoulder
D. Finger
Scenario You are called at the ice rink to a 75year-old lady who has slipped on the ice and fallen. She put her left arm out as she landed. She is now complaining of severe pain in her upper arm. She cannot move her shoulder or elbow. There is a tender swelling halfway between her shoulder and elbow.
Question 6 What is your diagnosis?

A. She has strained her biceps muscle and tendon B. She has fractured her humerus bone
C. She has dislocated her shoulder

D. She has sprained her elbow
Question 6 What is your diagnosis?

A. She has strained her biceps muscle and tendon B. She has fractured her humerus bone
C. She has dislocated her shoulder

D. She has sprained her elbow
Question 7 Which of these features is least useful for making your diagnosis?
A. The severity of the pain B. The mechanism of the injury
C. The presence of skin reddening

D. The age of the patient
Question 7 Which of these features is least useful for making your diagnosis?
A. The severity of the pain B. The mechanism of the injury
C. The presence of skin reddening

D. The age of the patient
Question 8 What will you do to help the casualty before taking her to the first aid post?
A. Give her a hot cup of tea B. Massage the injury site
C. Tie a crepe bandage tightly around the swollen area

D. Apply an arm sling
Question 8 What will you do to help the casualty before taking her to the first aid post?
A. Give her a hot cup of tea B. Massage the injury site
C. Tie a crepe bandage tightly around the swollen area

D. Apply an arm sling
Question 9 As you get the casualty to the first aid post in a wheelchair, she complains of feeling sick and faint. What do you do?
A. B. C. D. Walk her to the toilet to be sick Lay her down and raise her legs Give her two paracetamol tablets Leave her sat outside in the wheelchair to get some fresh air
Question 9 As you get the casualty to the first aid post in a wheelchair, she complains of feeling sick and faint. What do you do?
A. B. C. D. Walk her to the toilet to be sick Lay her down and raise her legs Give her two paracetamol tablets Leave her sat outside in the wheelchair to get some fresh air
Question 10 The casualty has left for hospital in an ambulance. What is your priority now?
A. Have a cup of coffee B. Go back to your station at the ice rink C. Radio control to tell them the casualty has left the first aid post D. Fill in a PRF, RIDDOR form and the ice rinks accident book
Question 10 The casualty has left for hospital in an ambulance. What is your priority now?
A. Have a cup of coffee B. Go back to your station at the ice rink C. Radio control to tell them the casualty has left the first aid post D. Fill in a PRF, RIDDOR form and the ice rinks accident book
The end
Any more questions?


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Strains, sprains, fractures and dislocations

Name London District 14 February LINKS2007 Autumn 2008

Any bone in the body can be broken if things go wrong

Strains, sprains, fractures and dislocations London District LINKS

Cartilage lines the bone surfaces

Strains, sprains, fractures and dislocations London District LINKS

Strains, sprains, fractures and dislocations London District LINKS

Common sites for strains Strains often occur around:

Why are these strains common?

Strains, sprains, fractures and dislocations London District LINKS

Recognising a strain How would you recognise a strain?

How to treat a strain The treatment is RICE

Strains, sprains, fractures and dislocations London District LINKS

How to treat a strain RICE is a key first aid acronym:

- Rest the affected area - Ice-pack the affected area

- Compress the affected area

Strains, sprains, fractures and dislocations London District LINKS

If it doesnt get better they can see their GP or go to A&E

Strains, sprains, fractures and dislocations London District LINKS

Common sites for sprains What joints are commonly sprained?

Recognising a sprain How would you recognise a sprain?

- Reddening of the skin

How to treat a sprain RICE is the key again:

- Rest the affected area - Ice-pack the affected area

- Compress the affected area

Strains, sprains, fractures and dislocations London District LINKS

Resting the joint is most important

Why is this important?

Strains, sprains, fractures and dislocations London District LINKS

Common sites for fractures Which bones commonly break?

Why are these fractures common?

Recognising a fracture How would you recognise a fracture?

Strains, sprains, fractures and dislocations London District LINKS

Treat for shock if necessary

Strains, sprains, fractures and dislocations London District LINKS

Strains, sprains, fractures and dislocations London District LINKS

Strains, sprains, fractures and dislocations London District LINKS

Common sites for dislocations Which joints commonly dislocate?

Due to the forces involved, fractures may occur with dislocations

Recognising a dislocation How would you recognise a dislocation?

Strains, sprains, fractures and dislocations London District LINKS

Treat for shock if necessary

Strains, sprains, fractures and dislocations London District LINKS

Practical skills Well now teach you how to:

Strains, sprains, fractures and dislocations London District LINKS

Question 1 A sprain is where:

Question 1 A sprain is where:

Question 2 How long does a strain take to heal, if RICE is followed?

Strains, sprains, fractures and dislocations London District LINKS

Question 2 How long does a strain take to heal, if RICE is followed?

Strains, sprains, fractures and dislocations London District LINKS

Question 3 The C in RICE stands for:

Strains, sprains, fractures and dislocations London District LINKS

Question 3 The C in RICE stands for:

Strains, sprains, fractures and dislocations London District LINKS

Question 4 The most important risk with an open fracture is that:

Question 4 The most important risk with an open fracture is that:

Question 5 Which of these joints is not commonly dislocated?

Strains, sprains, fractures and dislocations London District LINKS

Question 5 Which of these joints is not commonly dislocated?

Strains, sprains, fractures and dislocations London District LINKS

Question 6 What is your diagnosis?

C. She has dislocated her shoulder