MUSCULOSKELETAL TRAUMA

Dr. M. Ruksal Saleh, Ph.D., Sp.OT

Bagian Ortopedi & Traumatologi
Fakultas Kedokteran Universitas Hasanuddin
Makasasar, 2006

Introduction
Millions of cases annually.
Multiple MOI :
Falls, Automobile collisions, Crashes,
Violence, etc
Multi-system trauma

Rarely life threatening

Improperly treated can result permanent
disability.

Anatomy & Physiology of the

Musculoskeletal System

Structures

Skin
Bones
Joints where bones interact
Muscles
Tendons - connect muscle to bone
Ligaments - connect bone to bone
Neurovascular

The Skeleton

Types of Muscles

The Neurovascular

Function
Protects organs
Allows for efficient movement
Stores salts and other materials needed
for metabolism
Produces RBCis
Scaffolding / Support

Pathophysiology of the
Musculoskeletal System

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:
Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
Dislocation - displacement or separation of a bone from its
normal position at the joint.
Fracture - a break or disruption in bone
closed - the broken bones do not penetrate the skin
open - the skin is pierced by broken bone fragments

Musculoskeletal Injury Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

Musculoskeletal Assessment
Perform initial (primary) assessment
Locate, treat life-threats
Assess for injuries of head, chest,
abdomen, pelvis
Assess distal neurovascular function

Musculoskeletal Assessment
With exception of pelvic, possibly femur
fractures, orthopedic injuries are NOT lifethreatening.
Do NOT let spectacular orthopedic injury
distract you from ABCs
Its the unobvious things that kill patients!

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

Musculoskeletal Assessment
Evaluation must ALWAYS be done of distal
neurovascular function.

Pulse
Skin color
Capillary refill
Sensation
Movement

 Scene Size-up
Initial Assessment
Focused history and physical exam
Rapid Trauma Assessment

Detailed Physical Exam

Ongoing Assessment

Common Signals of Musculoskeletal Injury :

Pain
Swelling
Deformity
Discoloration of the skin (bruising)
Inability to use the affected part normally
Loss of sensation in the affected part.

Musculoskeletal Injury Management

General Principles
Protecting Open Wounds
Positioning the limb
Immobilizing the injury
Checking Neurovascular Function

Management
Immobilization Objectives
Prevent further damage to nerves/blood
vessels
Decrease bleeding, edema
Avoid creating an open Fx
Decrease pain
Early immobilization of long bone fractures
critical in preventing fat embolism

Management
When in doubt

SPLINT
It is difficult to differentiate fractures,
dislocations and sprains

Principles of Splinting
Do NOT move patients before splinting
unless patient is in danger
Remove clothes to allow inspection of limb
Note, record distal neurovascular function
before, after splinting

Principles of Splinting
Cover wounds with dry, sterile compression
dressings
Fractures: splint joint above, below fracture
Dislocations: splint bone above, below joint

Principles of Splinting
Minimize movement
Support injury until splinting
completed
Pad splint to avoid local pressure

Principles of Splinting
Angulated fractures
Realign before splinting
If resistance, pain encountered stop,
immobilize as is

Dislocations
Splint as is unless circulation compromised
Attempt to reposition once to restore pulse
If resistance, pain encountered stop,
immobilize as is

Guideline of immobilizing a long bone

Immobilizing a joint

Traumatic Amputation
First priority - ABCs
Bleeding from stump usually not a problem

Next priority is to save limb

Traumatic Amputation
Management
Control Bleeding
Elevate
Apply direct pressure to stump
Avoid tourniquet except as last resort

Traumatic Amputation - Limb

Management
Place in saline moist gauze
Place in plastic bag
Place bag on ice
Do not
Warm amputated part
Place part in water
Place directly on ice
Use dry ice

 Transportation from the site of injury replantation centre

Tissue

Gauze

Crush ice

Vinyl

Even a severely mangled extremity

Four months post-op

One years post-op

Preoperative

Debridement + necrotomy

Identification of artery, veins,

nerves & tendons

Bone Fixation

Repair ulnar artery

Repair of extensor tendons

Repair of flexor tendons

7 weeks post operation

Summary
Musculoskeletal system extends into all
parts of the body
Musculoskeletal trauma usually not life
threatening
Proper recognition and treatment is very
important to avoid permanent disability

Thank You