DIAGNOSIS OF MUSKULOSKLETAL TRAUMA

POKOK BAHASANDIAGNOSA TRAUMA MUSKULOSKLETALJENIS TRAUMA MUSKULOSKLETAL a. TRAUMA MSK SEDERHANA b. TRAUMA MSK MENGANCAM JIWA c. TRAUMA MSK YG MENGANCAM EKSTREMITASPERTOLONGAN BEDAH AWAL PADA TRAUMA MSKHAL HAL YANG MEMPERBURUK PROGNOSISINDIKASI KONSULTASI

Biomechanics of FracturesE ( Energy Kinetic ) = MVVmVMmM2Pelvis

SOFT TISSUE INJURY : skin, subcutan fat,muscle, artery,venous, nerves etc

BONE INJURY : broken bones

Early Intervention on trauma/multitrauma patient (included MSK trauma problems)

Early Intervention on trauma/multitrauma patient (included MSK trauma problems)

How to diagnose the muskuloskletal trauma problems?CLINICAL HYSTORY(not for the multitrauma patients)

PHYSICAL EXAM : LOOK, FEEL, MOVE,MEASUREMENT

DIAGNOSTIC IMAGING

MUSKULOSKLETAL TRAUMA PROBLEMSFRACTURES : Closed, Open

DISLOCATIONS,FRACTURE-DISLOCATION

SOFT TISSUE INJURIES :tendon rupture,muscle rupture w/ or w/o neurovascular lesion.

FRACTURESClose fractureOpen fractureCompound fracture

FRACTURESFRACTURES IS NOT ONLY LESION OF THE BONE

DOCTORS MUST THINGS : BEYOND THE PICTURES!!!

THE BONE : LOOKLIKE THE TREE WITH THE ROOT IS THE SOFT TISSUE !!

FRACTURES

FRACTURES

DIAGNOSISCLINICAL HISTORY (Not for multitrauma pts)

*WHEN (time) : golden periode

*HOW ..MOI (Mechanism of injury : Low velocity/High velocity trauma/trivial) !!!

LOOKDeformity Angulation - Rotation - DIscrepancyPositionEdemaAppearance of the distal partPaleDarken

LOOK

FEELCrepitation

Temperature of the distal partPulse

Sensory

FEEL (neurovasc exam)

MOVE

ActivePassivePowerFalse movement

MEASUREMENTMEASUREMENT- discrepancyTrue length,Anatomical lengthAppearance length

INVESTIGATIONX-ray (Immobilization first)2 VIEWS (AP-lateral)2 JOINTS (proximal & distal)2 SIDES (IF Necessary)Special order

INVESTIGATION (X RAY)

Open fracture communication between the fracture and the external environment30% pts with OF are polytrauma patients.Require emergency treatmentSignificant morbidityOPEN FRACTURES

OPEN FRACTURES

Grade I open fracture

Grade II open fracture

Grade III A open fracture

GRADE IIIb open fract

Grade III C open fracture

Principles of ManagementPrevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recoveryAO Principles of Fracture Management, 2000,

Prevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recoveryGolden 6 hours - Bacterial colonization and subsequent wound infection Once the skin barrier is disrupted, bacteria enter from the local environment and attempt to attach and growAssess contamination - appropriate antibioticsRadical Debridement - dead tissue is culture media( cant be replaced /prolonged GP by anykind of AB)Copious lavage > 10 litres - decrease bacterial load

ORTHOPAEDIC INFECTION:Diagnosis and treatment,1989 pp8

DebridementRadicalWound extended adequately for visualDecompress tight compartmentsCopious lavage

Avoid further soft tissue damage reduce and splint fracturesZones of Injury - Repeated DebridementGentle handlingBony stabilityEarly coverage < 1 weekDelay closurePrevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recovery

Prevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recovery

Prevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recovery

FRACTURES OF THE SPINECervical DislocationThorax Dislocation

Lumbar Fracture

DISLOCATIONS All joint s are surrounded by a joint capsule and ligaments, a dislocation to occur, at least a part of capsule and its ligaments must be torn

DISLOCATION

COMPLICATION OF MUSKULOSKLETAL TRAUMA1.DAMAGED OF NERVE OR SPINAL CORD2. DAMAGED OF THE VASCULAR

COMPARTEMENT SYNDROMECompression of nerve & bloodvessels

Within enclosed anatomic space (osteofacial)

Leading to impaired bloodflow

Sign & SymptomsClassic signs 5 PPainSevere extremity pain out of proportion to injuryEarly sign, worse with passively stretching involved muscle

Paresthesia or anesthesia to light touch

Paralysis

PulselessnessNot present in early cases Pallor

LATE COMPLICATION OF FRACTURES

INFECTION IN OPEN FRACT

Grade I less than 1%

Grade II 1-10 %

Grade III 10-50%

SIMPLE MUSKULOSKLETAL TRAUMA

LIFE THREATENING MUSKULOSKLETAL TRAUMA

LIMB THREATENING MUSKULOSKLETAL TRAUMA

Pre HospitalControl : Airway

Circulation

Immobilization

Transportation

********Reduction & Splinting alleviate pressure on injured ischemic soft tissueHaematoma spread controlled by sterile dressing

Zones of injuryTissues of questionable viability left over from previous debridement might be dead on the next debridement.******