14.Muskulo trauma.pptx

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


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MusculoskeletalTrauma


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ATLS (Advanced Trauma Life

Support) : TheBeginning ..................................

....


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TREAT PATIENT

AS A WHOLEHUMAN BEING

NOT PARTIALLY


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Initial Managemenet of

Trauma Patient


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



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Initial Assessment &

Management of Trauma Patients

Primary survey and

resuscitation of vitalfunctions are done

simultaneouslyin a

team approach



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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



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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"



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!rimar" Surve" &Breathing

Breathing pro'lems

3emot#oraks Pneumot#oraks Fla$l c#est 4lun% contus$on



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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



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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




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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




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!rimar" Surve"Circulation

ascular Access

Per$p#eral +e$n$nus$on

9enouscutdo'n

Intraoseus$nus$on




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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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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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OPEN FRACTURE

-ONE

EHPOSED TOOUTEREN9IRONMENT


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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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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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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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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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GRADE K C

Open racture '$t# ma!orarter"d$srupt$on

Grad$n% o open ractures


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3O* TO TREAT 11


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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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Pa$n @ pass$+estrec#

Parestes$aPallor

PunessPle%$Pulseless

Compartment S"ndrome

Compartment S"ndrome


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Compartment S"ndromePressure measurement

*#$tes$de tec#n$5ue


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Intracompartme

ntPressure

TissuePerfusion

4enousstasis

e,ema

9$sc$ous c"cle


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TREATMENT


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Fasc$otom"


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FRACTURE OF UPPEREHTREMIT0

C ll


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Collesracture

0orsal

,is5la-ement

of ,istal

fragment

Meta5)6seal

area

St6loi, ulna

fra-ture

B CA

$%ns o Colles racture


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A-

C

De&ned as


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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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Treatment


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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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FOREARM FRACTURE

Fracture od$ap#"s$s o

rad$us andulna


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Treatment

Closed

Open

GALEAI FRACTURE


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GALEAI FRACTURE

FRACTURE

DISLOCATION


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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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Treatment

Ind$cat$on or open

reduct$on and $nternal&.at$on cause (" #$%#rate o non un$on


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Monte%%$a racture

DISLOCATION

FRACTUR

E


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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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TREATMENT

OPEN REDUCTION

AND INTERNALFIHATION INDICATEDFOR MONTEGGIA

FRACTURE


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1

DISLOCATION OF T3E EL-O*


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DISLOCATION OF T3E EL-O*

7 EMERGENC07 -E*ARE OF NER9E IN2UR0

7 -E*ARE OF 9ASCULARIN2UR0


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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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3UMERAL


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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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S3OULDER DISLOCATION


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TREATMENT


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TREATMENT

REDUCTION MET3OD

3IPPOCRATES

8OC3ER STIMSON


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FRACTURE OF LO*ER

EHTREMIT0

3IP DISLOCATION


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3IP DISLOCATION


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T0PE OF 3IP DISLOCATION RELATED


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T0PE OF 3IP DISLOCATION RELATEDOF POSITION OF FEMORAL 3EAD TO

T3E ACETA-ULUM


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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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8nee d$slocat$on


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TI-IA PLATEAU

FRACTURE


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AN8LE FRACTURE


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AN8LE FRACTURE

PEDIATRIC FRACTURE


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PEDIATRIC FRACTURE

NOT ASMALL

ADULT

*3AT MA8E DIFFERENT 11


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< 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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I "ou do not kno' '#at"ou do not kno') $tWs t#e

end o learn$n%


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1


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T#ank 0ou

DankeAr$%ato

Grac$asMaturnu'un

14.Muskulo trauma.pptx

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