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Questions
Is it important?
Is it consider as priority
in management?
Will the patient survive?
Will the patient die
from such an injury?
Will it cause long term
morbidity?
Epidemiology
70-80% of trauma patients will involve
musculoskeletal system
Abdominal trauma 16%
Thoracic trauma 8%
Morbidity
Musculoskeletal trauma + Abdominal injury
Musculoskeletal trauma + Head injury
Sequele
Early Pressure sore, infection, gas gangren
Late Non union, malunion, myositis ossificans, AVN,
contracture, nerve compression, joint stiffness
Acute Management
ATLS Protocol
ABCDE
True life
threatening
musculoskeletal
emergency
Acute Management
When to consider
cervical spine injury
1. Unconcious patient
2. Bruises above the
clavicle
3. Midline tenderness
4. High energy injury/
dangerous mechanism
Acute management
Acute Management
GENERAL MANAGEMENT OF
FRACTURES AND DISLOCATION
1.
2.
3.
4.
Recognize
Reduce
Retain
Rehabilitation
Recognize
Look
Swelling
Deformities
Open wounds
Feel
Localized pain
Neurovascular
functions
crepitations
Move
Crepitations
Abnormal
movements
ROM
Recognize
Xray Examination
2 sides
AP/Lateral/Oblique
2 joints
Distal and proximal of
the suspected fracture
2 extremities
In paediatric patients
only
2 times
Fragmented Fractures
Apposition
Angulation
Rotation
Shortening/Length
Dislocation
A complete separation (no contact)
of two bones that made up a joint
Clinical findings:
Severe joint pain
Deformity of joint contoure
Pain on joint motion
Reduce
Closed reduction:
manual manipulation of
the fracture
General anesthesia
muscle relaxation
3 manouvers
1. traction of distal
fragment
(disengagement)
2. Reposition to anatomical
position
3. Realignment in 2
dimensions
Open reduction:
surgery direct reduction
in open fractures:
Conducted along with
debridement
In closed fractures:
Unsuccesful closed
reduction
Intra-articular fractures
Avulsion fractures
Retain
Splinting
Skin traction
Circular cast
Internal
fixation
External
fixation
Rehabilitation
Gait excercise
Complications of fractures
Early
Visceral injuries
Vascular injuries
Compartment syndrome
Neural injuries
Hemarthrosis
infections
late
Delayed union, non-union,
malunion
Muscle athropy
Myositis ossificans
Avascular necrosis
Algodystrophy
Osteoathritis
CRPS
Compartment syndrome
Hallmarks: 5P
1. Pain
2. Paresthesis
3. Pallor
4. Paralysis
5. Pulselessness
Management: Fasciotomy
Delayed Union
Fracture takes
longer than the
estimated union
time
Causes:
Heavy soft tissue
injury
Inadequate blood
supply
Infections
Inadequate
stabilization
Over-traction
Management: Bone
graft
Non-Union
Fracture fails to
heal
Caused by
fibrotic tissue
covering the
fractured area
Clinical finding:
pseudoathrosis
X-ray: visible
fracture line
Type:
Hypertrophic
athropic
Mal-union
Union in a
pathological
position
Types:
Angulation
Rotation
shortening
Myositis Ossificans
Abnormal, heterotopic bone formation
in muscles, commonly found in elbow
dislocations
Clinical findings:
Local swelling
Pain on palpation
Limited ROM
X-ray: calcification on soft tissues
Management:
Bone mass excision
Indometacin
radiation
Avascular necrosis
Injuries that causes bone
ischemia and eventually
necrosis
Commonly found in
injuries to :
caput femoris,
proximal part of os
schapoid,
os lunatum,
os talus
Ligament sprain
Injuries to the
ligaments without any
structural damage
Due to rotational or
attractional force
Clinical findings:
Joint pain
Swollen joints
Ligament rupture
Partial or total
discontinuity of a
ligament
Commonly found in:
Knee joint
Ankle
Fingers
Clinical findings:
Swelling
Severe joint pain
Subcutaneous bleeding
SPINE INJURY
Epidemiology
Cervical spine 5-15% of spine trauma
Thoracolumbar fracture 1/20.000 per year,
common in productive age men
Most common T11-L2
High morbidity due to spinal cord injury
Assesment
Sign and Symptoms
Respiratory distress
Tenderness at the site of injury on spinal column
Pain along the spinal column with movement
Deformity of the spine (rare)
Numbness, weakness or tingling in the arms or
legs
Loss of sensation or paralysis in the upper or lower
extremity
Incontinence or loss of bowel or bladder control
Priapism
Assesment
Radiology
Management
Objectives
Prevent or reserve neurologic deficit
Restore spinal stability
Prevent deformity or restore spinal alignment
Allow early mobilization
Medical Management
Managing spinal cord injury
High dose steroid (NASCIS III) No clear
evidence
<3 hours : initial dose 30 mg/kgbw/hour,
maintenance 5.4 mg/kgbw/24 hours
3-8 hours : maintenance 5.4 mg/kgbw/48 hours
Orthopaedic Management
Conservative treatment
Orthopaedic Management
Operative treatment
Best timing if <6 hours Debatable
Vertebroplasty
Posterior stabilization only
Decompression and Posterior stabilization
Combination of Posterior and anterior procedure
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