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DIAGNOSIS OF MUSKULOSKLETAL TRAUMA

DIAGNOSIS OF MUSKULOSKLETAL TRAUMA. Dwikora Novembri Utomo Lab/SMF Orthopaedi & Traumatologi FK Unair-RS dr Sutomo S U R A B A Y A. TIU.

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DIAGNOSIS OF MUSKULOSKLETAL TRAUMA

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  1. DIAGNOSIS OF MUSKULOSKLETAL TRAUMA Dwikora Novembri Utomo Lab/SMF Orthopaedi & Traumatologi FK Unair-RS dr Sutomo S U R A B A Y A

  2. TIU • PADA AKHIR MODUL PPGD INI,MAHASISWA FK SEMESTER 5 AKAN MAMPU MERENCANAKAN AWAL SECARA MANUAL MAUPUN MENGGUNAKAN ALAT, OBAT PADA KEGAWATDARURATAN TRAUMA MUSKULOSKLETAL SECARA TEPAT,CERMAT ,CEPAT, SEBELUM TINDAKAN DEFINITIF /SPESIALISTIK DILAKSANAKAN.

  3. TIK • MAMPU MELAKSANAKAN TATACARA PENANGANAN TRAUMA MUSKULOSKLETAL DENGAN CEPAT,CERMAT DAN CEPAT

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

  5. WHAT IS THE DIFFERENCE ?????

  6. Biomechanics of Fractures Pelvis VM Vm M m 2 E ( Energy Kinetic ) = ½ MV

  7. SOFT TISSUE INJURY : skin, subcutan fat,muscle, artery,venous, nerves etc • BONE INJURY : broken bones

  8. Definition • Emergency : • A situation that involves a potential disabling or life threatening condition. • Trauma : • A physical wound or injury to living tissue caused by an extrinsic agent • Fracture : discontinuity of cortex or cartilage • Dislocation : discontinuity of joint • luxation – subluxation • Multitrauma : emergency, life threatening more than one organ requiring immediate treatment intervention

  9. PRIMARY SURVEY The ABCDEs of muskuloskletal trauma care identify life threatening condition. • Airway maintenance w/ cervical spine protection • Breathing and ventilation • Circulation w/ hemorrhage control • Disability : neurological status • Exposure : completely undress but prevent hypothermia life threatening conditions are identified and simultaneous management is instituted

  10. SECONDARY SURVEY Done after the patient “stable” Head to toe ! Every orificiums/ every tubes!!

  11. Early Intervention on trauma/multitrauma patient (included MSK trauma problems) • A Airway and cervical spine protection, protec the cervical : inline imobilisation,collar brace ( head injury, • C Circulation w/ hemorrhage control (pelvic stabilisation • D Disability, neurological status(GCS), paraparese or paralysis…..spine fractures suspected…..inline imobilisation!!! • Exposure : deformity of extremity….imobilisation/splinting!!!

  12. Early Intervention on trauma/multitrauma patient (included MSK trauma problems)

  13. Early Intervention on trauma/multitrauma patient (included MSK trauma problems)

  14. The first step toward cure is to know what the disease is (latin proverb)

  15. Solving the mysteri of a diagnosis is the “detective work of medicine” (Sherlock Holmes)

  16. How to diagnose the muskuloskletal trauma problems? • CLINICAL HYSTORY(not for the multitrauma patients) • PHYSICAL EXAM : LOOK, FEEL, MOVE,MEASUREMENT • DIAGNOSTIC IMAGING

  17. MUSKULOSKLETAL TRAUMA PROBLEMS • FRACTURES : Closed, Open • DISLOCATIONS,FRACTURE-DISLOCATION • SOFT TISSUE INJURIES :tendon rupture,muscle rupture w/ or w/o neurovascular lesion.

  18. FRACTURES • Open fracture • Compound fracture Close fracture

  19. 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 !!

  20. FRACTURES

  21. FRACTURES

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

  23. LOOK • Deformity – Angulation - Rotation - DIscrepancy • Position • Edema • Appearance of the distal part • Pale • Darken

  24. LOOK

  25. FEEL • Crepitation • Temperature of the distal part • Pulse • Sensory

  26. FEEL (neurovasc exam)

  27. MOVE • Active • Passive • Power • False movement

  28. MEASUREMENT • MEASUREMENT- discrepancy • True length,Anatomical length • Appearance length

  29. CLINICAL DIAGNOSIS • “Patognomonis sign/definite sign” of fracture: deformity,false movement, • From Clinical History,Physical Exam ,the clinical diagnosis of fracture is established, • Investigation ( X RAY)…important for : “fracture configuration & planning of definitive treatment” , prognosis.

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

  31. INVESTIGATION (X –RAY)

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

  33. OPEN FRACTURES

  34. Grade I open fracture

  35. Grade II open fracture

  36. Grade III A open fracture

  37. GRADE IIIb open fract

  38. Grade III C open fracture

  39. AO Principles of Fracture Management, 2000, pp 671

  40. Gustilo, Burgess, Tscherne, the AO-ASIF group, recommended the following steps for open injuries: • Treat OF as emergencies • Initial evaluation to diagnose life & limb-threatening injuries • Appropriate antibiotic tx in the emergency OR and continue treatment for 2 to 3 days only • Immediately debride the wound of contaminated and devitalized tissue, copiously irrigate, repeat debridement within 24 to 72 hours • Stabilize the fracture with the method determined at initial evaluation • Leave the wound open • Rehabilitate the involved extremity aggressively

  41. Principles of Management • Prevention of infection • Soft tissue healing and bone union • Restoration of anatomy • Functional recovery AO Principles of Fracture Management, 2000,

  42. 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( can’t be replaced /prolonged GP by anykind of AB) • Copious lavage > 10 litres - decrease bacterial load

  43. ORTHOPAEDIC INFECTION:Diagnosis and treatment,1989 pp8

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

  45. 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

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

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