DIAGNOSIS OF

MUSKULOSKLETAL TRAUMA

POKOK BAHASAN
1.
2.

DIAGNOSA TRAUMA MUSKULOSKLETAL

JENIS TRAUMA MUSKULOSKLETAL
a. TRAUMA MSK SEDERHANA
b. TRAUMA MSK MENGANCAM JIWA
c. TRAUMA MSK YG MENGANCAM
EKSTREMITAS
3. PERTOLONGAN BEDAH AWAL PADA TRAUMA MSK
4. HAL HAL YANG MEMPERBURUK PROGNOSIS
5. INDIKASI KONSULTASI

Biomechanics of Fractures

Pelvis

Vm
m

E ( Energy Kinetic ) =

VM
2

 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
PROBLEMS
FRACTURES : Closed, Open

DISLOCATIONS,FRACTURE-DISLOCATION

SOFT TISSUE INJURIES :tendon

rupture,muscle rupture w/ or w/o neurovascular
lesion.

FRACTURES

Close fracture

Open fracture
Compound fracture

FRACTURES
FRACTURES 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

DIAGNOSIS
CLINICAL HISTORY (Not for multitrauma pts)
*WHEN (time) : golden periode
*HOW ..MOI (Mechanism of injury : Low velocity/High
velocity trauma/trivial) !!!

LOOK
Deformity Angulation
- Rotation
- DIscrepancy
Position
Edema
Appearance of the
distal part
Pale
Darken

LOOK

 FEEL
Crepitation
Temperature of the distal part
Pulse
Sensory

FEEL (neurovasc exam)

MOVE
Active
Passive
Power
False
movement

MEASUREMENT
MEASUREMENTdiscrepancy
True
length,Anatomical
length
Appearance length

INVESTIGATION
X-ray (Immobilization first)
2 VIEWS (AP-lateral)
2 JOINTS (proximal & distal)
2 SIDES (IF Necessary)
Special order

INVESTIGATION (X RAY)

OPEN FRACTURES
fracture

Open
communication
between the fracture
and
the
external
environment
30% pts with OF are
polytrauma patients.
Require emergency
treatment
Significant morbidity

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 Management
Prevention of infection
Soft tissue healing and bone
union
Restoration of anatomy
Functional recovery

AO Principles of Fracture Management, 2000,

Prevention of infection
Soft tissue healing and bone union
Restoration of anatomy
Functional recovery
Golden 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 grow
Assess contamination - appropriate antibiotics
Radical 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

Debridement
Radical
Wound extended
adequately for visual
Decompress tight
compartments
Copious lavage

Prevention of infection
Soft tissue healing and bone union
Restoration of anatomy
Functional recovery
Avoid further soft tissue damage
reduce and splint fractures
Zones of Injury - Repeated
Debridement
Gentle handling
Bony stability
Early coverage < 1 week
Delay closure

Prevention of infection
Soft tissue healing and bone union
Restoration of anatomy
Functional recovery

Prevention of infection
Soft tissue healing and bone union
Restoration of anatomy
Functional recovery

FRACTURES OF THE SPINE

Cervical Dislocation

Thorax 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
TRAUMA
1.DAMAGED OF NERVE OR
SPINAL CORD
2. DAMAGED OF THE
VASCULAR

COMPARTEMENT SYNDROME
Compression of nerve & bloodvessels
Within enclosed anatomic space
(osteofacial)
Leading to impaired bloodflow

Sign & Symptoms

Classic signs 5 P
Pain
Severe extremity pain out of proportion to
injury
Early sign, worse with passively stretching
involved muscle

 Paresthesia or anesthesia to light touch

Paralysis
Pulselessness
Not 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 Hospital
Control :

Airway
Circulation
Immobilization
Transportation