The Body

There are many ways in which injury can occur to the body as a result of an accident. Damage may be temporary and resolve after a period of healing or be permanent and have lifelong consequences.

The Skeleton
The skeleton is the structure that supports the body, provides the structure for the attachment of muscles and affords protection to the major organs. The human skeleton is made up of some 206 bones. Joints connect each of these bones and most, although not all, move freely giving the skeleton mobility.

Anyone can suffer a fracture or dislocation but those most likely to are children and adults who are active and take part in sports and those people with medical conditions that cause a loss of bone density.

Road traffic accidents involving drivers, passengers, pedestrians, motorcyclist and cyclists; falls; accidents at work; sports accidents and assaults are just some of the traumatic incidents that are the cause of broken bones.

Fractures
Fractures are classified in orthopaedic terms as closed or open (compound) and simple or multi-fragmentary (comminuted).

Closed Fracture - Where the bone is broken but the skin remains intact.
Open Fracture (Compound) - Where the bone has been exposed to contamination via a break in the skin or is protruding through an open wound.

Simple Fracture – This type of fracture occurs along a single line, breaking the bone into two pieces.
Multi-fragmentary fractures - Involve the bone splitting into several pieces.

Simple, closed fractures are much more straightforward to treat than multi-fragmented fractures or open ones which may be contaminated and become infected. Other complications occur with displacement of the fracture, where there is a gap between the pieces of bone, and angulation where the bone is out of its original alignment and in either of these situations reduction, or manipulation, of the bone may be required. The healing of such injuries may take considerably longer than those without such complications.

Other types of fracture are:-

• Complete Fracture- Bone fragments separate completely
• Incomplete Fracture- Bone fragments are still partially joined
• Linear Fracture- Fracture running parallel to the long axis of the bone
• Transverse Fracture- Fracture that is at a right angle to the long axis of the bone
• Oblique Fracture- Fracture that is diagonal to the long axis of the bone
• Compression Fracture- Fracture that usually occurs in the vertebrae
• Spiral Fracture- Fracture where at least one part of the bone has been twisted
• Greenstick Fracture- Fracture is incomplete. Generally occurs in children

Dislocation
Dislocation of the joint occurs when the ends of the bones are forced out of their normal position. The injury causes deformity at the site and renders the joint immobile. Dislocation may occur in the major joints which are the shoulder, elbow, hip, knee and ankle or the smaller joints of the fingers, thumbs and toes.

Some dislocations can have serious long term consequences, for example, a dislocation of vertebrae may damage the spinal cord and if a dislocation of a hip or shoulder damages the major nerves that supply the related limbs it may result in paralysis.

Dislocation is a common sporting injury particularly in contact sports like rugby, football and hockey or sports where falls are not unusual, such as skiing, horse riding and gymnastics. They may also occur as a result of a blow to the joint such as experienced in a road traffic accident. However, a simple slip or fall can be sufficient to displace the joint from its normal position.

Soft Tissue

This is the term used to refer to tissues that connect, support or surround the skeleton and organs of the body and include muscles, tendons, ligaments, fascia, nerves, fibrous tissues, blood vessels, synovial tissues and fat.

Injuries to other structures such as bones and organs often involve damage to some of the soft tissue of the body as well.

Muscles and Tendon Injury

These may be strained, ruptured or bruised.

• Strain – Occurs when the muscle is overstretched, in some instances the muscle may partially tear. This tends to happen at the point where the muscle joins the tendon that attaches the muscle to the bone
• Rupture – Where the muscle or tendon is torn completely. This generally occurs in the main bulk of the muscle or tendon
• Bruising – This may be extensive in areas where the muscle is large and bulky. It is usually accompanied by bleeding into the surrounding tissues

Ligament Injury
These are the fibrous cords that connect bones at a joint.

• Sprain - The most common form of injury to a ligament. It occurs when the bones in a joint are forced apart, often due to an unexpected wrenching motion, tearing the surrounding tissues

Sports injury, trips and falls, and accidents at work are among the most common cause of these types of injury.

Skin
The skin is the largest organ of the body, completely covering and protecting the soft tissue and internal organs within. It forms a vital barrier against germs and harmful substances and contains the nerves that allow the body to be sensitive to heat, pain, cold and touch. It’s function as a shield for the inner structures of the body means that it is liable to both accidental and intentional damage.

Breaks in the skin are called wounds and can be classified into the following types:-

Incised wound – Caused by a clean cut from a sharp edged object. The wound tends to bleed a lot and tendons, nerves or arteries may be damaged.

Laceration – Caused by ripping or crushing forces. They tend to bleed less than the incised wound but there is often more tissue damage. The risk of infection in these wounds is high as they are liable to be contaminated with dirt.

Abrasion – The top superficial layers of skin are scraped off leaving raw, tender areas. Dirt or foreign bodies may be embedded making them liable to become infected.

Bruise (Contusion) – Caused by a blow which ruptures the blood carrying capillaries beneath the skin allowing blood to seep into the surrounding tissues.

Puncture wound – Caused by a thin pointed object, such as a nail or needle, puncturing the skin. The entry wound is small but the damage to the underlying tissue may be deep. Germs can be carried deep within the body giving a very high risk of infection.

Skin damaged by burning loses its ability to act as a barrier to infection. Different types of burns and possible causes are as follows:-

• Dry Burn – Caused by fire, hot objects i.e. domestic appliances or cigarettes. Rope burn (Friction)
• Scald – Steam or hot liquids
• Electrical burn – Caused by exposure to low voltage current as seen with domestic electricity and appliances. High voltage burns associated with overhead mains cable. Lightning strikes
• Freeze burn – Frostbite. Contact with freezing metals. Contact with freezing vapours such as liquid oxygen or liquid nitrogen
• Chemical burn – Caused by chemicals and agents. May be to the skin or inhaled into the lungs through corrosive gases and fumes
• Radiation burn – Sunburn. Over-exposure to ultra-violet rays as with sunbeds. Exposure to a radio-active source such as x-ray

Damage to the skin can cause permanent scarring, deformity and temporary or permanent loss of sensation.