Travel Reference
In-Depth Information
tire pelvis and is centered over the hip joints. Ideally two individuals, one on each side of
the injured person, should apply tension in opposite directions, and the ends should be tied
over the midportion of the pelvis. The wrap can be tightened by inserting a stick or rod
through the knot and rotating it like a windlass, as is done to tighten a tourniquet. During
tightening, the injured person may have increased pain, but this should resolve with pelvic
stabilization. Fracture pain, however, does require ongoing pain medication, often opiates.
Figure 11-6. Wrapping a pelvic fracture to control bleeding
Splinters of bone from pelvic fractures frequently damage the organs within the pelvis,
particularly the urinary bladder. This complication should be suspected if the person fails
to void or passes only a few drops of bloody urine after the injury. (Injuries of the bladder
are discussed in
Chapter 10: Abdominal Injuries
.
)
Vertebra
Fractures of the vertebral column (spine) in the back and neck are particularly threaten-
ingbecausetheyarealwaysaccompanied bythepossibility ofinjurytotheenclosedspinal
cord. These fractures are discussed in
Chapter 8: Head and Neck Injuries
.
Other Fractures
Rib fractures are discussed in
Chapter 9: Chest Injuries
;
skull fractures and fractures of
the face and jaw are discussed in
Chapter 8: Head and Neck Injuries
.
DISLOCATIONS
A dislocation is an injury in which the normal relationships of a joint are disrupted. The
bonemaybeforcedoutofasocket,asoccursindislocations oftheshoulder,elbow,orhip.
Some joints, like those between the bones in the fingers, have no socket, and the joint sur-
facesaresimplydisplaced.Bonesmaybefracturedandadjacentnerves,bloodvessels,and
supportive structures may be injured.
Thesignsofdislocation aresimilar tothoseofafracture: painthatisaggravated bymo-
tion, tenderness, swelling, discoloration, limitation of motion, and deformity of the joint.
The findings are localized to the area around a joint, but comparison with the opposite,
uninjured joint may be necessary to be certain that a definite abnormality is present. Fre-
quently,thedislocatedjointappearslargerthannormalduetooverlappingoftheboneends.
Pain and muscle spasm usually prevent use of the extremity for physical activities.
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