Post on 15-Jan-2015
description
““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