Many types of musculoslceletal injuries can be life-threatening and life-altering. In addition to bandaging and splinting, these injuries may require surgical intervention and physical therapy during the healing process.

The femur, or upper leg bone, is the longest and heaviest bone in the body. Because of the size of this bone and the muscle and tissue that surround it, bleeding into the area can be lifethreatening. You are also faced with the femoral artery running right down the center of your leg. The femoral artery is a central artery about the size of your thumb. Femur fractures may be characterized by a shortening of the affected leg and an inward rotation of the foot on that leg.

To prevent life-threatening injury from a femur fracture, manual stabilization is needed for the injured leg. If EMS is expected to arrive within the next several minutes, you need do little else. However, if you are in a remote location where additional help is unavailable, you must take some other action. Support the leg above and below the fracture site and gently straighten the leg while at the same time applying traction. Traction is the act of gently, but continually pulling the leg away from the body. At first, this will hurt as you pull the muscles out of spasm, but will then make the patient feel more comfortable. Once you make a decision to apply traction, you must maintain it either manually or with a splint. If traction is released, the broken bone ends will slide back, possibly creating further damage to surrounding vessels and nerves.

As our bodies age, our bones become more brittle and easier to fracture.

This, coupled with the fact that elderly patients are more prone to falls, indicate hip fractures are common in the elderly age group. Each year, 1 in 3 adults over the age of 65 will fall. A hip fracture can occur from a simple fall to the ground and great caution is needed to provide care and prevent further injury. Hip fractures are considered one of the most painful fractures.

To provide help to this patient, place pillows under and around the hip. This will not only pad the area from the hard ground but will also aid in splinting. When a hip fracture is suspected, prevent the patient from moving. Less movement will minimize pain and prevent further injury and bleeding. Some key signs and symptoms of a hip fracture include mechanism of injury, extreme pain, deformity and outward rotation of the foot

Elderly people can limit their risk of falling by taking some very easy steps. First, maintain an exercise routine. Stronger muscles will improve balance and coordination. Secondly, remove tripping hazards in the home. Use non-slip mats in bathrooms, install handrails on stairs and steps and have vision checks each year.

The bones of the spinal column are the main supporting structure of the skeletal system. In addition, it houses the spinal cord. Because of these critical functions, it is important to spend some extra time when caring for suspected spine injuries. Spinal injuries most commonly occur from trauma. Pain, with or without movement, is the classic symptom associated with spinal injuries. Complaints of numbness, weakness, tingling or the inability to move limbs may indicate spinal cord injury as well. In severe cases, a patient may lose bladder or bowel control and may have difficulty breathing.

Keep in mind, the absence of pain does not in any way rule out the possibility of a spinal injury. This is especially true when alcohol or drugs are involved as either can mask the pain. Activate the EMS system. While doing your primary survey, have a bystander stabilize the head and neck in a neutral position. This position should be maintained until help arrives. Do not use traction in the case of suspected spinal injury.

When assessing someone for a possible spinal Injury, key questions include:

For unresponsive trauma patients, stabilize the head and neck in the position you found them. Only move them if you are unable to maintain an open airway. To stabilize the patient's head and neck, place one hand on either side of their head. Spread your fingers wide and support the lower part of the ear and the neck at the same time. You are simply there to remind the patient not to move their head. Someone should stay in this position until medical personnel can apply a cervical collar.

If you are unable to maintain an airway, you may need to log roll the patient onto their back. Follow guidelines for rolling discussed earlier but maintain the in-line stabilization of the head and neck. If the patient is unresponsive and in a vehicle, try to manage them in the position found. Once EMS is on the scene, they have the specialized splints and equipment required to safely remove an injured person with a suspected spinal cord injury from a vehicle.

After childhood, the skull cannot expand to accommodate a swelling brain. This can create a potentially life-threatening situation from any form of head trauma. Any patient who has been injured and was knocked unconscious, has the potential for a brain or skull injury.

Clear, watery fluid leaking from the ears or nose may be a sign of a skull fracture. If you see this, place a loose sterile dressing over the area to help prevent infection. Bruising under the eyes or behind the ears is also cause for you to be concerned. Be especially alert for the trauma patient with a decreasing level of responsiveness. They may also begin to seize due to increasing pressure inside their skull.

Head injuries are the most time-sensitive emergencies you will encounter and rapid access to EMS is critical.

You should assume any patient with a brain or skull injury also has a neck injury, so you should manually stabilize the head and neck in a neutral position. Aside from 911, ABCD's and patient reassurance, there is little you can do for a brain or skull injury. Your most important job is to get help coming and prevent further injury by stabilizing the head and neck.