A soft tissue injury refers to damage to the skin, subcutaneous tissue, fascia, muscles, tendons, ligaments, blood vessels, or nerves without primary involvement of bone.

Injury is defined as an insult to the body resulting in structural or functional damage. It may be caused by:

• Physical trauma (blunt or penetrating)

• Chemical/toxic injury

• Thermal injury (burns, frostbite)

• Mechanical stress (sprain/strain)

Patients typically present to a healthcare facility with:

• Pain

• Bleeding

• Swelling

• Bruising

• Loss of function

• Deformity (if associated with fracture/dislocation)

Soft tissue injuries range from minor contusions to life-threatening crush injuries with vascular compromise.

2. Classification

A. Closed Injuries

• Contusion (bruise)

• Hematoma

• Sprain (ligament injury)

• Strain (muscle/tendon injury)

• Crush injury

B. Open Injuries

• Abrasion

• Laceration

• Incised wound

• Puncture wound

• Avulsion

• Degloving injury

• Bite wound

3. Pathophysiology

Following trauma:

1. Tissue disruption

2. Bleeding and hematoma formation

3. Inflammatory response

4. Edema and swelling

5. Pain due to inflammatory mediators

6. Healing phase (if no infection or ischemia)

Severe injuries may cause:

• Compartment syndrome

• Vascular compromise

• Nerve injury

• Internal organ damage

4. Signs and Symptoms

Local Signs

• Pain (most common)

• Swelling

• Tenderness

• Bruising (ecchymosis)

• Bleeding (external wounds)

• Decreased range of motion

• Deformity (if associated fracture)

• Open wound of varying size

Red Flag Symptoms (Suggest Serious Injury)

• Severe increasing pain

• Pallor or cold limb

• Absent distal pulse

• Numbness or tingling

• Inability to move limb

• Blood in urine (renal trauma)

• Shock (internal bleeding)

• Blood or serous discharge from ear/nose (skull base fracture)

5. Diagnostic Criteria

Diagnosis is clinical and based on:

• Pain only

• Traumatic swelling

• Bruises with intact skin

• Cuts and abrasions

• Puncture wounds

• Open wounds

• Functional limitation

Important considerations:

• Exclude fractures using X-ray

• Assess for internal organ injury

• Recognize subtle signs of organ damage

• Closed long bone injuries may damage vessels

• Contamination with soil increases infection risk

6. Investigations

A. Basic Imaging

• X-ray (exclude fracture/dislocation)

• Ultrasound (hematoma, soft tissue tear)

• Doppler ultrasound (vascular injury)

• CT scan (deep trauma/internal organ injury)

B. Laboratory Tests (if severe)

• Full blood count

• Blood grouping and crossmatch

• Coagulation profile

• Urinalysis (detect hematuria)

• Blood glucose (diabetics)

7. Emergency Management (ABCDE Approach)

1. Airway

2. Breathing

3. Circulation (control bleeding immediately)

4. Disability (neurological status)

5. Exposure (full injury assessment)

8. Treatment

A. Pharmacological Management

1. Pain Control

• Paracetamol 15 mg/kg PO every 6 hours

AND

• Diclofenac 75 mg IM every 6 hours (if oral not tolerated)

2. Antibiotics (for contaminated or open injuries)

• Cloxacillin 500 mg IV every 6 hours for 7 days

• Ceftriaxone 1 g IV every 8 hours

• Metronidazole 500 mg IV every 8 hours

This combination covers:

• Gram-positive bacteria

• Gram-negative bacteria

• Anaerobic organisms

3. Tetanus Prophylaxis

Protection against Clostridium tetani

TT = Tetanus ToxoidTIG = Tetanus Immunoglobulin

Dose:

• TT: 0.5 mL IM

• TIG: 1 mL IM

B. Non-Pharmacological Management

1. Immobilization

• Apply splint or POP cast after reduction

• Prevent further damage

• Reduce pain and swelling

2. Monitoring

• Vital signs

• Distal pulse

• Capillary refill

• Limb color and temperature

• Signs of compartment syndrome

3. Wound Care

Surgical Debridement

Removal of:

• Dead tissue

• Foreign bodies

• Dirt and contaminants

Wound Closure

• Suture clean wounds

• Delayed closure for contaminated wounds

Do NOT perform primary closure if:

• Dirty or contaminated

• Crushed tissue

• Projectile injury

• Bite wound

• Necrotic tissue present

4. RICE Protocol (for sprains/strains)

• Rest

• Ice (first 24–48 hours)

• Compression

• Elevation

9. Complications

Early

• Infection

• Compartment syndrome

• Hemorrhage

• Vascular injury

• Nerve damage

Late

• Chronic pain

• Joint stiffness

• Scar formation

• Contractures

• Osteomyelitis

• Tetanus

• Functional disability

10. Prevention

• Use protective equipment at work

• Road safety compliance

• Sports protective gear

• Safe handling of sharp objects

• Early wound cleaning

• Complete tetanus immunization schedule

• Immediate hospital evaluation for deep injuries

11. Patient Education

Seek urgent medical attention if:

• Increasing pain

• Numbness

• Limb becomes pale or cold

• Fever develops

• Pus discharge

• Swelling rapidly increases

Do not:

• Apply herbs or soil to wounds

• Ignore deep puncture wounds

• Remove deeply embedded objects at home

12. Prognosis