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BASIC PRINCIPLES OF MUSCULOSKELETAL TRAUMA MANAGEMENT
Bitariho DeogratiasM.B.Ch.B, M.Med(Ortho), FCS(ECSA)
TRAUMAHARD TISSUE:- BONE/SKELETON - FRACTURE
B. SOFT TISSUE : - LIGAMENT - MUSCLE - TENDON
PRINCIPLES:- FIRSTLY DO NO HARM - COOPERATE WITH THE LAWS OF NATURE
FRACTUREOPERATIVE : - OPEN REDUCTION- INTERNAL FIXATION: RIGID/STABLE
B. CONSERVATIF: - FUNCTIONAL FRACTURE BRACING SYSTEM- EXTERNAL FIXATOR- TRACTION
FUNCTIONAL FRACTURE BRACING SYSTEMS
EARLY MOBILISATION AND WEIGHT-BEARINGCONCEPT FITTING PROSTHESISTIBIA : PATELLAR TENDON BEARINGFEMUR : QUADRILATERAL ISCHIAL-BEARING
SOFT TISSUE TRAUMALIGAMENT AND JOINT CAPSULEPARTIAL TEAR : - PARTIAL LIGAMENT - STABLE JOINT COMPLETE TEAR :- COMPLETE LIGAMENT - UNSTABLE JOINT - DISLOCATIONBLEEDING
DIAGNOSTIC :BLEEDING: EDEMA, PAIN, BRUISINGPAIN IN MOVEMENTHAEMARTHROSISJOINT STABLE OR UNSTABLE
THERAPYACUTE :
- REST- ICE COMPRESS- ELASTIC BANDAGE- ELEVATION
EXAMINATION OF JOINT STABILIZATION:- STABLE : STRAPPING- UNSTABLE:IMMOBILIZATION / STRAPPINGOPERATIVE
DISLOCATION
EARLY REDUCTION TO PREVENT:
AVASCULAR/ ASEPTIC NECROSISRECURRENT DISLOCATIONREDUCE OPERATIVE
HIP DISLOCATION POSTERIOR :FLEXIONADDUCTION- INTERNAL ROTATIONREDUCTION:- STIMSON - ALLIS - BIGELOW
Stimson Method
Allis Method
Bigelow Method
Shoulder Dislocation ANTERIOR :- DELTOID FLAT- SUPPORTED ARM WITH OTHER HAND
REDUCTION: - STIMSON - HIPOCRATES - KOCHER
Hipocrates
Stimson
Traction and counter traction
ELBOW DISLOCATIONPOSTERIOR : OLECRANON PROMINENCEPARTIAL FLEXION
Reduction: - TRACTION - PUSH - FLEXION
MUSCLE INJURY :STRAINSDIRECT TRAUMA (IMPACT) : COMPRESSION RUPTURES
INDIRECT TRAUMA (OVERLOADING, OVER STRECHING)- DISTRACTION RUPTURES
RUPTURE SITE: ORIGIN MUSCLE BELLY MUSCLE TENDON JUNCTION INSERTION
RUPTURE TYPE : PARTIAL TOTAL
DIAGNOSIS :A SHARP OR STABBING PAINDEFECT AT MUSCLE LUMP PAIN AND OEDEMA BRUISING AND MUSCLE SPASM
TRAUMA IMPACT:MUSCULAR HAEMATOMAINTRA MUSCULAR HAEMATOMAACUTE COMPARTMENT SYNDROMES
INTER MUSCULAR HAEMATOMA
COMPARTMENT SYNDROME
THERAPY :STOP BLEEDINGRESTICE PACKELASTIC BANDAGEELEVATION OF EXTREMITYPREVENT LOADING
SIGNS OF ACUTE COMPARTMENT SYNDROMES FASCIOTOMY
PARTIAL RUPTURE :EALSTIC BANDAGEATER 72 HOURS: HOT PACKACTIVE MUSCLES EXERCISES
TOTAL RUPTURE :REPAIR
TENDON INJURYFREQUENTLY:ACHILLESBICEPSQUADRICEPS
RUPTURE :PARTIALTOTAL
DIAGNOSTIC :SUDDEN SNAP + PAINHAEMATOMA + EDEMAUNABLE TO MOVE THE JOINTDEFECTLUMPTHOMSON/SQUEEZ TEST
THERAPY:ACUTE : - REST- COOLING- ELASTIS BANDAGETOTAL RUPTURE : ADULT= REPAIROLD : - IMMOBILIZATION - EXERCISEPARTIAL RUPTUR : IMMOBILIZATION - EXERCISE
COMPARTMENT SYNDROMES PRESSSURE IN OSTEOFASCIAL COMPARTMENT THAT CAUSES ELEVATION : VOLKMANNS ISCHAEMIC CONTRACTURE
Compartment Syndrome
CAUSES :DECREASED COMPARTMENT SPACE- TIGHTING FASCIAL SUTURED- BANDGAE/ CASTINGOVER EXTERNAL PRESSURE
ELEVATION OF COMPARTMENT CONTENT- BLEEDING- HYPERMEABILITY- INCREASED INTRA CAPILARY PRESSURE- MUSCLE HYPERTROPHY- NECROTIC SYNDROME
SIGNS: 4 PSPAINPALLORPARESE - PARALYSISPULSE LESS NESSIntracompartmental PRESSURE
Measurement of CS
THERAPY:Decompression 6 - 12 hoursRelease all bandage/ castingFasciotomy
Fat embolism syndromeLong Bone fractureACUTE RESPIRATORY DISTRESS SYNDROMES :- Breathless- Headache, DELIRIUM COMA- TACHYCARDIA B.P. - PETECHIAE- Chest XRAY : INFILTRAT : SNOW STORM APPEARANCE
Therapy :Balance electrolyteCorticosteroidLOW MOLECULAR WEIGHT DEXTRANSINTUBATION OR TRACHEOSTOMYMECHANICAL RESPIRATION SUPPORT