1. “ BASIC PRINCIPLES OF
MUSCULOSKELETAL
TRAUMA MANAGEMENT“
HERMANSYAH, MD

2. TRAUMA
A.
HARD TISSUE:
 BONE/SKELETON
 FRACTURE
B. SOFT TISSUE:
 LIGAMENT
 MUSCLE
 TENDON

3. PRINCIPLES

FIRSTLY DO NO HARM

COOPERATE WITH THE “LAWS OF NATURE”

4. FRACTURE
A.
OPERATIVE :
- OPEN REDUCTION
- INTERNAL FIXATION: RIGID/STABLE
B. CONSERVATIVE:
- “FUNCTIONAL FRACTURE BRACING
SYSTEM”
- EXTERNAL FIXATOR
- TRACTION

7. FUNCTIONAL FRACTURE
BRACING SYSTEMS

EARLY MOBILISATION AND WEIGHT-BEARING”

CONCEPT “FITTING PROSTHESIS”

TIBIA : “PATELLAR TENDON BEARING”

FEMUR : “QUADRILATERAL ISCHIAL-BEARING”

9. SOFT TISSUE TRAUMA
LIGAMENT AND JOINT CAPSULE
– PARTIAL TEAR:
 PARTIAL LIGAMENT
 STABLE JOINT
– COMPLETE TEAR:



COMPLETE LIGAMENT
UNSTABLE JOINT
DISLOCATION
– BLEEDING

10. DIAGNOSTIC :

BLEEDING: EDEMA, PAIN, BRUISING

PAIN IN MOVEMENT

HAEMARTHROSIS

JOINT STABLE OR UNSTABLE

11. THERAPY

ACUTE :
–
–
–
–
REST
ICE COMPRESS
ELASTIC BANDAGE
ELEVATION

EXAMINATION OF
JOINT STABILIZATION:
– STABLE : STRAPPING
– UNSTABLE:
 IMMOBILIZATION /
STRAPPING
 OPERATIVE

12. DISLOCATION
EARLY REDUCTION TO PREVENT:
 AVASCULAR/ ASEPTIC NECROTIC
 RECURRENT DISLOCATION
 REDUCE OPERATIVE

13. HIP DISLOCATION

POSTERIOR:
-

FLEXION
ADDUCTION
INTERNAL ROTATION
REDUCTION:



STIMSON
ALLIS
BIGELOW

14. Stimson Methode

15. Allis Method

16. Bigelow Method

17. Shoulder Dislocation

ANTERIOR :
 DELTOID FLAT
 SUPPORTED ARM WITH OTHER HAND

REDUCTION:
 STIMSON
 HIPOCRATES
 KOCHER

18. Hipocrates

19. Stimson

20. Traction and counter traction

21. ELBOW DISLOCATION
 POSTERIOR
-
:
OLECRANON
PROMINENCE
-
PARTIAL FLEXION

22.  Reduction:
 TRACTION
 PUSH
 FLEXION

23. MUSCLE INJURY: STRAINS

DIRECT TRAUMA (IMPACT) :
“ COMPRESSION RUPTURES”

INDIRECT TRAUMA (OVERLOADING, OVER
STRECHING)
 “ DISTRACTION RUPTURES”

24. RUPTURE SITE:




ORIGO
MUSCLE BELLY
MUSCLE – TENDON JUNCTION
INSERTION
RUPTURE TYPE:


PARTIAL
TOTALY

25. DIAGNOSTIC:
•
“ A SHARP OR STABBING PAIN”
•
DEFECT AT MUSCLE
•
“ LUMP “
•
PAIN AND EDEMA
•
“ BRUISING “ AND “ MUSCLE SPASM “

26. TRAUMA IMPACT:
MUSCULAR HAEMATOMA
INTRA MUSCULAR HAEMATOMA
“ACUTE COMPARTMENT SYNDROMES“


INTER MUSCULAR HAEMATOMA

27. THERAPY: STOP BLEEDING

REST

ICE PACK

ELASTIC BANDAGE

ELEVATION EXTREMITY

PREVENT LOADING

FASCIOTOMY

28. PARTIAL RUPTURE:
•
•
•
•
EALSTIC BANDAGE
ATER 72 HOURS: HOT PACK
ACTIVE MUSCLES EXERCISES
REPAIRE
TOTAL RUPTURE :

29. TENDON INJURY
FREQUENTLY:
– ACHILLES
– BICEPS
– QUADRICEPS
RUPTURE :
– PARTIAL
– TOTALY

30. DIAGNOSTIC:

“ SUDDEN SNAP” + PAIN

HAEMATOM + EDEMA

UNABLE TO MOVE THE JOINT

DEFCT

“ LUMP”

THOMSON/SQUEEZ TEST

31. THERAPY:

ACUTE :
-
REST
- COOLING
- ELASTIS BANDAGE

TOTAL RUPTURE :
ADULT= REPAIR
OLD
: - IMMOBILIZATION
- EXERCISE

PARTIAL RUPTUR :
- IMMOBILIZATION
- EXERCISE

32. COMPARTMENT SYNDROME

33. COMPARTMENT SYNDROMES

34. CAUSES:

DECREASE COMPARTMENT SPACE
– TIGHTING FASCIAL SUTURED
– BANDAGE/ CASTING
– OVER EXTERNAL PRESSURE

ELEVATION OF COMPARTMENT CONTENT
– BLEEDING
– HYPERMEABILITY
– INCREASE INTRA CAPILARY PRESSURE
– MUSCLE HYPERTROPHY
– NECROTIC SINDROME

35. SIGNS: 4 P’S

PAIN

PALLOR

PARESIS - PARALYSIS

PULSELESSNESS

Intra-compartmental PRESSURE

37. THERAPY:

Decompression 6 - 12 jam

Release all bandage/ casting

Fasciotomy

38. Fat embolism syndrome

LONG BONE FRACTURE

ACUTE RESPIRATORY DISTRESS
SYNDROMES:
 Breathless
 Headache, – DELIRIUM – COMA
 TACHICARDIA – B.P.
 PETECHIAE
 Chest XRAY: “SNOW STORM APPEARANCE”

39. Therapy:

Balance electrolyte

Corticosteroid

LOW MOLECULAR WEIGHT
DEXTRANS

INTUBATION OR TRACHEOSTOMY

MECHANICAL RESPIRATION
SUPPORT