Surviving the Medical Meltdown (31 page)

22
SPRAINS, STRAINS, AND BROKEN BONES

B
y definition a
sprain
is stretching and/or tearing of a ligament – a fibrous band connecting bone to bone. A
strain
is either a muscle injury or injury to the tendon that connects muscle to bone. Broken bones are
fractures
.

SPRAINS

Sprains generally involve the ankle or wrist and are caused by twisting or overextending the joint. There is swelling and tenderness over the soft tissue of the ligaments, and sometimes bruising will be noticed later. The only way to completely rule out a fracture is an X-ray, but the following rules generally apply. You can probably watch and wait unless you have the triad of bone tenderness, focal swelling, and bruising over the area of tenderness. These indicate a fracture.

Initial treatment consists of elevating the extremity, applying ice to the area, and splinting if possible. Usually a sprain will be much better in seventy-two hours, but total healing time is longer, so don’t expect
complete
resolution.

An exception to all this is a knee sprain. Knee ligaments are extremely important and unforgiving. A twisting injury to the knee
that results in swelling needs professional orthopaedic evaluation – not in the middle of the night but as soon as practicable.

SPLINT AMAL

An arm sling

Moldable splint material (you can order A + Z Medical Professional Emergency Veterinary Splint on Amazon for around $14)

An “air cast” splint for ankle sprains

One-inch silk tape and 2 x 2-inch gauze for buddy taping

Several (3- and 4-inch) ACE wraps

When applying splints, there are certain principles: Always apply a splint over cloth, a sock, or an ACE wrap. Never splint directly on the skin, as this may cause blistering and skin death. Try to splint an extremity in as close to a normal use position as possible. Don’t splint fingers if the wrist is all that is involved. Stiffness is the biggest problem with prolonged splinting. If you are going to watch and see, you should rest, ice, and observe for seventy-two hours, and then remove the splint and reassess. Never use a too-tight ACE wrap. Remove the splint if there is any increasing numbness, tingling, or pain. If pain becomes unbearable, something is wrong – usually the swelling is compressing nerves or blood supply, and this needs immediate emergency room attention.

If you dislocate and relocate a finger, you can buddy tape it to a neighboring finger and seek orthopaedic care during the light of day. To buddy tape, put dry two-by-two-inch gauze between the fingers, then lay the tape around the two fingers at two points: above the joint and below the joint. Just lay the tape on; don’t stretch it or make it too tight.

All fractures that are not open and are generally aligned can be
splinted and seen in an orthopaedic office within forty-eight hours. Even the slightest pinhole around the fracture is an emergency. All dislocations, open fractures, severely angulated fractures, or fractures with any nerve or circulation compromise need urgent professional care.

HOW TO WRAP A SPLINT USING A SAM SPLINT

DOUBLE LAYER WRIST

Step 1: Fold a 36-inch SAM Splint in half upon itself.

Step 2: Roll the end over to provide more comfort for the fingers.

Step 3: Add strength by creating a C curve.

Step 4: Using your own arm as a template, mold the splint to the general shape of the wrist and forearm.

Step 5: Make adjustments to fit the injury and apply to the patient. Only small adjustments should be made once the splint is in place. Secure with your wrap of choice.

ANKLE STIRRUP