MUSCULOSKELETAL INJURIES

Ifran Saleh
Consultant Orthopaedic & Spine Surgeon
Div.Orthopaedic & Traumatology
Dept.of Surgery, Fac.of Medicine
Univ.of Indonesia / Cipto Mangunkusumo Hosp.
Jakarta

MUSCULOSKELETAL INJURY
Bones & Muscles may be injured
in 4 basic ways :
Fracture
Dislocation
Sprain
Strain

Musculoskeletal Injury
Mechanism of Injury
Direct
Indirect
Twisting forces
Bending forces
Compression forces
Distraction forces

Musculoskeletal Injury
Signs & Symptoms
Deformity or angulations
Identify and treat life threats
Stabilize the injured extremity
Expose the injury site
Treat any open wounds
Allow the patient to rest in a position of
comfort

Musculoskeletal Injury
Splinting

Splint is any device used to immobilize a body part :

It may be soft or rigid

Aim of splinting :
To prevent motion of bone fragment or
dislocated joints
To minimize damage to surrounding tissues,
nerves, bloud vessels & injured bone
To help control bleeding & swelling
To help prevent shock
To reduce pain & suffering

Musculoskeletal Injury

Type of splints
Rigid splints
Traction splints
Circum ferential splints
Improvised splints
Sling & swathe

Musculoskeletal Injury
General rules of splinting
Do not release manual stabilization of an
injured extremity until it is properly &
completely immobilized
Never intentionally replace protrudine bones
or push them back below the skin
Control bleeding & dress all open wounds
before applying a splint
If a long bone is injured, immobilize it until
Thebones above & below

 If a limb is severely deformed by the injury

or if the limb has no pulse or cyanctic below
the injury site
align it with gentle
manual traction
Pad a splint before applying it
Before & after applying a splint, assess pulse,
movement and sensation below the injury site

Musculoskeletal Injury
Improper Splinting :
Compress nerves, tissue & blood vessels
Under the splint
aggravate the injury
and furthe damage
Move displaced or broken bone
Reduces blood flow below the injury site
Delay transport of a patient who has a life
Threatening problem

Injuries to the head

Open injury
Closed injury
Open head injury
Is accompanied by a break in the skull caused by
A fracture or an impaled object
direct local
Damage to brain tissue

Closed head injury

No break or wound
Brain can be seriously injured (Swelling &
Bleeding brain pressure)

Head Injury
Patient assessment
Altered mental status from confusion
to un responsiveness
Irregular breathing
Open wounds to the scalp
Penetrating wounds to the head
Softness or depression of the skull
Blood or cerebrospinal fluid leaking
from the ears nose

 Facial bruises
Bruising around the eyes (raccdon eyes)
Bruising behind the ears (Battle sign)
Headache
Nausea, vomiting
Unequal pupil size with altered
mental status
Seizure activity

Head Injury
Suspect spine injury in any patient
With a head injury
immediate
Stabilize the patients head & neck

Head Injury
Guidelines for emergency care
Make the airway a top priority
Control bleeding & press open wounds
Apply a rigid cervical immobilization device
Monitor vital signs closely
Calm & reassure the patient

Head Injury
Skull Fracture
Signs & Symptomps
Visible laceration in the scalp
Deformity of the skull or face
Pain or swelling at the injury site
Clear or pinkish fluid dripping from
Nose, ears, mouth or head wounds
Unusual size of pupils
Raccoon eyes
Battles sign

Head Injury
Injuries to he brain
Signs & Symptoms
Changes in mental status
(confusion unresponsiveness)
Paralysis or flaccidity, usually only on
one side
Un equal facial movement, squinting,
drooping, Unequal pupil, disturbances
of vision

 Ringing in the ears, loss of hearing

Rigidity of all limbs
Loss of balance, staggering or stumbling gait
High BP with a slow pulse
Vomiting
Incontinence
Rapid, labored breathing

Head Injury
Conclussion
Is a temporary loss of the brains ability
to function
No detectable damage to the brain
Could be mild, moderate or severe
Based on the tome interval before
Return to responsiveness