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View All Subscription Options. The skeletal system serves as a framework for tissues and organs to attach themselves to. This system acts as a protective structure for all vital organs. Major examples of this are the brain being protected by the skull and the heart with the lungs being protected by the rib cage. Within the long bones are two distinctions of bone marrow yellow and red.
The yellow marrow has fatty connective tissue and is found in the marrow cavity. During starvation, the body uses the fat in yellow marrow for energy [ 2 ]. The red marrow of some bones is an important site for blood cell production; here, all erythrocytes, platelets, and most leukocytes form in adults. From the red marrow, erythrocytes, platelets, and leukocytes migrate to the peripheral blood to do their special tasks approximately 2.
Another function of bones is the storage of certain minerals. Calcium and phosphorus are among the main minerals being stored. When the fluctuation of minerals is high, these minerals are stored in bone; when it is low, it will be withdrawn from the bone. There are three types of muscles smooth, skeletal, and cardiac. Smooth muscles are nonstriated muscles used to control the flow of substances within the lumens of hollow organs like vessels and bowels and are involuntarily controlled [ 3 ].
Skeletal and cardiac muscles have striations that are visible under a microscope due to the components within their cells. Only skeletal and smooth muscles are part of the musculoskeletal system and only the skeletal muscles can move the body skeleton. Skeletal muscles are attached to bones and arranged in opposing groups around joints.
Cardiac muscles are found in the heart only and used to pump blood; they are like the smooth muscles, involuntarily controlled.
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Muscles are innervated by nerves which conduct electrical currents from the central nervous system and cause the muscles to contract. Joints, also called articulations, serve two important functions in the human body: holding the skeleton together and allowing it to be mobile. Simply defined as the site where two or more bones meet [ 2 ]. There are three types of joints according to its functional classification which measures the amount of movement the joint provides: diarthrosis joints which allow extensive mobility between two or more articular heads; synarthrosis or false joints which are joints that do not provide mobility and amphiarthrosis joints which allow little or very minimal movement.
Structural classification is based on the type of the material binding the bones together. This fluid lowers the friction between the articular surfaces and is kept within an articular capsule allowing maximum mobility. Cartilaginous joints are the joints where bone ends are tied by cartilage, and fibrous joints are the joints where the bone ends are united by fibrous tissue; the latter two types vary in mobility according to their subclassifications and position in the body [ 2 ].
A tendon is a tough, flexible band of fibrous connective tissue that connects muscles to bones [ 4 ].
As muscles contract, tendons transmit the forces to the relatively rigid bones, pulling on them and causing movement. Tendons can stretch substantially, allowing them to function as springs during locomotion, thereby saving energy. A ligament is a small band of dense, white, fibrous elastic connective tissue [ 2 ] that connects both ends of bones together in order to form a joint and they transfer force from one bone to the other allowing movement [ 6 ].
Most ligaments limit dislocation or prevent certain movements that can cause injury or tears. Since they are elastic tissue, they increasingly lengthen when under pressure; when the force exceeds the limit of elasticity, the ligament can handle; it becomes susceptible to damage which can result in severe injuries and tears or in an unstable joint movement. Ligaments may also restrict some actions and movements such as hyperextension or hyperflexion that is limited by the ligament ability to prevent this movement to an extent [ 7 ]. A bursa is a small synovial fluid-filled sac contained within white fibrous connective tissue which is lined internally with synovial membrane.
The fluid-filled sac can be found in multiple regions in the body mostly around joints [ 2 ]. Other things to keep in mind are to pay special attention to excessive pressure over prominences as they may result in a peripheral nerve compression, compartment syndromes, or crush syndromes. A thorough history is the first step; always ask about the mechanism of the trauma, it is very essential in the management of musculoskeletal injuries and then past medical history to assess any morbidities, history of medications, any previous injuries, and the last meal the patient had and the timing of it.
Second in line is physical examination. The physical examination in the emergency department for these injuries is based on simple four steps: Inspection discoloration, swelling, or deformity. Assess range of motion both active and passive with consideration to the joint above and below the injured part. The soft tissue is a term that encompasses all body tissue except the bones. It includes skin, muscles, vessels, ligaments, tendons, and nerves.
Their injuries can range from the trivial, such as a scraped knee, to the critical that includes internal bleeding; those which involve the skin and underlying musculature are commonly divided either as closed or open wounds. Ecchymosis: discoloration under the skin that is caused when blood leaks out into the surrounding soft tissues causing the skin to turn different colors. Strain: stretching or tearing of a muscle resulting from overstretching or overexertion.
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Also known as a pulled muscle or torn muscle [ 8 ]. Also known as a torn ligament [ 8 ]. Closed injuries can be managed effectively by applying the R. This involves the application of R rest, I ice, C compression, E elevation, and obtaining a R referral for appropriate medical treatment.
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There may be a mild deformity of the injured joint in addition to complete or near complete loss of movement of joint; treatment consists of pain control, supportive strapping or bandaging, and immobilization by splinting so that affected muscle is in relaxed position. If injury is severe, R. R must be followed [ 9 , 10 ]. Also, make sure to cover the following: Reassure the patient. Amputations: partial or full detachment of a limb or other appendage of the body which may be iatrogenic or due to trauma.
The management is usually so minimal requiring cleansing of the wound; small bandages may be applied but tactical situations will usually preclude applying field dressings that are needed for more serious injuries. A large amount of dirt may be ground into the wound; therefore, secondary treatment measures should focus on preventing or stopping infections.
Treatment is generally the same as for abrasions. It is very important to remember protecting yourself from disease by using medical gloves, wash or irrigate the injury with warm saline, remove all foreign bodies, control bleeding by applying local compression and dressing, start intravenous fluids when necessary e. Insure to keep the patient warm, elevate the injured part of the body.
If major tendons and muscles are completely cut, immobilize the limb to prevent further damage. Bleeding should be controlled by direct pressure on the bleeding site; the avulsed part should be managed by applying several pressure dressings or an air splint and followed by regular dressing. Contamination should be avoided; ensure avulsed flap is lying flat and that it is aligned in its normal position. If the avulsed part is completely pulled off, make every effort to preserve it.
Wrap that part in a saline or water-soaked field dressing, pack wrapped part in ice, and whenever possible be careful to avoid direct contact between the tissue and ice. Transport the avulsed part with the patient but keep it well-protected from further damage and out of view of the patient [ 4 ]. With complete amputations, there is less bleeding than with partial or degloving cases. This is due to elastic nature of blood vessels as they are tended to spaz and retract into the surrounding tissue.
It is very important to notice that replantation is performed only with an injury of isolated finger or extremity and should be performed by a skilled surgical team. If a tourniquet is applied, it must occlude arterial inflow, as occluding only venous system can increase bleeding. The physician must be able to make such decision and be aware that this choice is for life and against limb. Place the patient in shock position head down, feet elevated.
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Make every effort to preserve the amputated part and transfer the patient to the theater as soon as possible after stabilization of the ABCDE. Wrap the amputated part in a sterile dressing, place in ice and send with patient, and prevent direct contact between tissue and ice as possible [ 7 ].
A break in the continuity of bone which may result in partial or complete disruption of the bone. Fractures are further classified as open or closed. The latter has a higher likelihood of contamination. Initiate IV antibiotics usually broad-spectrum type to cover both Gram-positive and Gram-negative bacteria , in addition to tetanus prophylaxis. DO NOT re-place protruding bone or explore the wound nor clamp any vessel at the emergency setting and wait for the orthopedic physician.