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