7.1 Identification of fractures, sprains, and strains

Fractures, sprains, and strains are common musculoskeletal injuries that can occur due to trauma or overuse. Understanding the types, signs, and symptoms of these injuries is crucial for proper assessment and treatment in first aid situations.

Identifying these injuries involves recognizing key indicators like pain, swelling, and limited mobility. Physical examination techniques and diagnostic tests help pinpoint the exact nature and severity of the injury, guiding appropriate first aid measures and further medical care.

Fractures

Types of Fractures

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• Fracture occurs when a bone breaks or cracks due to trauma, overuse, or disease
• Open fracture (compound fracture) involves a broken bone that protrudes through the skin, increasing the risk of infection and complications
• Closed fracture (simple fracture) occurs when the bone breaks but does not penetrate the skin, which is generally less severe than an open fracture
• Deformity refers to the abnormal shape or position of a body part, often indicating a fracture or dislocation (angulation, rotation, or shortening)
• Crepitus is the grating, crackling, or popping sensation felt or heard when broken bone ends rub against each other, which can help identify a fracture

Signs and Symptoms of Fractures

• Pain, especially when pressure is applied or the affected area is moved
• Swelling and bruising around the injured area due to damage to blood vessels and soft tissues
• Inability to bear weight on the affected limb or joint
• Visible deformity, such as an abnormal bend or twist in the bone (angulation or rotation)
• Tenderness and guarding of the injured area to protect it from further damage

Soft Tissue Injuries

Types of Soft Tissue Injuries

• Sprain occurs when a ligament, which connects bone to bone, is stretched or torn due to excessive force or overextension (ankle sprain)
• Strain happens when a muscle or tendon, which connects muscle to bone, is stretched or torn due to overexertion or improper use (hamstring strain)
• Dislocation occurs when a bone is forced out of its normal position within a joint, often causing visible deformity and severe pain (shoulder dislocation)
• Swelling is the accumulation of fluid in the soft tissues surrounding an injury, causing the area to appear larger or puffier than normal
• Bruising (contusion) occurs when small blood vessels beneath the skin are damaged, causing discoloration and tenderness in the affected area

Signs and Symptoms of Soft Tissue Injuries

• Pain and tenderness in the affected area, which may worsen with movement or weight-bearing
• Limited range of motion in the affected joint due to pain, swelling, or muscle spasms
• Instability or weakness in the affected joint, especially in cases of severe sprains or dislocations
• Cramping or muscle spasms in the affected muscle, particularly with strains
• Discoloration of the skin, such as redness or bruising, indicating damage to blood vessels

Assessment Techniques

Physical Examination

• Range of motion assessment involves asking the patient to move the affected joint or limb through its normal range of motion to determine any limitations or pain
• Pain assessment includes asking the patient to rate their pain on a scale (0-10) and describe its location, intensity, and character (sharp, dull, burning)
• Palpation involves gently pressing on the affected area to identify points of tenderness, swelling, or deformity, which can help localize the injury
• Visual inspection of the affected area for signs of swelling, bruising, deformity, or open wounds, which can provide important clues about the nature and severity of the injury

Diagnostic Tests

• X-rays can help identify fractures, dislocations, and other bony abnormalities
• MRI (magnetic resonance imaging) scans provide detailed images of soft tissues, such as ligaments, tendons, and muscles, to help diagnose sprains, strains, and other soft tissue injuries
• CT (computed tomography) scans combine X-rays and computer technology to create cross-sectional images of bones and soft tissues, which can help diagnose complex fractures or dislocations
• Ultrasound uses high-frequency sound waves to create images of soft tissues, which can help diagnose muscle and tendon injuries, as well as guide needle placement for injections or aspirations