SCAPULAR WAIST FRACTURES
ELBOW INJURIES
HAND AND WRIST FRACTURES
PELVIC AND FEMORAL FRACTURES
KNEE, BONE AND LEG FRACTURES
ANKLE AND FOOT FRACTURES
SCAPULAR WAIST FRACTURES
- These generally result from direct trauma, and the usual signs of fractures are present
- They are fractures that should be immobilized by placing the arm at the chest and then passing a band over the thorax so that there are no rotational movements of the limb during transportation.
Humerus fractures
- Fractures that require attention and care during prehospital manipulation, since they can often be complicated by vascular and nerve injuries, due to the proximity of vessels and nerves to the bone;
- In case of a humeral fracture, one should always look for changes in sensibility, mobility, colour, temperature, and pulse. The study of mobility is passive, that is, it is the victim who moves or not. The pre-hospital emergency team should not actively mobilize the limb at the risk of aggravating existing injuries.
- In the absence of a radial pulse, traction and alignment should be performed immediately, followed by immobilization.
- The nerve most commonly injured is the radial nerve. This characteristically presents with a ‘hanging hand’, the victim being unable to extend the hand.
- Median or distal fractures should be immobilized with wooden splints up to the armpit, while proximal fractures should be immobilized like scapular girdle injuries.
Forearm Fractures - The signs and symptoms of fractures may be masked by the fact that there is a fracture of only one bone (radius or ulna).
- In this situation, the other bone acts as a splint. However, rotational movements can cause injury because they allow the bone tops to move.
- Thus, the general rules of fracture treatment apply here without exception.
ELBOW INJURIES
- Can result from direct (falling on the elbow) or indirect (falling on the hand with the arm in extension) trauma.
- Fractures of the distal extremity of the humerus are sometimes complicated by vascular injury to the humeral artery, and the radial pulse should always be checked.
- Immobilization should be done with minimal traction without forcing, since flexion associated with the edema that usually sets in can compress the vessels that pass at the level of the elbow, preventing normal blood flow.
HAND AND WRIST FRACTURES
- At the level of the fingers, the most frequent mechanism is direct trauma to the fingers.
- The most frequent wrist fracture is Colles’ fracture. This fracture typically presents with a ‘forked’ wrist deformity.
PELVIC AND FEMORAL FRACTURES
Pelvic Fractures
- This type of injury requires careful handling, with immobilization on a vacuum stretcher and gentle transport to the hospital.
- The rolling technique should be avoided at all costs when mobilizing these victims.
Femoral fractures
- Functional impotence and limb shortening are some of the signs.
- The typical sign of this type of fracture is external rotation of the lower limb, with the foot pointing outward the approach to be taken when a fracture of the femoral neck is suspected follows the basic rules of immobilization of fractures: traction, alignment, and immobilization done with long splints up to the waist and over the foot, in order to maintain traction and alignment of the limb.
KNEE, BONE AND LEG FRACTURES
Knee injuries
- When the injury results from direct trauma (falls on the knee, sports accidents, and traffic accidents) never forget to look for other associated fractures: femur, femoral neck, and pelvis;
- Knee injuries can be serious, as they are often associated with vascular and nerve injuries;
- Immobilization should be done in the position in which the limb is found, if extension is not possible.
Bone and leg fractures
- They usually result from direct trauma (traffic accidents) and may fracture both bones or just one of them (tibia or fibula);
- They are the most frequently found exposed fractures, since the tibia is immediately under the skin;
- Immobilization follows the basic rules already mentioned.
ANKLE AND FOOT FRACTURES
Ankle fractures
- Sometimes these fractures are complicated by dislocation of the joint with compromised circulation (the foot begins to turn purple), in which case it is permissible to try to align the foot with the rest of the limb in order to facilitate circulation.
- if this is not possible, one should immobilize it as it is and quickly transport it to the hospital.
Foot fractures
- Immobilize in accordance with the suspicion even if the victim does not show suggestive signs.
- Since the edema in this type of fracture is usually large and rapid, the shoe should be removed with gentle manoeuvres so as not to aggravate the existing injuries.
- The foot should be kept elevated during transport and immobilized with splints.