Post on 23-Dec-2015
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Lower Extremity Injuries
All You Need to Know
Asses CSMAsses CSM
Immobilize InjuryImmobilize Injury
TransportTransport
Introduction
Epidemiology of Ski InjuriesEpidemiology of Ski Injuries Types of Knee InjuriesTypes of Knee Injuries
Sprains/ligament tearsSprains/ligament tears FracturesFractures DislocationsDislocations
Other Lower Extremity InjuriesOther Lower Extremity Injuries Prehospital CarePrehospital Care QuestionsQuestions
Epidemiology of Ski Injuries
1970s: 5 to 8 per 1000 skier days1970s: 5 to 8 per 1000 skier days 1990s: 2 to 3 per 1000 skier days1990s: 2 to 3 per 1000 skier days Lower Ext. Injury:Upper Ext. InjuryLower Ext. Injury:Upper Ext. Injury
4:1 in 19804:1 in 1980 2:1 in 19902:1 in 1990
Epidemiology of Lower Extremity Injuries
in Ankle Injuriesin Ankle Injuries
in ACL Injuriesin ACL Injuries Knee sprains most common (30% of all Knee sprains most common (30% of all
injuries in adults)injuries in adults)
Knee Anatomy
Knee Anatomy
Types of Knee Injury
SprainsSprains DislocationsDislocations FracturesFractures
Sprains
Injury to ligaments supporting a jointInjury to ligaments supporting a joint Secondary to abnormal motion of the jointSecondary to abnormal motion of the joint Range from minor tearing to complete Range from minor tearing to complete
disruptiondisruption
Anterior Cruciate Ligament
Prevents tibia from Prevents tibia from
moving forward on the moving forward on the
femurfemur
Involved in 40% of sprainsInvolved in 40% of sprains
Usually injured by Usually injured by
deceleration, flexion and rotationdeceleration, flexion and rotation
Medial Collateral Ligament
Patellar Tendon/Quad. Ligament
Dislocations
Loss of continuity between articular Loss of continuity between articular surfacessurfaces
Patellar dislocationPatellar dislocation Knee dislocationKnee dislocation
Patella Dislocation
Secondary to twisting Secondary to twisting
injury on an extended injury on an extended
kneeknee Patella is displacedPatella is displaced
laterallylaterally Usually easily reduced Usually easily reduced
by hyperextending knee by hyperextending knee
and flexing hipand flexing hip
Knee Dislocation
Secondary to Secondary to hyperextension, and hyperextension, and rotary or direct forcerotary or direct force
Associated ligamentous Associated ligamentous and possibly artery and and possibly artery and nerve injurynerve injury
May reduce May reduce spontaneously but will spontaneously but will be grossly unstablebe grossly unstable
Fracture
Can occur secondary to direct trauma or Can occur secondary to direct trauma or forceful twisting.forceful twisting.
Incidence has been declining Incidence has been declining between 1972 and 1994 there was an between 1972 and 1994 there was an
89% decrease in adult tibial fractures89% decrease in adult tibial fractures
Other Lower Extremity Injuries
PelvisPelvis HipHip FemurFemur Tibia/FibulaTibia/Fibula AnkleAnkle FootFoot
Pelvis Fracture
Pelvis Fracture
Direct Blow - Skier vs TreeDirect Blow - Skier vs Tree Many TypesMany Types Potential for Significant InjuryPotential for Significant Injury
Laceration of blood vesselsLaceration of blood vessels Proximity of other organsProximity of other organs
Examination Examination TreatmentTreatment
Hip Injuries
Relatively UncommonRelatively Uncommon FractureFracture
Shortened and externally rotatedShortened and externally rotated DislocationDislocation
Hip and knee flexed, thigh internally Hip and knee flexed, thigh internally rotatedrotated
Femur Fracture
Direct Blow or Violent TwistingDirect Blow or Violent Twisting Possibility of Significant Blood LossPossibility of Significant Blood Loss CSM assessmentCSM assessment Traction SplintTraction Splint ReassessReassess TransportTransport
Tibia/Fibula Fracture
““Boot-Top Fracture”Boot-Top Fracture” Frequently Angulated and/or RotatedFrequently Angulated and/or Rotated Re-alignmentRe-alignment
PainfulPainful Reduce bleeding and preserve functionReduce bleeding and preserve function Allows splint placementAllows splint placement
Ankle Injuries
Snowboarders and TelemarkersSnowboarders and Telemarkers SprainsSprains FracturesFractures DislocationsDislocations CSM AssessmentCSM Assessment Splint Splint
RealignmentRealignment
Foot
Uncommon in SnowsportsUncommon in Snowsports Falls From HeightsFalls From Heights Heel Fx Associated with Back InjuryHeel Fx Associated with Back Injury
Prehospital Care
Assess neuro-vascular statusAssess neuro-vascular status Realignment Realignment
especially if greater than 1 hour from helpespecially if greater than 1 hour from help Immobilize Immobilize TransportTransport