MUSCULOSKELETAL TRAUMA

ADRIANSYAH AMRI
TREE OF ANDRY NICOLAS ANDRE
 Introduction
 Millions of cases annually.
 Multiple MOI :
 Falls, Automobile collisions, Crashes,
Violence, etc
 Multi-system trauma
 Rarely life threatening
 Improperly treated can result permanent
disability.
Anatomy & Physiology of the
Musculoskeletal System
Structures
 Skin
 Bones
 Joints – where bones interact
 Muscles
 Tendons - connect muscle to bone
 Ligaments - connect bone to bone
 Neurovascular
The Skeleton
Types of Muscles
The Neurovascular
Function
 Protects organs
 Allows for efficient movement
 Stores salts and other materials needed
for metabolism
 Produces RBCis
 Scaffolding / Support
Pathophysiology of the
Musculoskeletal System
Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:

 Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
 Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
 Dislocation - displacement or separation of a bone from its
normal position at the joint.
 Fracture - a break or disruption in bone
 closed - the broken bones do not penetrate the skin
 open - the skin is pierced by broken bone fragments
Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:

 Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
 Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
 Dislocation - displacement or separation of a bone from its
normal position at the joint.
 Fracture - a discontinuity of the bone, partial or total
 closed - the broken bones do not penetrate the skin
 open - the skin is pierced by broken bone fragments
Injuries to the Musculoskeletal System

Four basic types of musculoskeletal injuries are:

 Strain - An extreme stretching or tearing of MUSCLE & /
OR TENDON.
 Sprain - partial or complete tearing of LIGAMENTS and
tissues at the joint.
 Dislocation - displacement or separation of a bone from its
normal position at the joint.
 Fracture - a discontinuty of the bone , partial or total
 closed - the broken bones do not penetrate the skin
 open - the skin is pierced by broken bone fragments
Musculoskeletal Injury Assessment
Scene Survey
Initial Assessment
Focused history and physical exam
 Rapid Trauma Assessment
Detailed Physical Exam
Ongoing Assessment
Scene Size-up
Initial Assessment
Focused history and physical exam
 Rapid Trauma Assessment
Detailed Physical Exam
Ongoing Assessment
Scene Size-up
Initial Assessment
Focused history and physical exam
 Rapid Trauma Assessment
Detailed Physical Exam
Ongoing Assessment
Scene Size-up
Initial Assessment
Focused history and physical exam
 Rapid Trauma Assessment
Detailed Physical Exam
Ongoing Assessment
Scene Size-up
Initial Assessment
Focused history and physical exam
 Rapid Trauma Assessment
Detailed Physical Exam
Ongoing Assessment
Common Signals of Musculoskeletal Injury :
 Pain
 Swelling
 Deformity
 Discoloration of the skin (bruising)
 Inability to use the affected part normally
 Loss of sensation in the affected part.
Musculoskeletal Injury Management
General Principles
 Protecting Open Wounds
 Positioning the limb
 Immobilizing the injury
 Checking Neurovascular Function
Immobilizing a joint
Four months post-op

One years post-op

Preoperative
Debridement + necrotomy Identification of artery, veins,
nerves & tendons
Bone Fixation Repair ulnar artery
Repair of extensor tendons Repair of flexor tendons
7 weeks post operation
COMPARTMENT
SYNDROME
Compartment Syndrome
 Occurs when pressure w/i soft tissues in a
fixed body compartment increases to level
that exceeds venous pressure,
compromising venous blood flow, and
limiting capillary perfusion.
 Leads to muscle ischemia and necrosis.
 TRUE ORTHOPEDIC EMERGENCY
Compartment Syndrome
Contributing Factors
 External:
 Conditions that reduced size of muscle
compartment (casts/splints); occlusive
dressing; eschar of burns
 Internal:
 Conditions that increase compartment
volume: bleeding, swelling, fluid
extravasation into tissue
 CS-Recognition
 Suspect with long bone fx, crush injuries, Fx’s
associated w/ significant vascular injuries or
pronounced swelling.
 Presents as pain out of proportion to physical
findings, +/- hypoesthesia, pulselessness (late).
 Compartment Syndrome

 Intra-compartment pressures must be measured once

the issue of compartment syndrome is raised.
 Summary
 Musculoskeletal system extends into all
parts of the body
 Musculoskeletal trauma usually not life
threatening
 Proper recognition and treatment is very
important to avoid permanent disability
TERIMA KASIH