Orthopedic injuries are quite common. With so many people earning a living using their hands, proper care of upper extremity injuries is very important.
Most upper extremity injuries are very apparent. Victims often show the classic signs and symptoms of musculoskeletal trauma, such as localized pain, tenderness, swelling and sometimes deformity.While upper extremity injuries may be considered insignificant, they can cause permanent disabilities, frequently becoming a chronic problem long after the victim has recovered from the injuries. To reduce these potential complications, first aiders should thoroughly evaluate all upper extremity injuries, fully assess nerve function and blood circulation, and stabilize the injured part.
Types of injuries
There are many types of musculoskeletal injuries, ranging from simple bruises to complex open fractures. While it is difficult to determine the exact nature of an injury in the prehospital setting, a detailed description of the injury and your findings, is important for a physician to know. The orthopedic injuries most often seen by first aiders are:
- Strains - muscles are stretched or torn.
- Sprains - tearing or stretching of ligaments which are found in the joints.
- Dislocations - displacement of bone from its normal joint alignment out of its socket or out of its normal position.
- Fractures - break in a bone. Can be classified as open (overlying skin has been broken) or closed (overlying skin has not been broken).
Neurovascular evaluatioin
First aiders should check out the status of an arm's blood circulation, sensation and movement. Use this the mneumonic acyonym to remember: CSM; C = circulation; S = sensation; M = movement.
- Circulation. To assess blood circulation, first check the radial pulse (located on thumb side of the wrist) on the injured arm. Next, inspect the fingernail beds for discoloration, and assess capillary refill.
Perform the capillary refill test by pressing a fingernail (make it blanch or turn white) and release it. If it returns to its normal color within two seconds, it means that the blood circulation is normal. If it takes more than two seconds to return, it indicates that the blood circulation is affected.
Evaluate and compare skin color and temperature against that of the injured hand.
- Sensation. To evaluate sensation, lightly squeeze or pinch one or more fingers for feeling. Remember to evaluate and compare sensation in the uninjured hand.
- Movement. Assess by first having the victim wiggle his or her fingers.
First aid
Begin with the primary survey - is the victim breathing and is the heart beating? Provide rescue breathing and/or cardiopulmonary resuscitation if necessary. If the victim's injury is an open fracture and has led to extensive blood loss, arrange for immediate emergency medical service transportation.
Obtain a history by asking how and when the injury happened and whether there is numbness or tingling. Remove clothing surrounding the injured area, cutting the shirt seam if needed. Look for swelling, discoloration, deformity, tenderness and open wounds. Remove jewelry from the victim's fingers and wrists, and return it to the victim.
Control bleeding with direct pressure over the bleeding site, and cover all wounds before splinting. Evaluate the CSM before and after splinting.
Avoid necessary movement or excessive manipulation of the arm before splinting. Pad bony parts, such as the collarbone, elbow or wrist, to avoid pressure and pain on the arm.
When splinting suspected fractures, stabilize the joints above and below the fracture site. When splinting potential dislocations, stabilize the bones above and below the dislocation.
Straighten angulated fractures (fractures in which the bone is angled away from its normal anatomical position). When splinting a moderately deformed humerus (upper arm bones), radius or ulna (lower arm bones), apply gentle manual traction along the longitudinal axis of the bone. This will help restore the blood vessels to their normal position. If, however, the victim shows increased pain or resistance to traction, splint the arm in the deformed position.
Never reduce or replace open fractures in the field. Instead, cover the wound with a sterile dressing and apply a splint.
Splint joint injuries in the position found if the CSM is all right. If the victim's hand is cold, pale and pulseless and medical care is more than one hour away, a dislocated joint should be replaced. In such situations, first aiders can replace dislocated anterior shoulders, patellas (knee cap) and fingers.
An injured pulseless arm is a significant orthopedic emergency requiring immediate surgical intervention.
Conclusion
Although upper extremity injuries are rarely life-threatening, they can lead to secondary complications if not adequately managed in the prehospital setting. A good evaluation and proper first aid along with prompt medical care are the fundamental components of good orthopedic care.