20 - Extremity trauma

Summary

Scope of the problem

Trauma to an extremity is a common reason for a patient to present to the emergency department (ED). According to the Centers for Disease Control and Prevention, there were nearly 15 million visits to the ED in the year 2000 for injuries involving the extremity. The most common sites of injury were the wrist and hand, followed by the ankle and shoulder. It is important to perform a thorough but efficient history and physical examination in order to accurately diagnose and provide initial treatment for these injuries. When improperly treated, extremity injuries may lead to long-term pain and disability for the patient.

Anatomic essentials

Each extremity can be viewed as a group of individual bones held together by a musculo-ligamentous apparatus. Careful attention must be paid to the vascular and nerve supply to each extremity; injury to these structures may be over-looked when fractures are present. Each extremity is encased in soft tissue that is often subdivided into fascial compartments. The clinician should become familiar with the normal anatomy and pathology of an extremity in this context: bones and ligaments, muscles and tendons, nerves and vessels, and soft tissue (compartments). The examination is complete only when all of these structures in the relevant area have been assessed (Tables 20.1 and 20.2).

Sensory and motor innervation of the extremities can be rapidly assessed.