MUSCULOSKELETAL TRAUMA

Dr. M. Ruksal Saleh, Ph.D., Sp.OT

Bagian Ortopedi & Traumatologi
Fakultas Kedokteran Universitas Hasanuddin
Makasasar, 2006

Introduction
Millions of cases annually.
Multiple MOI :
Falls, Automobile collisions, Crashes,
Violence, etc
Multi-system trauma

Rarely life threatening

Improperly treated can result permanent
disability.

Anatomy & Physiology of the

Musculoskeletal System

Structures

Skin
Bones
Joints where bones interact
Muscles
Tendons - connect muscle to bone
Ligaments - connect bone to bone
Neurovascular

The Skeleton

Types of Muscles

The Neurovascular

Function
Protects organs
Allows for efficient movement
Stores salts and other materials needed
for metabolism
Produces RBCis
Scaffolding / Support

Pathophysiology of the
Musculoskeletal System

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Musculoskeletal Injury Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

Common Signals of Musculoskeletal Injury :

Pain
Swelling
Deformity
Discoloration of the skin (bruising)
Inability to use the affected part normally
Loss of sensation in the affected part.

Musculoskeletal Injury Management

General Principles
Protecting Open Wounds
Positioning the limb
Immobilizing the injury
Checking Neurovascular Function

Immobilizing a joint

Four months post-op

One years post-op

Preoperative

Debridement + necrotomy

Identification of artery, veins,

nerves & tendons

Bone Fixation

Repair ulnar artery

Repair of extensor tendons

Repair of flexor tendons

7 weeks post operation

COMPARTMENT
SYNDROME

Compartment Syndrome
Occurs when pressure w/i soft tissues in a
fixed body compartment increases to level
that exceeds venous pressure,
compromising venous blood flow, and
limiting capillary perfusion.
Leads to muscle ischemia and necrosis.
TRUE ORTHOPEDIC EMERGENCY

Compartment Syndrome
Contributing Factors
External:
Conditions that reduced size of muscle
compartment (casts/splints); occlusive
dressing; eschar of burns

Internal:
Conditions that increase compartment
volume: bleeding, swelling, fluid
extravasation into tissue

CS-Recognition
Suspect with long bone fx, crush injuries, Fxs
associated w/ significant vascular injuries or
pronounced swelling.
Presents as pain out of proportion to physical
findings, +/- hypoesthesia, pulselessness (late).

Compartment Syndrome
Intra-compartment pressures must be measured once
the issue of compartment syndrome is raised.

Deep Venous Thrombosis

Deep Venous Thrombosis

Clot forming in one of the deep veins of an extremity:
Legs > Arms.
If clot propagates above the popliteal fossa, substantial
risk of piece of clot breaking free, embolizing to the
pulmonary circulation.
Risk of respiratory distress, hypoxia, pleuritic chest
pain, circulatory compromise, death.
Doppler ultrasound; CXR; V/Q Scan; spiral CT
Treatment: anticoagulation

Summary
Musculoskeletal system extends into all
parts of the body
Musculoskeletal trauma usually not life
threatening
Proper recognition and treatment is very
important to avoid permanent disability

Thank You