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PuntodewoPuntodewoDept. of Dept. of OrthopaediOrthopaedicscs & Traumatolog & Traumatologyy
FFaculty of Medicine, Uaculty of Medicine, UGM/ RGM/ RSS D Drr SardjitoSardjito, , YOGYAKARTAYOGYAKARTA
MUSCULOSKELETAMUSCULOSKELETAL INJURYL INJURY
Background
Swelling number of vehicles and increased speed of vehicles
No concomitant increase in traffic management system
Sports: lifestyle, hobby risk of injury
High incidence of RTA High incidence of RTA
ExtremityExtremity
Upper extremitUpper extremityyShoulderShoulder
Upper ArmUpper Arm
Lower ArmLower Arm
HandHand
Lower extremitLower extremityyHipHip
Upper legUpper leg
Lower legLower leg
FootFoot
Musculoskeletal InjuryMusculoskeletal Injury
Muscle contusionMuscle contusion Sprain, strainSprain, strain Open & closed fractureOpen & closed fracture DisloDislocation and fracture-dislocationcation and fracture-dislocation Fracture with nerve injury and/or Fracture with nerve injury and/or
vascular (bleeding)vascular (bleeding) Compartment syndromeCompartment syndrome
Musculoskeletal InjuryMusculoskeletal Injury
Thorough clinical examination is Thorough clinical examination is essentialessential
Proper investigation is essentialProper investigation is essential
AC joint injuryAC joint injury
SlingSling Surgery: Surgery:
TBW + TBW + screwscrew
Docimo S Jr. et al. (2008). Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Curr Rev Musculoskelet Med. 2008 June; 1(2): 154–160.
Back injuriesBack injuries StrainStrain FractureFracture Bracing Bracing
G J Browne (2006). Cervical spinal injury in children’s community rugby football Br J Sports Med 2006;40:68–71.
Hamstring StrainHamstring Strain
RICERICE AnalgesicAnalgesic
s s Heiderscheit, BC. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. J Orthop Sports Phys Ther. 2010 February; 40(2): 67–81.
Patellofemoral Pain Patellofemoral Pain SyndromeSyndrome
Activity modification
Bracing
Wilson, NA. (2009). In Vivo Noninvasive Evaluation of Abnormal Patellar Tracking During Squatting in Patients with Patellofemoral Pain. J Bone Joint Surg Am. 2009 March 1; 91(3): 558–566.
Patella tendinitisPatella tendinitis
Activity modification
Bracing Abate M, et al. (2009). Pathogenesis of tendinopathies: inflammation or degeneration?Arthritis Res Ther. 2009; 11(3): 235.
Meniscus injuryMeniscus injury Bracing Bracing Surgery: repair or Surgery: repair or
excisionexcision Open or ArthroscopyOpen or Arthroscopy
Suter LG et al (2009). Medical Decision Making in Patients With Knee Pain, Meniscal Tear, and Osteoarthritis. Arthritis Rheum. 2009 November 15; 61(11): 1531–1538.
Runner’s kneeRunner’s knee
-Splinting
Fairclough J et al. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006 March; 208(3): 309–316.
Knee cartilage injuryKnee cartilage injury
Surgery: Surgery:
micro-micro-fracturization, fracturization, implantationimplantation
THOMPSON LR et al (2009). The Knee Pain Map: Reliability of a Method to Identify Knee Pain Location and Pattern. Arthritis Rheum. 2009 June 15; 61(6): 725–731.
Knee Knee ligamentligamentss rupture rupture
Bracing/ Bracing/ CastingCasting
Surgery: Surgery: Repair Repair
Phisitkul P. et al. (2006). MCL Injuries of the Knee: Current Concepts Review. Iowa Orthop J. 2006; 26: 77–90.
Knee Ligament Knee Ligament Rupture (cont.)Rupture (cont.)
Han, HS et al. (2008). Anterior Cruciate Ligament Reconstruction: Quadriceps Versus Patellar Autograft. Clin Orthop Relat Res. 2008 January; 466(1): 198–204.
Shin splintsShin splints
Activity modification
Bracing
van Gent RN et al. (2007)., Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 August; 41(8): 469–480.
Ankle sprainAnkle sprain
N. Kofotolis (2007). Ankle Sprain Injuries: A 2-Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388–394
Footballers ankleFootballers ankle BracingBracing UnloadingUnloading
N. Kofotolis (2007). Ankle Sprain Injuries: A 2-Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388–394
Achilles TendinitisAchilles Tendinitis, , Achilles tendon ruptureAchilles tendon rupture
SplintingSplinting Surgery: Surgery:
repairrepair
Munteanu SE (2009). Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial. J Foot Ankle Res. 2009; 2: 27.
Plantar fasciitisPlantar fasciitis BracingBracing StretchingStretching Shoe Shoe
modification modification
Radford JA et al. (2007). Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2007; 8: 36.
((OpenOpen)) Fracture Fracture
Fracture Fracture Wound Wound microbial contaminationmicrobial contamination
General Emergency General Emergency ManagementManagement : Airway, : Airway, Breathing, CirculationBreathing, Circulation
Initial stabilizationInitial stabilization : : Splint, slab, Splint, slab, compressive dressingcompressive dressing
Open FractureOpen FracturePrinciples of ManagementPrinciples of Management
Open FractureOpen FracturePrinciples of Principles of ManagementManagement
AntibioticAntibiotic Irrigation and Irrigation and
debridement : debridement : to to decrease microbial decrease microbial conconccentrationentration
StabiliStabilizationzation/fi/fixationxation (definiti(definitiveve) : IF/EF) : IF/EF
RehabilitRehabilitationation
Dislocation Dislocation & Fracture-Dislocation& Fracture-Dislocation
Attitude Attitude Risk of Risk of
neurovascular neurovascular disdisturbanceturbance
Early reductionEarly reduction General General
anesthesiaanesthesia immobilizationimmobilization Rehabilitation Rehabilitation
Dislocated shoulderDislocated shoulder
Closed Closed reductionreduction
Surgery Surgery for for neglected neglected casescases
BleedingBleeding
Pelvic fracture : 2 LPelvic fracture : 2 L Femur fracture : 1,5 LFemur fracture : 1,5 L Fluid resuscitationFluid resuscitation Stabilization of Stabilization of
fracture fracture – Internal fixationInternal fixation– External fixationExternal fixation
Increased fluid content in compartment
Compartment
Syndrome
External compression
Constriction of compartment
Arterial Trauma Trauma / fracture exercise (athlete) Old compression
• Edema• Bleeding
Increased pressure within the compartment
Intracompartmental pressure exceeds“Critical Closing Pressure”
Muscle ischemia Nerve ischemia
Volkmann contracture
MUSCLE INFARCTIONMUSCLE INFARCTION
FASCIOTOMYFASCIOTOMY