BASIC PRINCIPLES OF MUSCULOSKELETAL TRAUMA MANAGEMENT

Bitariho Deogratias M.B.Ch.B, M.Med(Ortho), FCS(ECSA)

TRAUMA
A. HARD TISSUE:- BONE/SKELETON - FRACTURE B. SOFT TISSUE : - LIGAMENT - MUSCLE - TENDON

- FIRSTLY DO NO HARM

PRINCIPLES:

- COOPERATE WITH THE LAWS OF NATURE

FRACTURE
A. OPERATIVE : - OPEN REDUCTION - INTERNAL FIXATION: RIGID/STABLE

B. CONSERVATIF: - FUNCTIONAL FRACTURE BRACING SYSTEM - EXTERNAL FIXATOR - TRACTION

FUNCTIONAL FRACTURE
BRACING SYSTEMS
EARLY

MOBILISATION AND WEIGHT-BEARING CONCEPT FITTING PROSTHESIS TIBIA : PATELLAR TENDON BEARING FEMUR : QUADRILATERAL ISCHIAL-BEARING

SOFT TISSUE TRAUMA

LIGAMENT AND JOINT CAPSULE

PARTIAL TEAR

: - PARTIAL LIGAMENT - STABLE JOINT COMPLETE TEAR : - COMPLETE LIGAMENT - UNSTABLE JOINT - DISLOCATION BLEEDING

DIAGNOSTIC :
BLEEDING: EDEMA, PAIN, BRUISING PAIN IN MOVEMENT HAEMARTHROSIS JOINT STABLE OR UNSTABLE

THERAPY
ACUTE :
REST ICE COMPRESS ELASTIC BANDAGE ELEVATION

EXAMINATION OF JOINT STABILIZATION:

- STABLE : STRAPPING - UNSTABLE: IMMOBILIZATION / STRAPPING OPERATIVE

DISLOCATION
EARLY REDUCTION TO PREVENT:
AVASCULAR/

ASEPTIC NECROSIS RECURRENT DISLOCATION REDUCE OPERATIVE

HIP DISLOCATION

POSTERIOR

FLEXION - ADDUCTION - INTERNAL ROTATION

REDUCTION:

- STIMSON - ALLIS - BIGELOW

Stimson Method

Allis Method

Bigelow Method

Shoulder Dislocation

ANTERIOR :
- DELTOID FLAT - SUPPORTED ARM WITH OTHER HAND

REDUCTION:

- STIMSON
- HIPOCRATES - KOCHER

Hipocrates

Stimson

Traction and counter traction

ELBOW DISLOCATION
POSTERIOR : - OLECRANON PROMINENCE - PARTIAL FLEXION

Reduction:

- TRACTION
- PUSH - FLEXION

MUSCLE INJURY : STRAINS

DIRECT TRAUMA (IMPACT) : COMPRESSION RUPTURES
INDIRECT TRAUMA (OVERLOADING, OVER STRECHING) - DISTRACTION RUPTURES

RUPTURE SITE:
ORIGIN MUSCLE BELLY MUSCLE TENDON JUNCTION INSERTION

RUPTURE TYPE :
PARTIAL

TOTAL

DIAGNOSIS :

A SHARP OR STABBING PAIN DEFECT AT MUSCLE LUMP PAIN AND OEDEMA BRUISING AND MUSCLE SPASM

MUSCULAR HAEMATOMA
INTRA MUSCULAR HAEMATOMA ACUTE COMPARTMENT SYNDROMES

TRAUMA IMPACT:

INTER MUSCULAR HAEMATOMA

COMPARTMENT SYNDROME

THERAPY : STOP BLEEDING

REST ICE PACK ELASTIC BANDAGE ELEVATION OF EXTREMITY PREVENT LOADING
SIGNS OF ACUTE COMPARTMENT SYNDROMES FASCIOTOMY

PARTIAL RUPTURE :

EALSTIC BANDAGE ATER 72 HOURS: HOT PACK ACTIVE MUSCLES EXERCISES

TOTAL RUPTURE :

REPAIR

TENDON INJURY
FREQUENTLY:
ACHILLES BICEPS QUADRICEPS

RUPTURE :
PARTIAL TOTAL

DIAGNOSTIC :
SUDDEN

SNAP + PAIN HAEMATOMA + EDEMA UNABLE TO MOVE THE JOINT DEFECT LUMP THOMSON/SQUEEZ TEST

THERAPY:

ACUTE :
- REST

- COOLING - ELASTIS BANDAGE

TOTAL RUPTURE :
ADULT= REPAIR OLD : - IMMOBILIZATION - EXERCISE

PARTIAL RUPTUR :
- IMMOBILIZATION - EXERCISE

COMPARTMENT SYNDROMES
PRESSSURE IN OSTEOFASCIAL COMPARTMENT THAT CAUSES ELEVATION : VOLKMANNS ISCHAEMIC CONTRACTURE

Compartment Syndrome

CAUSES :
DECREASED COMPARTMENT SPACE
TIGHTING FASCIAL SUTURED - BANDGAE/ CASTING - OVER EXTERNAL PRESSURE
-

ELEVATION OF COMPARTMENT CONTENT

- BLEEDING - HYPERMEABILITY - INCREASED INTRA CAPILARY PRESSURE - MUSCLE HYPERTROPHY - NECROTIC SYNDROME

SIGNS: 4 PS
PAIN 2. PALLOR 3. PARESE - PARALYSIS 4. PULSE LESS NESS
1.

Intracompartmental PRESSURE

Measurement of CS

THERAPY:
Decompression

hours Release all bandage/ casting Fasciotomy

6 - 12

Fat embolism syndrome

Long Bone fracture ACUTE RESPIRATORY DISTRESS SYNDROMES :

- Breathless - Headache, DELIRIUM COMA - TACHYCARDIA B.P. - PETECHIAE - Chest XRAY : INFILTRAT : SNOW STORM APPEARANCE

Therapy :
Balance

electrolyte Corticosteroid LOW MOLECULAR WEIGHT DEXTRANS INTUBATION OR TRACHEOSTOMY MECHANICAL RESPIRATION SUPPORT