Emergency In Orthopaedic

Dr. Primadika Rubiansyah,

SpOT
 Emergency in
Orthopaedic
Emergency : trauma cases
- Life threatening
- Limb treatening
85 % of blunt trauma affect
musculoskeletal system
Resuscitation priority is like
another trauma
Life saving before limb
saving
Life before
Limb
 Primary Survey &
Resuscitation

Bleeding control direct padding

Splinting bleeding
Fluid resuscitation

BE AWARE OF REPERFUSION INJURY !

Adjunction in Primary Survey

Fracture immobilization
Traction anatomical position
Splint
Be careful in dislocation !

X-Ray
Secondary survey
Primary survey
 Secondary Survey
History
AMPLE

From Head to toe examination

Every orifice must be examined
Dont forget the back!
 Secondary Survey
Physical Examination

Undress the patient

Component have to be examined :
1. Skin
2. Neuromuscular function
3. Circulatory state
4. Bone & ligament integrity
 Secondary Survey

Physical Examination
Look
Feel
Move

X-Ray
Rule of 2
 Life Threatening
Musculoskeletal Trauma

Pelvic Trauma with Massive Bleeding

 Pelvic
Wrapping
 Life Threatening
Musculoskeletal Trauma

Main Arterial Rupture

1. Trauma
- sharp, blunt
2 Examination
- Artery pulse, Doppler
- Ankle / brachial index
3. Management
- Pneumatic tourniquet
- Vascular clamp?
- Traction, Splint
 Life Threatening
Musculoskeletal Trauma

Crush Syndrome
1. Trauma
- Crush injury & long compression ;
thigh, leg
2. Examination
- Dark Urine
- Rabdomiolisis hipovolemic,
metabolic acidosis, hipercalemia,
hipocalsemia & DIC
3. Management
- Fluid resuscitation & osmotic diuretic
- Alkalinization
 Life Threatening
Musculoskeletal Trauma

Open Fractures

Initial management
Multiple injuries & severe shock
Wound should be covered
Tetanus prophylaxis
 Life Threatening
Musculoskeletal Trauma

Open Fractures

Classifying the injury

Gustilos classification (Gustilo et al,
1990)
Open Fracture grade 1
Open Fracture grade 2
Open Fracture grade 3A
Open Fracture grade 3B
Open Fracture
grade 3C
 Life Threatening
Musculoskeletal Trauma

Open Fractures

Principles of treatment
Objectives :
- Prevention of infection
(sepsis/osteomyelitis)
- Promote bone healing
- Restoration of function
 Life Threatening
Musculoskeletal Trauma

Open Fractures

Principles of treatment
4 essentials are :
1. Wound irrigation & debridement
2. Antibiotic prophylaxis
3. Stabilization of the fractures
4. Early wound coverage
 Open Fracture

Complicated case

Not proper initial management

 Limb Threatening
Musculoskeletal Trauma

Vascular Trauma & Traumatic Amputation

History & Examination

Vascular Insufficiency
Capillary refill
Ankle / brachial index
Limb Threatening Musculoskeletal Trauma
Vascular Trauma & Traumatic Amputation
Limb Threatening Musculoskeletal Trauma
Vascular Trauma & Traumatic Amputation

Management
Muscle necrosis : 6 h
Warm & Cold
Ischemic
Reimplatantation &
Revascularization
Proper amputee
management!
 Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome

Fractures of the arm or leg ischemia

Infarcted muscles fibrous tissue
(Volkmanns ischemic contracture)
 Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome

Clinical features
Elbow, forearm bones,
1/3 prox. of tibiae,
multiple fractures of the
foot or hand, crush
injuries &
circumferential burns
Five Ps
The presence of a pulse
does not exclude the
diagnosis
 Limb Threatening
Musculoskeletal Trauma
Compartement Syndrome

Treatment
Decompression
Open fasciotomi
 Limb Threatening
Musculoskeletal Trauma

Dislocations

Displacement of bone from normal joint

Location : hip, shoulder, elbow, finger,

patella, knee, ankle, acromioclavicular

Sign : loss of normal shape &

loss of movement
Posterior Hip Dislocation
 Limb Threatening
Musculoskeletal Trauma

Massive skin avulsion

Abdominal flap
following skin avulsion
of the hand
Limb Threatening Musculoskeletal Trauma
Massive skin avulsion
Kelirumologi in Fracture
Management (Neglected )