Penanganan Trauma Muskuloskeletal

dan Imobilisasi

Yudha Mathan Sakti

Orthopaedi & Traumatologi
FK UGM / RS DR Sardjito
Jogjakarta
What should we do ??
B = Breathing D =dissability

A
= Airway

C =circulation
 Do the ATLS Procedure

Musculoskeletal trauma
A : Airway C Spine control
B
C
: Breathing
?? +
: Circulation
Oxigenation
Control bleeding
D : Dissability
E : Environment
and exposure
 Examples :

Re Check the B and C !!

A = Airway
A = Airway + C spine control
 B = Breathing + oxigenation
Assess the thoracal
condition !!
Inspection:
Jejas, luka terbuka, Ketinggalan
gerak, flail movement

Palpation :
Vokal fremitus, asimetris?

Percussion :
Sonor ?, dullness

Auscultation :
Vesicular, asimetris ?
 C = Circulation + Control bleeding

Management :
Systemic, local and observation
 simultaneously
 D = Dissability

VS
AVPU system ?

E = Exposure and environment

Expose all body part but still prevent
hypothermia
 ???
Betul / tidak
 Do the ATLS Procedure

A : Airway C Spine control

B
C
: Breathing
+
: Circulation
Oxigenation
Control bleeding
D : Dissability
E : Environment
and exposure

Musculoskeletal trauma ??
Management of musculoskeletal trauma

 Skeletalsystem
provides support and
form
 Also provides some
protection to vital
organs against injury

 Precipitates movement
 Muscles would not be
able to perform without
skeletal support &
connection
 Types of musculoskeletal injury
 Fracture
 Loss of bone discontinuity

 Dislocation
 Disruption of a joint

 Sprain
 Joint injury with tearing of ligaments

 Strain
 Stretching or tearing of a muscle
 Types of musculoskeletal injury

Hard tissue injury Soft tissue injury

Tulang / Bukan Tulang
Hubungan antar tulang
- Kutis
- Sub kutis
- Lemak
- Tendon (urat)
- Ligamen
- STRUKTUR
NEUROVASKULER
 How to DIAGNOSE

Diagnosis cedera
musculoskeletal Anamnesis

Pemeriksaan Fisik

Penunjang (X ray)

Identifikasi DIAGNOSIS dan PENYULIT

 How to DIAGNOSE
(Pemeriksaan Fisik)

Diagnosis cedera - Deformitas

musculoskeletal - Swelling
- Shortening (pemendekan)
- Luka terbuka
(keterlibatan tendon?)
Look

Feel

Move
 How to DIAGNOSE
(Pemeriksaan Fisik)

- Tenderness
Diagnosis cedera - Krepitasi
musculoskeletal - False movement
- NEUROVASKULER
disturbance (NVD) !!!

Look

Feel

Move
 How to DIAGNOSE
(Pemeriksaan Fisik)

Diagnosis cedera
musculoskeletal

Look
- Pastikan pergerakan
sendi proksimal dan distal
Feel lokasi cedera
.....

Move  Keterlibatan bagian lain

 How to DIAGNOSE
(Pemeriksaan Penunjang)

Pemeriksaan
radiologis
Two Joint = 2 sendi

Two view = 2 posisi

Rule of 2
Two side = 2 sisi

Two ocassion = 2 waktu

Fracture Types
 Kominutif Transversal

Spiral Oblique Transverse

?
 Fracture management

 Perawatan darurat Imobilisasi dan splinting

Pencegahan kerusakan jaringan
Penanganan definitif

 lunak sekitar fraktur
 Mengurangi nyeri
 Rehabilitasi
 Mengurangi risiko emboli lemak
dan syok
 Memudahkan transportasi pasien
 Splinting Principles
 Remove clothing from the area.
 NVD status ??
 Cover all wounds with a dry, sterile
dressing.
 Immobilize the joints above and below
the injured joint.
 Pad all bony prominences.
 When in doubt, splint.
General Splinting Principles
 Immobilize all suspected spinal injuries
in a neutral in-line position.
 Ifthe patient has signs of shock, align
limb in normal anatomic position and
transport.
Hazards of Improper Splinting
 Compression of nerves, tissues,
and blood vessels
 Delay in transport of a patient
with a life-threatening condition
 Reduction of distal circulation
 Aggravation of the injury
 Injury to tissue, nerves, blood
vessels, or muscle
 Upper
extremity
injury

Lower
extremity
injury
Upper extremity injury
Velpeau bandage / arm to body bandage
Posisi !!!!
Volkman contracture
Galleazzi fracture

Montegia fracture
 Shahnaz, F, 20 yo
Close fracture of shaft of the right 2nd metacarpal
(OTA 77-A2.2)
 ?
? ?
Lower extremity injury
Di splint bisa / tidak ya ??
 Sumarjo, M, 41 yo
Open comminutive fracture of middle third of the right femur due to gun
shoot with foreign body (Bullet) at lateral region of the right knee joint
(OTA 32-C1.1)
Post TEST !!!
 Radiyo, M, 81 y.o.
Close fracture of intertrochanter of the right femur (31-A2)
HHD, Hypertension stage II, Hematuria
 Sudjiatmi, F, 55 yo
Close right Galeazzi fracture (OTA 22-A2.3)
 Nadya E, Girl, 16 yo
Open fracture of distal third of the left ulna Grade II (OTA 22-A3.2)
Open fracture of middle third of the left radius Grade II (OTA 22-A3.2)
 Nadya E, Girl, 16 yo
Open fracture of distal third of the left ulna Grade II (OTA 22-A3.2)
Open fracture of middle third of the left radius Grade II (OTA 22-A3.2)
Thank You ^-^