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Musculoskeletal System
The system of muscles, tendons, ligaments,
bones,
joints,
nerves,
vessels
and
associated tissues that provides form,
support, stability, and movement to the
body.
Musculoskeletal Trauma
Musculoskeletal injuries
High morbidity
Low mortality
Musculoskeletal trauma
Traffic, factory, domestic, school and
sport.
Fractures,
Dislocations,
Ruptures
Emergency
Emergencies in Musculoskeletal Trauma :
1. Open fracture
2. Fractures with neuro-vascular disturbances
3. Joint dislocations
Extremity injuries
First aids
control
hypothermia
SECONDARY SURVEY
Done after the patient
stable
Head to toe
Every orificiums/every
tubes
Diagnosis of Fractures
History
Fall, twisting injury, direct blow, MVA
Localized pain, aggravated by movement
Crepitus
Physical Examination
General condition associated injuries
Look : deformity, swelling, abN movement
Feel : localized tenderness, muscle
spasm, NVD
Move : ROM
Diagnostic Imaging
Exact nature & extent of fracture
X-ray : min AP & lat (ocassional : oblique)
CT / MRI : spine, pelvis
Salter RB. Textbook of Disorders and Injury of
Diagnosis
History :
Biomechanics ~ Forces.
Time of injury
Possibilities or serious injuries.
Decrease / lost of functions.
Previous management, transportation.
Physical examination
General condition
Vital signs
ABCs
Local condition :
Look
Feel
Move
Local Condition
Look :
Deformities : angulations, discrepancy, rotation.
Bone exposed
Swelling
Feel :
Pain, crepitation, edema
Move :
Functio laesa
NEURO VASCULAR !!
Neurovascular
disturbance
Supporting examinations
Laboratory
Imaging
Splint
Straight, strong, flat + padding
Stable
Safe
Immobilization
2 joints
3 dimension
Alignment / anatomic position
Neuro-vascular conditions
Splints
Immobilization
Splinting
Immobilize 2 joints / 2 bones
Neuro-vascular functions
Advantages :
Decreasing pain.
Prevent further damages
Decrease or stop the bleeding
Easy transportation.
Treatment
1.
2.
3.
4.
5.
6.
First do No harm
Base treatment on an Accurate Diagnosis
and Prognosis
Select Treatment with Specific Aims
Cooperate with the Law of Nature
Nature
Make Treatment Realistic and Practical
Select treatment for your patient as an
individual
SPRAIN
A Sprain is an injury to a joint and its ligaments
Sprain
RICE
RICE
STRAIN
An injury to a muscle in which the muscle fibers
tear as a result of over stretching
PRICE
Protection, Rest, Ice, Compression, and Elevation
Joint Dislocation
Joint contact
Complete / incomplete
Risk of avascular necrosis of the joint cartilage
and bones
Dislocation
Diagnosis / dd :
Dislocation
Fracture
Fracture dislocation
Joint Dislocation
Treatment
Reposition ~ instability
Immobilization ~ stable position
Rehabilitation ~ stability, tissue healing
Dislocation
Fractures
Trauma that produce discontinuity of bone,
Treatment of Fracture
4 R :
Recognition diagnosis, soc ec, religion, etc
Reposition displaced /deformity to anatomic
/ acceptable position
Retaining fixation of fragments : external,
internal
Rehabilitation early joint ROM, muscle
action, edema, psychological consideration ,
previous activity
Closed Fractures
Management
Intact skin
Closed reduction + immobilization (cast, traction)
Surgery :
If closed treatment was failed (reduction and
stability)
Open Fractures
Open wound, relations between bone fragments
OPEN FRACTURES
Type I open
fracture
Type II open
fracture
Open Fracture
Management
Emergency
Other life threatening injuries
Multiple injuries ?
Antibiotics
Debridement
Fracture fragment Stabilization
Wound coverage
Bone grafting
Rehabilitation
Rehabilitation
INFECTION IN OPEN
FRACTURE
Type I
Type II
Type III
less than 1%
1-10 %
10-50%
haemorrhagic shock :
Fracture of pelvis
fracture of femur
Both are an emergency
conditions that needs an
immediate management.
Blood vessels may injured by
the bone fragments,
fragments so it
always needs a good
examination of the circulation
at distal part of the limb.
Deformity and
impairment
Compartment Syndrome
- variable
8 hours
- irreversible
Nerve
2 hours
4 hours
- neuropraxia
8 hours
- irreversible
Compartment
Syndrome
Clinical Signs :
Classical signs : 5 P (pain,
paresthesia, pallor,
paralysis, pulselessnes).
Bulae
Significant sign : strecth
pain and paresthesia,
decompresion fasciotomy.
Measurement of the intra
compartment pressure
fasciotomy
Ischemic contractures
Amputation
Death
Volkmanns
Contracture
Management
Remove extrinsic compression
Elevate to at least level of heart
Compartment pressure measurement?
Fasciotomy
INDICATION OF CONSULTATION
ALL FRACTURES & DISLOCATION ARE PATOLOGIC
CONDITION
IMMOBILISATION/SPLINT FIRST
STRICTLY NO DELAY OF TRANSFERING PATIENTS W/
DO NOT DO HARM
SUMMARY
Thank you
to cure sometimes, to relieve often, to comfort
always.
- Edward Livingston Trudeau -