SOFT TISSUE INJURIES,
DISLOCATIONS AND
FRACTURES
Soft tissue injuries
Contusions, strains and sprains all fall
under the classification of soft tissue injury.
Contusions (bruises)
- Result of trauma to the skin which causes
damage to the underlying blood vessels.
- Does not cause the skin to break
- Amount of discolouration and swelling
under the skin will depend upon the size
and the number of blood vessels disrupted.
Strains
Occurs when a muscle is exposed to a
greater workload than is normally
encountered and is stretched beyond its
normal limit.
It can also occur if a muscle comes under
stress before it is has properly warmed up.
Can occur within the muscle belly itself, or
in the tendon which attaches the muscle
to the bone.
Severity of the strain can vary from minor
discomfort and damage through to a
complete rupture of the muscle.
Sprains
A sprain occurs at a joint and is normally associated
with the stretching of that joint beyond its normal
range of movement, often causing the ligaments to
stretch and sometimes tear.
Some joints also have cartilage pads located in them
to provide cushioning.
IMPORTANT!
If you are unsure whether the injury is a soft
tissue injury or a fracture or a dislocation, treat
as a fracture or dislocation until proven
otherwise. After going through the usual
assessment procedures, the management of
this group of injuries is similar.
Managing soft tissue injuries
Signs and symptoms
- Pain
- Bruising
- Swelling
- Loss of motion
- Deformity
- Shock
Management of soft tissue injuries require the application of
the RICER principle.
Rest- The injured part
Ice- An ice pack or cold compress should be applied to the injured site. Do
not apply directly to the skin, but wrap in a damp cloth. The ice should
be applied for 10 to 20 minutes every 2 hours.
Compression-Apply a compression bandage to the injured site
Elevation-The injured area should be elevated
Referral- If unsure of the extent of the injury, medical advice should be
sought
IF IN DOUBT, GET IT CHECKED OUT
Dislocations
Injuries to joints where one bone is displaced from another
Can be caused by direct trauma or abnormal twisting, often
resulting in displacement of a bone from its normal position in a
joint. Joint is pushed past its normal ROM.
Signs and symptoms include: pain, deformity and loss of motion.
Surrounding connective tissue, ligaments and tendons are also
damaged.
Urgent medical attention is required if a distal pulse (i.e. one
furthest from the heart than the injury site) is unable to be located,
or there is altered sensation, such as numbness.
Common sites of dislocations are:
Fingers, shoulder and patella.
Left Shoulder Dislocation
Photograph
Right Knee Dislocation
Photograph
Left Knee Dislocation
Photograph
Can you spot the
difference????
Left ankle fracture/dislocation
Photograph
Dislocations-treatment
The following guidelines should be
observed when treating a dislocation:
Never attempt to relocate the displaced
bone yourself nor let anyone besides a
doctor attempt to relocate the bone.
Risk = disrupting blood supply to joint,
therefore can lead to necrosis of the limbs.
Damage to the nerve supply and increased
damage to the surrounding tissue.
Hard Tissue Injuries:
A fracture is a break in a bone. Sometimes the
Fractures
fracture may be a single, clean break or there may
be several breaks. Children often suffer a
greenstick fracture, which is the splintering of
bone.
CAUSES:
Direct force-bone is broken at site of impact
Abnormal muscle contraction
Indirect force-bone breaks some distance from the
point of impact.
Diseased bone-(causes include osteoporosis and
cancer)
Signs and symptoms of fractures include:
1. Pain at the site of the injury
2. Inability to move the injured part, or
3.
4.
5.
6.
7.
unnatural movement of the injured
part
Deformity of the injured part
Swelling and discolouration
Grating of bones
Tenderness
Possible shock
Types of Fractures
Type of
Fracture
Definition
Associated
Factors
The bone is fractured Bleeding remains
Closed
(simple)
Open
(compound)
but there is no cut or
wound at the fracture
site
concealed beneath the
skin
The end of the
Visible external
fractured bone
protrudes through the
skin
The fractured bone
Complicated
damages the local
tissues, i.e. organ(s)
bleeding occurs.
Infection may enter
the body and the
bone.
Compound Fracture
Photographs
Fractures-treatment &
If responsive:
Conduct a Primary Survey and act accordingly
- management
- The main aim is to prevent any movement at the site of the
fracture. If unsure, keep the victim still and comfortable and call an
ambulance.
- Immobilise the joint above and below the fracture site, if possible.
- If necessary, splint in position of comfort for the victim.
(Refer to Lippmann & Natoli (2006), pp 51-52) for splinting and
immobilisation technique examples.
- Do not attempt to realign a badly deformed limb
- Where possible, an immobilised fractured limb should be elevated
to reduce pain and swelling.
- Treat for shock
- Support a fractured jaw with the hand. If necessary, pull the lower
jaw forward to keep the airway open.
- Note: If in a metropolitan region or one in which is close to medical
assistance it may be preferable not to splint the affected site. Leave
this to ambulance or paramedical services.
Fractures-treatment &
Management
If unresponsive:
- Arrange urgent medical treatment
- Immediately place the victim in the
recovery position
- Conduct a Primary Survey and Vital
Sign Surveys and act accordingly.
Slings-Full
Arm
Sling
When to use: Injuries to the forearm
and wrist
How to apply:
-Support the injured forearm
approximately parallel to the ground with
the wrist slightly higher than the elbow
-Place an opened triangular bandage
between the body and the arm, with its
apex towards the elbow
-Extend the upper point of the bandage
over the shoulder on the uninjured side
-Bring the lower point up over the arm,
across the shoulder on the injured side
to join the upper point and tie firmly.
-Ensure the elbow is secured by folding
the excess bandage over the elbow and
securing with a safety pin
Slings-Elevation Sling
When to use: Injuries to the shoulder and collar bone
How to apply:
Support the casualtys arm with the elbow
beside the body and the hand extended
towards the uninjured shoulder
-Place an opened triangular bandage over
the forearm and hand, with the apex
towards the elbow
-Extend the upper point of the bandage
over the uninjured shoulder
-Tuck the lower part of the bandage under
the injured arm, bring it under the elbow
and around the back and extend the
lower point up to meet the upper point at
the shoulder
-Tie firmly with a reef knot
-Secure the elbow by folding the excess
material and applying a safety pin, then
ensure that the sling is tucked under the
arm giving firm support
Slings-Collar and Cuff Sling
When to use: Injuries to the
upper arm
How to apply:
-allow the elbow to hang naturally at the side and place the hand
extended towards the shoulder on the uninjured side
-using a narrow fold triangular bandage, form a clove hitch by forming two
loops one towards you, one away from you
-put the loops together by sliding your hands under the loops and closing
with a clapping motion.
-If you are experienced at forming a clove hitch, then apply a clove hitch
directly on the wrist, but take care not to move the injured arm
-slide the clove hitch over the hand and gently pull it firmly to secure the
wrist
-extend the points of the bandage to either side of the neck and tie firmly
with a reef knot
-allow the arm to hang comfortably. Should further support be required, eg
for support to fractured ribs, apply triangular bandages around the body
