Unstable Musculoskeletal Injuries (HB)

An unstable musculoskeletal injury does not allow for normal (or even limited) function.

Using the earlier example of the rolled ankle, an unstable injury would not allow you to bear weight. If you attempted to put weight on the unstable ankle, it would not support you, or the pain would be unmanageable.

A broken bone is also an unstable musculoskeletal injury. Skeletal bones are structural elements, and they are designed to distribute stress along their length. When it is compromised, it can no longer function properly.

Our biggest concern with an unstable injury is that it impairs circulation, motor function, and sensation. A lack of circulation will cause ischemia, which can lead to infarction. Prolonged reduction of motor function or sensation (due to ischemia of the nerves) can cause permanent damage. If we have CSM impairment, we need to restore the joint or bone to the correct anatomical position. We do this by using a technique called “traction into position” (TIP).

Traction into position is pretty simple. Apply gentle but firm traction to the affected limb and gently manipulate it back into place. If you encounter significant resistance, or the patient expresses pain out of apparent proportion to the injury, you should stop. There is likely another internal injury that we cannot assess. You could end up causing further damage if you continue.

After you traction the injury back into position, you want to protect it from further harm, so you should build a splint to support and keep the injured area in its normal anatomical position.