““BASIC PRINCIPLES OF BASIC PRINCIPLES OF MUSCULOSKELETAL MUSCULOSKELETAL

TRAUMA MANAGEMENT“TRAUMA MANAGEMENT“

HERMANSYAH, MD

TRAUMATRAUMA

A.A. HARD TISSUE:HARD TISSUE: BONE/SKELETONBONE/SKELETON FRACTUREFRACTURE

B. SOFT TISSUE: B. SOFT TISSUE: LIGAMENTLIGAMENT MUSCLEMUSCLE TENDONTENDON

PRINCIPLESPRINCIPLES

FIRSTLY DO NO HARMFIRSTLY DO NO HARM

COOPERATE WITH THE “LAWS OF COOPERATE WITH THE “LAWS OF

NATURE”NATURE”

FRACTUREFRACTUREA.A. OPERATIVE : OPERATIVE :

- OPEN REDUCTION- OPEN REDUCTION

- INTERNAL FIXATION: RIGID/STABLE- INTERNAL FIXATION: RIGID/STABLE

B. CONSERVATIVE:B. CONSERVATIVE:

- “FUNCTIONAL FRACTURE BRACING - “FUNCTIONAL FRACTURE BRACING SYSTEM”SYSTEM”

- EXTERNAL FIXATOR- EXTERNAL FIXATOR

- TRACTION- TRACTION

FUNCTIONAL FRACTURE FUNCTIONAL FRACTURE BRACING SYSTEMSBRACING SYSTEMS

EARLY MOBILISATION AND WEIGHT-BEARING”EARLY MOBILISATION AND WEIGHT-BEARING”

CONCEPT “FITTING PROSTHESIS”CONCEPT “FITTING PROSTHESIS”

TIBIA : “PATELLAR TENDON BEARING”TIBIA : “PATELLAR TENDON BEARING”

FEMUR : “QUADRILATERAL ISCHIAL-BEARING”FEMUR : “QUADRILATERAL ISCHIAL-BEARING”

SOFT TISSUE TRAUMASOFT TISSUE TRAUMA

LIGAMENT AND JOINT CAPSULELIGAMENT AND JOINT CAPSULE

– PARTIAL TEAR:PARTIAL TEAR: PARTIAL LIGAMENTPARTIAL LIGAMENT STABLE JOINTSTABLE JOINT

– COMPLETE TEAR:COMPLETE TEAR: COMPLETE LIGAMENTCOMPLETE LIGAMENT UNSTABLE JOINTUNSTABLE JOINT DISLOCATIONDISLOCATION

– BLEEDINGBLEEDING

DIAGNOSTIC :DIAGNOSTIC :

BLEEDING: EDEMA, PAIN, BRUISINGBLEEDING: EDEMA, PAIN, BRUISING

PAIN IN MOVEMENTPAIN IN MOVEMENT

HAEMARTHROSISHAEMARTHROSIS

JOINT STABLE OR UNSTABLEJOINT STABLE OR UNSTABLE

THERAPYTHERAPY

ACUTE :ACUTE :

– RESTREST– ICE COMPRESSICE COMPRESS– ELASTIC BANDAGEELASTIC BANDAGE– ELEVATIONELEVATION

EXAMINATION OF EXAMINATION OF JOINT STABILIZATION:JOINT STABILIZATION:

– STABLE : STRAPPINGSTABLE : STRAPPING– UNSTABLE:UNSTABLE:

IMMOBILIZATION / IMMOBILIZATION / STRAPPINGSTRAPPING

OPERATIVEOPERATIVE

DISLOCATIONDISLOCATION

EARLY REDUCTION TO PREVENT: EARLY REDUCTION TO PREVENT:

AVASCULAR/ ASEPTIC NECROTICAVASCULAR/ ASEPTIC NECROTIC

RECURRENT DISLOCATIONRECURRENT DISLOCATION

REDUCE OPERATIVEREDUCE OPERATIVE

HIP DISLOCATIONHIP DISLOCATION

POSTERIOR:POSTERIOR:

- FLEXIONFLEXION- ADDUCTIONADDUCTION- INTERNAL ROTATIONINTERNAL ROTATION

REDUCTION:REDUCTION:

STIMSONSTIMSON ALLISALLIS BIGELOWBIGELOW

Stimson MethodeStimson Methode

Allis MethodAllis Method

Bigelow MethodBigelow Method

Shoulder DislocationShoulder Dislocation

ANTERIORANTERIOR:: DELTOID FLATDELTOID FLAT

SUPPORTED ARM WITH OTHER HANDSUPPORTED ARM WITH OTHER HAND

REDUCTION:REDUCTION: STIMSONSTIMSON

HIPOCRATESHIPOCRATES

KOCHERKOCHER

HipocratesHipocrates

StimsonStimson

Traction and counter Traction and counter tractiontraction

ELBOW DISLOCATIONELBOW DISLOCATION

POSTERIOR : POSTERIOR :

- OLECRANON OLECRANON

PROMINENCEPROMINENCE

- PARTIAL FLEXIONPARTIAL FLEXION

Reduction: Reduction: TRACTIONTRACTION PUSHPUSH FLEXIONFLEXION

MUSCLE INJURY: STRAINSMUSCLE INJURY: STRAINS

DIRECT TRAUMA (IMPACT) :DIRECT TRAUMA (IMPACT) :

“ “COMPRESSION RUPTURES”COMPRESSION RUPTURES”

INDIRECT TRAUMA (OVERLOADING, OVER INDIRECT TRAUMA (OVERLOADING, OVER STRECHING)STRECHING)

““DISTRACTION RUPTURES”DISTRACTION RUPTURES”

RUPTURE SITE:RUPTURE SITE:

ORIGOORIGO MUSCLE BELLYMUSCLE BELLY MUSCLE – TENDON JUNCTIONMUSCLE – TENDON JUNCTION INSERTIONINSERTION

RUPTURE TYPE:RUPTURE TYPE:

PARTIALPARTIAL TOTALYTOTALY

DIAGNOSTIC:DIAGNOSTIC:

• ““A SHARP OR STABBING PAIN”A SHARP OR STABBING PAIN”

• DEFECT AT MUSCLEDEFECT AT MUSCLE

• “ “ LUMP “LUMP “

• PAIN AND EDEMAPAIN AND EDEMA

• “ “ BRUISING “ AND “ MUSCLE SPASM “BRUISING “ AND “ MUSCLE SPASM “

TRAUMA IMPACT:TRAUMA IMPACT:MUSCULAR HAEMATOMAMUSCULAR HAEMATOMA

INTRA MUSCULAR HAEMATOMAINTRA MUSCULAR HAEMATOMA

““ACUTE COMPARTMENT SYNDROMES“ ACUTE COMPARTMENT SYNDROMES“

INTER MUSCULAR HAEMATOMAINTER MUSCULAR HAEMATOMA

THERAPY: STOP BLEEDINGTHERAPY: STOP BLEEDING

RESTREST

ICE PACKICE PACK

ELASTIC BANDAGEELASTIC BANDAGE

ELEVATION EXTREMITYELEVATION EXTREMITY

PREVENT LOADINGPREVENT LOADING

FASCIOTOMYFASCIOTOMY

PARTIAL RUPTURE:PARTIAL RUPTURE:

• EALSTIC BANDAGEEALSTIC BANDAGE• ATER 72 HOURS: HOT PACKATER 72 HOURS: HOT PACK• ACTIVE MUSCLES EXERCISESACTIVE MUSCLES EXERCISES

TOTAL RUPTURE :TOTAL RUPTURE :• REPAIREREPAIRE

TENDON INJURYTENDON INJURY

FREQUENTLY:FREQUENTLY:– ACHILLESACHILLES– BICEPSBICEPS– QUADRICEPSQUADRICEPS

RUPTURE :RUPTURE :– PARTIALPARTIAL– TOTALYTOTALY

DIAGNOSTIC:DIAGNOSTIC:

““SUDDEN SNAP” + PAINSUDDEN SNAP” + PAIN

HAEMATOM + EDEMAHAEMATOM + EDEMA

UNABLE TO MOVE THE JOINTUNABLE TO MOVE THE JOINT

DEFCTDEFCT

““LUMP”LUMP”

THOMSON/SQUEEZ TESTTHOMSON/SQUEEZ TEST

THERAPY:THERAPY:

ACUTE : ACUTE :

- - RESTREST

- COOLING- COOLING

- ELASTIS BANDAGE- ELASTIS BANDAGE

TOTAL RUPTURE : TOTAL RUPTURE :

ADULT= REPAIRADULT= REPAIR

OLD : - IMMOBILIZATIONOLD : - IMMOBILIZATION

- EXERCISE- EXERCISE

PARTIAL RUPTUR : PARTIAL RUPTUR :

- IMMOBILIZATION IMMOBILIZATION

- EXERCISE- EXERCISE

COMPARTMENT SYNDROMECOMPARTMENT SYNDROME

COMPARTMENT SYNDROMESCOMPARTMENT SYNDROMES

CAUSES:CAUSES:

DECREASE COMPARTMENT SPACEDECREASE COMPARTMENT SPACE

– TIGHTING FASCIAL SUTUREDTIGHTING FASCIAL SUTURED

– BANDAGE/ CASTINGBANDAGE/ CASTING

– OVER EXTERNAL PRESSUREOVER EXTERNAL PRESSURE

ELEVATION OF COMPARTMENT CONTENTELEVATION OF COMPARTMENT CONTENT

– BLEEDINGBLEEDING

– HYPERMEABILITYHYPERMEABILITY

– INCREASE INTRA CAPILARY PRESSUREINCREASE INTRA CAPILARY PRESSURE

– MUSCLE HYPERTROPHYMUSCLE HYPERTROPHY

– NECROTIC SINDROMENECROTIC SINDROME

SIGNS: 4 P’SSIGNS: 4 P’S

PAINPAIN

PALLORPALLOR

PARESIS - PARALYSISPARESIS - PARALYSIS

PULSELESSNESSPULSELESSNESS

Intra-compartmental PRESSUREIntra-compartmental PRESSURE

THERAPY:THERAPY:

Decompression 6 - 12 jamDecompression 6 - 12 jam

Release all bandage/ castingRelease all bandage/ casting

FasciotomyFasciotomy

Fat embolism syndromeFat embolism syndrome

LONG BONE FRACTURELONG BONE FRACTURE

ACUTE RESPIRATORY DISTRESS ACUTE RESPIRATORY DISTRESS

SYNDROMES:SYNDROMES: BreathlessBreathless

Headache, – DELIRIUM – COMAHeadache, – DELIRIUM – COMA

TACHICARDIA – B.P. TACHICARDIA – B.P.

PETECHIAEPETECHIAE

Chest XRAY: “SNOW STORM APPEARANCE”Chest XRAY: “SNOW STORM APPEARANCE”

Therapy:Therapy:

Balance electrolyteBalance electrolyte

CorticosteroidCorticosteroid

LOW MOLECULAR WEIGHT LOW MOLECULAR WEIGHT

DEXTRANSDEXTRANS

INTUBATION OR TRACHEOSTOMYINTUBATION OR TRACHEOSTOMY

MECHANICAL RESPIRATION MECHANICAL RESPIRATION

SUPPORTSUPPORT