MUSCULOSKELETAL

TRAUMAS
SPRAIN, STRAIN, FRACTURE,
DISLOCATION
 SPRAIN VS. STRAIN
 A sprain is a stretching or tearing of ligaments, the tough,
fibrous bands of tissue that connect bones to one another
at a joint.
 A strain is a stretching or tearing of tendon or muscle
tissue, commonly called a pulled muscle.  
 Etiology
 Anything that places sudden or unaccustomed stress on --
or chronic overuse of -- joints or muscles may cause a
sprain or strain.
 Falls, lifting heavy objects, exertion of an unfamiliar sport
 Being overweight, inactive, or in poor physical condition
boosts the likelihood of injury.
 Improperly warming up and not stretching muscles before
intense physical activity
Ankle Sprain
*May be due to
sudden
twisting/ankle
inversion
*Most common:
Talofibular
ligament
 What are the signs of a sprain?
 While the intensity varies, pain, bruising, swelling,
and inflammation are common to all three
categories of sprains: mild, moderate, severe.
 The individual will usually feel a tear or pop in the
joint.
 A severe sprain produces excruciating pain at the
moment of injury, as ligaments tear completely, or
separate from the bone.
 This loosening makes the joint nonfunctional.
 A moderate sprain partially tears the ligament,
producing joint instability, and some swelling.
 A ligament is stretched in a mild sprain, but there
is no joint loosening.
STRAIN
*Tendinitis/ elbow
strain
*Hamstring & Achilles
tendon strain
What are the signs of a strain?
 Typical indications include pain, muscle
spasm, muscle weakness, swelling,
inflammation, and cramping.
 In severe strains, the muscle and/or tendon
is partially or completely ruptured, often
incapacitating the individual.
 Some muscle function will be lost with a
moderate strain, where the muscle/tendon is
overstretched and slightly torn.
 With a mild strain, the muscle/tendon is
stretched or pulled, slightly.
 Physical
Examination
Severity Findings Impairment Pathophysiology Typical Treatment

Grade 1 Minimal Minimal Microscopic Weight bearing as tolerated

tenderness and tearing of No splinting/casting
swelling collagen fibers Isometric exercises
Full range-of-motion and
stretching/ strengthening
exercises as tolerated
Grade 2 Moderate Moderate Complete tears Immobilization with air
tenderness and of some but splint
swelling not all collagen Physical therapy with range-
Decreased fibers in the of-motion and stretching/
range of ligament strengthening exercises
motion
Possible
instability
Grade 3 Significant Severe Complete tear/ Immobilization
swelling and rupture of Physical therapy similar to that
tenderness ligament for grade 2 sprains but over a
longer period
Instability
Possible surgical reconstruction
 Sprain and Strain
 Grade 1 : stretching injury
 Grade 2 : partial tearing
 Grade 3 : complete tearing/torn
 Acute Management includes PRICESM
 Protection
 Rest
 Ice pack
 Compression
 Elevation
 Support
 Medication
 After 48 hours:
 Progressive ROM exercises
 Passive  Active assistive  Active 
Resistive
 Hot / Warm compress
 Imaging Tests
 X-rays
 Magnetic Resonance Imaging (MRI)
 Surgical options include:
 Arthroscopy
A surgeon looks inside the joint to see if there
are any loose fragments of bone or cartilage, or
part of the ligament caught in the joint.
 Reconstruction
A surgeon repairs the torn ligament with
stitches or suture, or uses other ligaments
and/or tendons found in the foot and around
the ankle to repair the damaged ligaments.
 Prevention
 The best way to prevent ankle sprains is to maintain
good strength, muscle balance and flexibility.
 Participate in a conditioning program to build muscle
strength
 Do stretching exercises daily
 Always wear properly fitting shoes
 Nourish your muscles by eating a well-balanced diet
 Warm up before any sports activity, including practice
 Use or wear protective equipment appropriate for that
sport
 Pay attention to your body's warning signs to slow
down when you feel pain or fatigue
 Pay attention to walking, running or working surfaces
FRACTURE
 Any break in the continuity of bone; broken
bone
 May be traumatic or pathologic
 Direct blow
 Sudden twisting
 Severe muscle contraction
 Sports-related injury
 Secondary to disease that has weakened the bones
 Classification
 According to communication to the
environment
 Closed/ Simple fx
 Open/ Compound fx
 Completeness
 Complete fx
 Incomplete fx
 Anatomical position
 Proximal 1/3
 Middle 1/3
 Distal 1/3
 According to line of breakage/
displacement
 Transverse fx
 Longitudinal fx
 Oblique fx
 Spiral fx
 Other classification
 Comminuted fx
 Greenstick fx
 Impacted fx
 Distraction fx
 Compression fx
 Garden’s classification of femoral Fx
 Type I : incomplete femoral neck fx;
intertrochanteric crest fx
 Type II : complete femoral neck fx;
intertrochanteric + lesser trochanter fx
 Type III : complete femoral neck fx + <50% displacement;
intertrochanteric + greater trochanter fx
 Type IV : complete femoral neck fx + > 50% displacement;
intertrochanteric + lesser + greater trochanter fx
 Salter-Harris classification
 Type I : growth plate
 Type II : metaphysis and growth plate
 Type III : epiphysis and growth plate
 Type IV : metaphysis and epiphysis
 Type V : crushing injury
Signs and Symptoms
 Usually, you will know immediately if you have
broken a bone…
 may hear a snap or cracking sound
 The area around the fracture will be tender and
swollen
 A limb may be deformed, or a part of the bone
may puncture through the skin.
 Stress fractures are more difficult to diagnose,
because they may not immediately appear on an
X-ray; however, there may be pain, tenderness
and mild swelling.
 Document neurovascular examination (and address
deficits immediately)
 Perform on initial exam and repeat before and
after any intervention
 Keep high index of suspicion for Compartment
Syndrome
 Check capillary refill and distal pulses
 Check motor and Sensory Examination
 Evaluate skin over fracture site
 Signs of open fracture
 Signs of displaced fracture (skin tenting)
 Clues suggesting fracture (swelling, Ecchymosis,
and point tenderness over fracture site)
 Devitalized skin at risk of necrosis
 Evaluate joints, muscles, ligaments, and tendons
above and below the fracture
Indications: Referral to Orthopedics

 Emergent referral indications

 Fracture with neurologic deficit
 Fracture with vascular deficit
 Fracture with secondary Compartment Syndrome
 Open fracture
 Severe crush or shearing injury resulting in skin
devitalization
Principles in Fracture
Management
 Reduction/ Bone setting/ Realignment
 Open reduction (e.g. ORIF), Closed Reduction /
Careful manipulation, Traction
 Immobilization/ Maintenance of reduction
 Internal fixation (metal pins, rods, nails, screws,
plates), External fixation (casts, molds, braces),
Traction
 Rehabilitation/ Restoration of function
 Progressive exercises
DISLOCATION
 Displacement of bones from its articulating
surfaces
Dislocation
 May be congenital, traumatic and
pathologic

 Complete : bones are displaced and not

in contact to the articulating surface
 Incomplete : partial/subluxation; bones
are displaced but still in contact to its
articulating surface