Musculoskeletal injuries

Muscles form groups that work in opposition to each other; as one lengthens the other shortens. An example of this is the biceps and triceps of the upper arm. In order to lift something towards the body the biceps shorten and the triceps lengthen. Tendons facilitate this movement as muscles are attached to bones via tendons. Ligaments attach a bone to a bone at a joint to allow movement of the joint.

The types of injuries that can occur to the musculoskeletal system are:

• Bone Fractures (breaks) that can be closed or open
  
• Dislocations of joints
  
• Avulsions of digits (forcible separation of tips of fingers or toes)
  
• Sprains (the joint is forced beyond its normal range)
  
• Strains (over stretching of muscle)
  
• Lacerations (a cut or tearing of the skin) 
  
• Abrasions

Soft Tissue Injuries

Sprains and strains are considered as soft tissue injuries and usually occur due to sporting activities. However, sprains and strains can occur through other mechanisms such as trips, falls, minor collisions and minor crush injuries.

• Sprains are caused when the joint is forced beyond its normal range of motion resulting in overstretching and tearing of the ligament that supports the joint. This often occurs when walking over uneven ground and the ankle turns inwards.
• Strains are caused by muscles over-stretching or contracting too quickly, resulting in a partial or complete tear of the muscle and/or tendon fibres. Again, gain a good history from the patient as sprains and strains present in a very similar way.
  

Minor wounds are also considered soft tissue injuries and officers will typically encounter the following types:

• Abrasions; usually only affect the epidermis and there is minimal bleeding as only capillaries are damaged. Abrasions can be painful and the application of Cophenylcaine can assist with the pain.
• Lacerations; caused by a cut or tear, either deep or superficial that can affect all three layers of the skin. These normally occur due to a sharp object or impact injury form a blunt object for force. Lacerations that penetrate into the dermis may also cause damage to underlying veins and arteries. The severity of bleeding is dependent upon the depth of the laceration and the location on the body. For example, head and facial wounds bleed more profusely as there is a more extensive network of capillaries, veins and arteries in these areas of the body.
• Punctures

The level of vascular damage that has occurred can be assessed by observing and recording the colour and characteristics of the bleeding.

• Capillary damage (red oozing)
• Venous damage (dark red, pours/pools)
• Arterial damage (bright red, spurts, pulsates)
  

If an artery has been damaged there is the potential for a significant amount of bleeding to occur.

Fractures & Dislocations

A fracture is a crack or break in the bone structure and can be caused by direct or indirect force.

Fractures can be classified as closed or open.

• An open fracture occurs when the bone breaks the skin and protrudes to the air; it may then recede back into the wound and not be visible through the skin. This is very painful for the patient and there is a higher risk of infection, nerve and blood vessel damage.
• In a closed fracture, the broken bone doesn't break your skin; there is no puncture or open wound.
  

Dislocations occur when a bone moves outside of the joint. This leads to pain and limited movement of the limb. Often the limb looks deformed.

Simple fractures are often caused due to sporting injuries, motor vehicle collisions falls, trips or assaults. Sometimes patients may present with a fracture but have had no history of these mechanisms of injury (this is rare). The cause is usually due to an underlying medical condition, e.g. osteoporosis or bone cancer etc. This is why it is important to take a history from the patient.

Dislocations are also caused by the same mechanism of injury as fractures. Some patients may have a fracture dislocation of a limb.

Assessment

In trauma, one should always examine the injured limb and compare it to the non-injured. Look and assess for:

• A present pulse
• Swelling
• Bruising
  
• Heat/inflammation
  
• Broken skin (laceration, puncture wounds)
  
• Range of movement (ask the patient to move the limb through the normal range, don’t force the limb through the normal range of movement, noting any limited movement)
  
• Pain
  
• Neurovascular observations: Colour / Warmth / Movement / Sensation (CWMS)
• Can they weight bear if it’s a lower limb injury (are they limping)?
  
• Can they grip if it’s a hand or wrist injury?

In all cases (e.g. major or minor trauma, epistaxis, etc.) always take a history from the patient including:

• How the trauma occurred
• How long the bleeding has occurred
• What medications the patient is taking (noting any anticoagulating (blood thinning) medications, as clotting times will be delayed)

Treatment

Manage as per Minor Wounds, and Fractures & Dislocations clinical skills. Remember to also apply the Trauma Management Principles, and Relief of Pain.

Always remember to do no harm:

• H – Do not apply heat to the injury
  
• A – Do not consume alcohol
  
• R – Do not run around or limit activity
  
• M – Do not massage the injury

Handle the limb carefully to prevent further injury and pain. Always explain to the patient what you are going to do and why. Consider the use of the Formable Splint as it can be shaped to the contours of the deformed limb and be cut to the size required.

A dislocated joint should be immobilised in the most comfortable position for the patient with the use of triangular bandages. Never attempt to place the joint back in position