MUSCULOSKELETAL TRAUMA

The next series of blogs will be an in-depth review of the recognition and management of musculoskeletal trauma in the wilderness, marine, disaster, and military environments.  This body of knowledge is the best example of the difference between urban, or street medicine, and the extended care environment. 

In the urban realm, typically, the ER is just minutes away and the primary concern is to stabilize the fracture or dislocation in the position found, and transport. Once outside the golden hour, the primary concern becomes circulation distal to the site of the injury. This may require straightening out angulated fractures, reducing dislocations, proper long-term splinting with big, ugly, fat, fluffy splints, and monitoring the circulation every 15 minutes for the duration of the evacuation.

ANATOMY AND PHYSIOLOGY OF THE MUSCULOSKELETAL SYSTEM

ANATOMY:

Bones:
Consist of a dense cortex surrounding an inner, soft marrow and they provide the rigid framework to which everything attaches. Bones also store calcium, an essential electrolyte, and produce the blood cells in the bone marrow.
Cartilage:
Acts as a lubricated durable cap on the ends of the bones so that your joints can
flex and rotate smoothly and without friction. Cartilage also provides support for muscle in areas where more flexibility than bone offers is needed.
Periosteum:
Is the tough fibrous layer that covers the bones and which contains the nerves that produce the pain associated with injuries.
Synovial fluid:
Is the lubricant in the joint space produced by the synovial lining of the joint capsule that surrounds the joint, allowing for friction-free movement.
Muscles:
Are like bundles of bungee cords. In response to signals sent from your brain through your central nervous system, they contract and relax, which flexes your joints and allows you to move. All muscles work by contracting, 
Tendons:
Are the ties connecting muscles to bone. They span joints and allow for movement.
Ligaments:
Are like nylon cords and attach bones to other bones. They span joints, maintaining proper alignment and setting the limits of range of motion.

PHYSIOLOGY:  Musculoskeletal system functions:

Movement: 
The contraction of muscles provides us with purposeful movement.
Heat Production:
The contraction of muscles produces heat.
Protection: 
The strength and flexibility of  muscle protects many internal structures including the bundles of nerves, arteries, and veins beneath the muscles.
Calcium storage: 
The bones act as a large calcium store.  Calcium is an electrolyte that allows for the contraction of muscle, including the heart muscle, and the conduction of nerves impulses.
Hematopoiesis: 
The process by which the various blood cells (red blood cell, white blood cell, and platelets), are produced in the bone marrow.
Cosmesis: 
The muscular and skeletal structures contribute greatly to how we look.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

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