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8/10/2019 14.Muskulo trauma.pptx
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Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
PRINCIPLE OFFRACTURE AND
DISLOCATIONMANAGEMENT
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
T#$s presentat$on
General mana%ement or trauma Fracture de&n$t$on Fracture mana%ement
To stud" a p#enomenon o d$sease '$t#out (ooks $s to sa$l un
unc#arted sea) '#$le to stud" (ooks '$t#out pat$ents $s not to%o to sea at all S$r *$ll$am Osler
8/10/2019 14.Muskulo trauma.pptx
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MusculoskeletalTrauma
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Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
ATLS (Advanced Trauma Life
Support) : TheBeginning ..................................
....
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
TREAT PATIENT
AS A WHOLEHUMAN BEING
NOT PARTIALLY
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Initial Managemenet of
Trauma Patient
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
Primary Survey
Secondary Survey
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Concept of nitialAssessment
Pr$mar" Sur+e"
Resusc$tat$on
Ree+aluat$on
Deta$ledSecondar" Sur+e"
Ree+aluat$on
De&n$t$+e Care
Ad!uncts
Ad!uncts
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
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Initial Assessment &
Management of Trauma Patients
Primary survey and
resuscitation of vitalfunctions are done
simultaneouslyin a
team approach
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
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!rimar" Surve"
The priorities arethe same for allpatients
A A$r'a") '$t# C,sp$ne control
B -reat#$n%
C C$rculat$on) '$t# #emorr#a%e control
# D$sa($l$t"
$ E.posure / En+$ronmentMusculoskeletal module
General Concept of Musculoskeletal Injury
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Standard !recautions
Cap
Go'n
Glo+es
Mask
S#oe co+ers
Go%%les / ace s#$eld
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
AIR*A0 PRO-LEM 1
A$r'a"o(struct$on
Sol$d mater$al Flu$d Pos$t$on
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Air%a" Management
Orotrac#eal
$ntu(at$on
2a' t#rust
Cr$cot#"ro$otom"/trac#eostom"
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
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!rimar" Surve" &Breathing
Breathing pro'lems
3emot#oraks Pneumot#oraks Fla$l c#est 4lun% contus$on
Musculoskeletal moduleGeneral Concept of Musculoskeletal Injury
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!rimar" Surve"
Assess and ensure ade5uateo."%enat$on and +ent$lat$on
P$talls 1
A$r'a" +s +ent$lat$on pro(lem 1
Iatro%en$c pneumot#ora. or tens$onpneumot#ora.
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!rimar" Surve" &Breathing
Needlet#oracocentes$s
C#est tu(e$nsert$on
Musculoskeletal module
General Concept of Musculoskeletal Injury
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
CIRCULATION
3"po+olem$c s#ock
PULSE 6
-LOOD PRESURE7
DISORIENTATION CLAMM0 S8IN
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!rimar" Surve"
Control #emorr#a%eRestore +olume
Reassess parameters
Circulator"management
Musculoskeletal module
General Concept of Musculoskeletal Injury
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!rimar" Surve" &
CirculationControl 'leeding
D$rect pressure
Sur%$cal procedureascular access
Per$p#eral +e$ns
Central +e$n
9enous cutdo'n
Intra osseus $nus$on
Musculoskeletal module
General Concept of Musculoskeletal Injury
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!rimar" Surve"Circulation
ascular Access
Per$p#eral +e$n$nus$on
9enouscutdo'n
Intraoseus$nus$on
Musculoskeletal module
General Concept of Musculoskeletal Injury
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
MUSCULOSKELETAL PROBLEM I
PRIMAR! SUR"E!
1. PELVIC F!C"#E
$. FEM%!L F!C"#E
&. M#L"IPLE F!C"#E
A$r'a"
-reat#$n%
C$rculat$on
D$sa($l$t"
E.posure / En+$ronment
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hat is the secondar"surve" *
T#e complete
#$stor" andp#"s$cale.am$nat$on
3ead
Anter$or
Poster$or
:u$ckT$me; anda decompressor
areneededto seet#$s p$ctureat$on o racture s$tema" cause m$sal$%nment or deorm$t"
Inect$on) more common $n openractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
DISLOCATION
SEPARATIO
N OF T3E2OINT
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D$slocat$on / Su(lu.at$on
D$slocat$on B (ones $n a !o$nt(ecome d$splaced or m$sal$%ned
Su(lu.at$on B part$al d$slocat$on
Emergency condition
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D$slocat$on / Su(lu.at$on
D$slocat$on Su(lu.at$on
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+AT +A!!$7$# ,#SL8CAT87 8CC-$# *
ascular in6ur"
Soft tissueentrapment
7erve in6ur"
Associated %ithfracture
Ligament in6ur"
D$slocat$on =
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D$slocat$on =Su(lu.at$on
TreatmentIn$t$al treatmentImo($l$>at$on $n pos$t$on asound
De&n$t$+e treatment
Closed reduct$on) usuall" '$t#
GA
Open reduct$on) $ closed reda$l
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
OPEN FRACTURE
-ONE
EHPOSED TOOUTEREN9IRONMENT
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GUSTILLO & AN0ERSON 1 $2' 3
GRADE
*ound cm Usuall" $n,out 'ound S$mple racture M$ld,modreate
contam$nat$on
Grad$n% o open ractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GRADE ?
*ound J cm Per$osteal slee+ee.posed
No sot t$ssue
a+uls$on S#ort o(l$5ue racture Moderatecontam$nat$on
Grad$n% o open
ractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GRADE K A
Per$osteal str$pped
Sot t$ssue a+uls$on (utst$ll ade5uate co+era%e
Commun$t$+e racture Moderate #$%#
contam$nated
rad$n% o open ractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GRADE K -
Per$osteal str$pped and
no ade5uate sot t$ssueco+era%e t#at '$llre5u$re sur%$calco+era%e
Comm$nut$+e racture 3$%# contam$nated
rad$n% o open ractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GRADE K C
Open racture '$t# ma!orarter"d$srupt$on
Grad$n% o open ractures
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
3O* TO TREAT 11
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
COMPARTMENT S0NDROME
D$srupt$on od$stal
e.trem$t"peruss$oncause ("
$ncreas$n%$ntracompatm
ent pressure
Compartment
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CompartmentS"ndrome
An $ncreased pressure '$t#$n enclosed
osteoasc$al space t#at reduces cap$llar"peruss$on (elo' le+el necessar" or t$ssue+$a($l$t" t#e underl"$n% mec#an$sm $s B
$ncreased +olume '$t#$n space
decreased space or contents
com($nat$on o (ot#
#e3nition
8steofascial
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8steofascial
Compartment
Compartment
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Compartment
S"ndrome #iagnosis
3$stor"
Clinical examination : 5 Ps
Compartment pressure measurement
La(orator" B CP8) ur$ne m"o%lo($n
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Pa$n @ pass$+estrec#
Parestes$aPallor
PunessPle%$Pulseless
Compartment S"ndrome
Compartment S"ndrome
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Compartment S"ndromePressure measurement
*#$tes$de tec#n$5ue
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Intracompartme
ntPressure
TissuePerfusion
4enousstasis
e,ema
9$sc$ous c"cle
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
TREATMENT
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Fasc$otom"
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
FRACTURE OF UPPEREHTREMIT0
C ll
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Collesracture
0orsal
,is5la-ement
of ,istal
fragment
Meta5)6seal
area
St6loi, ulna
fra-ture
B CA
$%ns o Colles racture
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
A-
C
De&ned as
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
De&ned as B
Fracture t#rou%# t#e are outd$sal metap#"ses o rad$us)'$t# dorsall" d$splaced o
d$stal ra%ment ollo'ed '$t#st"lo$d ulna racture
A(ra#am Colles @ K QK
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Treatment
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Sm$t# Fracture
De&ned asre+erse colles
'$t# d$stalra%men o d$stalrad$usmetap#"s$s
d$splacedanter$orl"
FOREARM FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
FOREARM FRACTURE
Fracture od$ap#"s$s o
rad$us andulna
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Treatment
Closed
Open
GALEAI FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
GALEAI FRACTURE
FRACTURE
DISLOCATION
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
De&ned as B
Fracture o one t#$rd
rad$us d$ap#"s$sassoc$ated '$t#d$slocat$on o d$stalrad$oulnar !o$nt
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Treatment
Ind$cat$on or open
reduct$on and $nternal&.at$on cause (" #$%#rate o non un$on
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
Monte%%$a racture
DISLOCATION
FRACTUR
E
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
De&ned asFracture o one t#$rd
pro.$mal ulna d$ap#"s$sassoc$ated '$t# pro.$malrad$oulna d$slocat$on
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
TREATMENT
OPEN REDUCTION
AND INTERNALFIHATION INDICATEDFOR MONTEGGIA
FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
1
DISLOCATION OF T3E EL-O*
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
DISLOCATION OF T3E EL-O*
7 EMERGENC07 -E*ARE OF NER9E IN2UR0
7 -E*ARE OF 9ASCULARIN2UR0
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
C3EC8 PULSATION OF RADIALAND ULNAR ARTER0
IN CASE OF NO PULSATION B
ONE ATTEMP FORREALIGNMENT
IMMO-ILIED REFER AS SOON AS POSSI-LE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
3UMERAL
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
UFRACTURE
FACT IN 3UMERAL FRACTURE
V CASE 3EALED -0 NONOPERATI9E TREATMENT
MOST COMMON SITE FORMETASTASES AND PRODUCEDPAT3OLOGIC FRACTURE
MOST COMMON FRACTUREASSOCIATED *IT3 NER9E IN2UR0
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
S3OULDER DISLOCATION
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
TREATMENT
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
TREATMENT
REDUCTION MET3OD
3IPPOCRATES
8OC3ER STIMSON
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
FRACTURE OF LO*ER
EHTREMIT0
3IP DISLOCATION
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
3IP DISLOCATION
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
T0PE OF 3IP DISLOCATION RELATED
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
T0PE OF 3IP DISLOCATION RELATEDOF POSITION OF FEMORAL 3EAD TO
T3E ACETA-ULUM
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
FEMORAL FRACTURE
< Pro.$mal part a< Intertrac#anter (< Su(trcoc#anter
. D$ap#"seal racture
a< /K pro.$mal (< /K m$ddle c< /K d$stal
. D$stal part
a< Cond"lar (< Supracond"lar c< Intercond"lar
,emoral fracture
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treatment
/kintraction
Elastic nailIM nail
Lockin-
plate
'emispica
8 d$ l t$
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
8nee d$slocat$on
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
TI-IA PLATEAU
FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
AN8LE FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
AN8LE FRACTURE
PEDIATRIC FRACTURE
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
PEDIATRIC FRACTURE
NOT ASMALL
ADULT
*3AT MA8E DIFFERENT 11
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Musculoskeletal module
General Concept o Musculoskeletal In!ur"
< Fractures more common
?< Stron%er and more act$+eper$osteum
K< More rap$d racture #eal$n%Q< Spec$als pro(lem o d$a%nos$s
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
I "ou do not kno' '#at"ou do not kno') $tWs t#e
end o learn$n%
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Musculoskeletal moduleGeneral Concept o Musculoskeletal In!ur"
1
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T#ank 0ou
DankeAr$%ato
Grac$asMaturnu'un