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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.******