Musculoskeletal trauma lecture

MUSCULOSKELET

AL TRAUMA

OVERVIEW

Fractures

Dislocations

Soft tissue injury

FRACTURES

What?

Disruption in normal

continuity of bone

Also involve surrounding

structures

Pathophysiology

d/t mechanical overload

More stress than bone can absorb

Pathophysiology

Force provides the stress:

Direct force – eg. MVA

Indirect force – eg. Epilepsy

Quality of bone effects

fracture susceptibility

Pathophysiology

Displacement in

fracture – d/t

different muscle pull

Pathophysiology

Haematom

a

Fibrocartilage

formation

Soft callus

formation

Ossification

Consolidation

FRACTURE

HEALING

Manifestations, assessment &

diagnosis

History :

usually trauma

- MVA

- fall

Manifestations, assessment &

diagnosis

Physical

examination:

• tenderness

• swelling

• deformity

• shock

• neurovascular

involvement

Manifestations, assessment &

diagnosis

Radiographs – rule of 2

• 2 views – AP/lat

• 2 joints – above and below

Look for:

• Disrupted bone

• Disrupted joint

Manifestations, assessment &

diagnosis

Diagnosis is obvious esp. with h/o MVA or fall

Fracture classification extensive:

e.g: Open fracture (Gustilo))Grade I – wound <1cm, minimal

contamination

Grade II – wound >1cm, moderate contmination

Grade III – wound >1cm with extensive soft tissue damage and high degree contamination

Clinical management

Thorough initial management

Reduction and stabilization of fracture

Monitoring of complications

Remobilization and rehabilitation

Thorough assessment

RESCU

ER (at

site)

ABC’s

‘life before

limb’

Cervical

collar

Splinting

Soft tissue assessment

Wounds – cover (sterile

gauze)

Vessel damage:

compress /

tourniquet

Thorough assessment

A&E

Monitor for

hypovolaemic

shock

Detail on mech of injury

Open fractures:

• Irrigate

• ATT

• antibiotics

Keep pt NBM

Reduction & stabilization

AIM:

Restore alignment

Restore position

Restore length

HOW?

Closed manipulative reduction (CMR)

Open reduction and internal fixation (ORIF)

External fixation (ext-fix)

Traction

Reduction & stabilization - CMR

Maneuvers performed to reduce fracture witout

opening skin

A – traction

B – disengage

C – realignment

D – release traction

Reduction & stabilization - CMR

Reduction held with cast

Plaster of Paris (POP) Fibreglass cast

Reduction & stabilization - ORIF

Performed by surgeon

Fracture site opened and reduced under direct

visualisation

Fracture held with implants

Reduction & stabilization – ext-

fix

Maintain alignment by external pin and bars

To enable proper wound management

Most in open fractures

Reduction & stabilization -

traction

Application of pulling force to a body part with a countertraction in opposite direction

Mainly for temporary immobilization before definitive surgery

Types: skin traction, skeletal traction

to look out for….

Complications

Compartment syndrome

Pressure within fascial compartment high

Features:

Severe pain not resolved with normal meds

Tense swelling – may have blisters

spO2 drop, pale, pulseless

Treatment - fasciotomy

Fat embolism syndrome

Fracture forces marrow fat into circulation

Causes clinical syndrome

Features

Altered sensorium (GCS drop)

SOB / drop spO2

Petechia

Treatment – supportive

high flow O2

fluids

Deep vein thrombosis (DVT)

When thrombus forms in deep veins of the leg

May lead to pulmonary embolism – DEATH

Features:

Calf tenderness

Leg swelling

Treatment – mainly prevention

Compression stockings

Anti-coagulants

DISLOCATIONS

Pathophysiology

Occurs when the normal joint articulation is

disrupted

Usually due to trauma / sports injury

Assessment

Similar to fractures

DEFORMITY – most prominent feature

Most important feature to assess –

VASCULARITY

Common dislocations:

Shoulder

Hip

Clinical management

Main – reduction by CMR (under sedation /

GA)

Considered an orthopaedic emergency

If late may compromise joint circulation

SOFT TISSUE INJURIES

Strains

Trauma to the muscle body or tendinosus part

Can lead to tear or micro tears

Manifests as muscle spasm and reduced ROM

Management:

Mainly rest

RICE therapy

Sprains

Injury to the ligaments – at body or insertion

Common site – ankle

Management:

RICE therapy

Immobilisation

If severe – surgical repair

Questions?

THANK YOU…