Introduction

 Orthopedic emergencies are often found.

 Medical personnel are required to have adequate
knowledge and skills of first-time emergency
orthopedics treatment in the emergency room
 emergency orthopedics can be divided into two, the first is
life threatening and the second threatens continuity of the
extremities

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 Open fracture
 Referred to as an open fracture if there is a relationship between
the fractured area and the outer area, usually because the skin
is no longer intact.
 Open fractures are orthopedic surgical emergencies, because
the risk of infection in bone fractures is high.

( Thomas M Schaller, 2012. Open fracture)

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Management
 control bleeding,
 reduce pain
 prevent ischemia, and
 prevent contamination and infections such as foreign bodies

Management of open fractures in the emergency room:

 Primary Survey
 Wash the wound
 Debridement in the golden period (6 hours)
 Immobilization, clean wound covered cloth, fragments do not be
inserted
 Antibiotics and analgesics

(Richard Buckley.2012. management of the fracture)

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 Compartment syndrome
Definition
Acute compartment syndrome occurs when the tissue
pressure in the muscle compartment closes, exceeds the
pressure of perfusion and causes muscle and nerve
ischemia.

Etiology
The causes of compartment syndrome are varied and
include open and closed fractures, arterial injuries, gunshot
wounds, snake bites, leg compression, and burns

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Pathophysiology
 Increased pressure in the closed fascia causes a decrease
in perfusion pressure resulting in cell injury and death of
neurons and muscle tissue.
 hypoxia cell injury, release of mediator  increase
endothelial permeability  edema  increase compartment
pressure, decrease tissue pH n necrosis occurs

Diagnosis
The diagnosis is based on a classic compartment syndrome:
 For example: secondary to burns, soft tissue swelling,
prolonged tight wrapping,
 6 P  Pain, Pallor, Pulselessness,Parasthesia, Paralysis and
Poikilothermic

(Paula R. 2017.Compartment syndrome)

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 Timing: symptoms can appear within a few hours to several
days after injury.
 The sensory nerve is first affected, followed by the motor.

Management
 Get rid of the cause of compression
 Oxygen
 Maintain extremities at heart level
 Orthopedic consultation or emergency surgery
 Fasciotomy, Indications: acute compartment syndrome:
compartment pressure > 30 mmHg

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Fasciotomy
 Fasciotomy is an operative treatment of compartment
syndrome with fracture stabilization and repair of blood
vessels.
 A long incision is made in the fascia to remove the
increased pressure in it.
 The wound is left open (covered with a sterile dressing) and
closed on the second operation, usually 5 days later.

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Complications
 Tissue necrosis
 Infection
 Hypesthesia and pain
 Acute kidney failure

Prognosis
Acute compartment syndrome tends to have poor
outcomes. Although fasciotomy is performed quickly and
early, nearly 20% of patients experience persistent motor
and sensory deficits

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 Dislocation
Dislocation is an injury to the joint that occurs when the
bone shifts and comes out of its normal position. All joints
in the body can be dislocated, including shoulder, finger,
knee, hip and ankle joints.
In normal circumstances, cartilage gets nutrients from
synovial fluid from blood that has filtered erythrocytes,
diffusion occurs into the joint space when joint motion
mechanism occurs. When the nutritional dislocation stops.
Cartilage that dies is difficult to regenerate.

Dislocation of the toes can often

be reduced by local anesthesia in the
emergency room with simple
longitudinal traction. First
metatarsophalangeal(MTP) and
interphalangeal (IP) dislocations that
are open or cannot be reduced
require orthopedic consultation.
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 Traumatic amputation
Traumatic amputation is the loss of parts of the body
usually fingers, toes, arms, or legs that occur as a result of
an accident or trauma.
The most important thing here is
minimizing bleeding, shock, and
infection. Long-term outcomes for
amputation have improved
because of a better understanding
of traumatic amputation
management, early emergency
and critical care management,
initial rehabilitation, and new
prosthetics.

(Pike,Rockville.2013.Traumatic Amputation)

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 Large Vascular Trauma
 The most common large vascular lesions are the popliteal
artery and the radial artery, the inguinal artery, the brachial
artery and the femoral artery.
 The diagnosis is generally made by arteriography or Dopler,
and measurement of distal finger O2 saturation.

Management of venous injuries is

ligated and fluid resuscitation is
given. Control bleeding with pressure
for proximal blood vessels from
injury (for example, femoral pressure
in lower limb injuries)

(Scott H Bjerke. 2011.Vascular Trauma Extremities)

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 Septic arthritis
Septic arthritis is a sterile inflammatory process that
usually results from extra-articular processes. Septic
arthritis usually causes discomfort and difficulty moving the
Signs and
affected joint. The initial treatments that can be
symptoms
performed in patients with septic
include: arthrititis are: Drainage, Antibiotics, Joint
•Fever mobilization (Joint movement can keep
•Severe pain in the body from stiffening of joints and
the affected muscles. Movement also encourages
joint, especially blood flow and circulation which helps
when moving the body's healing process)
the joint
•Swelling of the
affected joint
•Warm in the
affected joint
area
(John L Brusch.2011. Septic Arthritis)

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 FAT EMBOLYSM SYNDROME
 Fat embolism syndrome (FES) is a clinical condition where
fat embolism or fat macrobules in the circulation causes
multisystem dysfunction
 Fat embolism actually occurs in all patients with long bone
fractures after nailing. Usually asymptomatic, but in some
patients will show symptoms of multi-organ dysfunction.

(Jawed M.2013. An update on fat embolism syndrome)

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 Gurd and Wilson Criteria

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 Management of FES is generally in the form of adequate
oxygenation and ventilation, hemodynamic stabilization,
rehydration, blood products as indicated
 Actually there is no specific therapy for FES; prevention and
early diagnosis, as well as symptomatic treatment are the
most important things.

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 Unstable Cervical Spine

• Management of cervical fracture patients in the

Emergency Room
Ambulation, like 4 people lifting beams. 1 person holds
the head with neck extension and traction 1 person lifts
his back 1 person lifts his waist and thighs 1 person
raises lower leg.
•On the bed with a flat and hard base The patient is
positioned supine.
•Attach the brace collar
•Neck extension
• Infuse RL,
•Give analgesics,
•X-rays.

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 Conclusion
 Orthopedic emergencies delivered about 20% of patients
who come to the hospital requires a quick treatment or
initial action and requires the skills of a doctor.
 Basic knowledge about orthopedic injuries, dislocations,
reduction techniques, and splint techniques, is needed to
manage injuries as well as an understanding of radiological
readings, making and interpreting the radiological results
needed for handling orthopedic emergencies.

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 Thank you

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