Muscular-skeletal lesion treatment

• Thorough history is the first step; always ask about

the mechanism of the trauma, it is very essential in
the management of musculoskeletal injuries and
then past medical history to assess any morbidities,
history of medications, any previous injuries, and
the last meal the patient had and the timing of it.
• Second in line is physical examination. The physical
examination in the emergency department for
these injuries is based on simple four steps:
• Inspection (discoloration, swelling, or deformity).
• Palpation (looking for tenderness and deformity).
• Assess range of motion (both active and passive)
with consideration to the joint above and below the
injured part.
• Neurovascular examination.
• This should cover the basic general approach of
these injuries.
• The most important part of treatment of
dislocations and fractures is an immobilization.A
cast or splint will immobilize the bone (keep it from
moving) in order to encourage the bones to align
(straighten) and to prevent use of the bone. In some
cases when the bone is small (toes or fingers), no
cast is needed and the fracture is immobilized by
wrapping
For bone fractues and dislocartions are
introduced plaster casts (circular,longetes),soft
bandages,in older periods skeletal tractions
were higlhy used.
• Skeletal traction involves the insertion of pins,
wires, or screws into a bone. Then, weight is applied
directly to the bone using a system of weights,
ropes, and pulleys.
• The conservative treatment
of fractures involves repositioning of the bone
fragments, wound closure (if necessary), and
application of a cast or a splint to hold the bones in
place. Immobilization facilitates the joining of the
fragments and with it the healing process.
Avulsions
 Traumatic dislocations
• The place where two or more bones in the body come
together is called a joint. A dislocation occurs when the
bones in a joint become separated or knocked out of their
usual positions. Any joint in the body can become
dislocated. If the joint is partially dislocated, it is called a
subluxation.
• Dislocations can be very painful and cause the affected joint
area to be unsteady or immobile (unable to move). They can
also strain or tear the surrounding muscles, nerves, and
tendons (tissue that connects the bones at a joint). Patient
should seek medical treatment for a dislocation.
• Dislocations are very common. They can happen to
any joint in the body, but they most often affect
these joints:
• Finger
• Shoulder
• Knee
• Elbow
• Hip
• Jaw
• Trauma that forces a joint out of place causes a
dislocation. Car accidents, falls, and contact sports
such as football are common causes of this injury.
• Dislocations also occur during regular activities
when the muscles and tendons surrounding the
joint are weak. These injuries happen more often in
older people who have weaker muscles and balance
issues.
• Symptoms of a dislocation vary depending on the
severity and location of the injury. The symptoms of
a dislocated joint include:
• Pain
• Swelling
• Bruising
• Instability of the joint
• Loss of ability to move the joint
• Visibly deformed joint (bone looks out of place)
• In most cases diagnostic method for dislocations is
x-ray.
• Treatment
• Applying ice and keeping the joint elevated can
help reduce pain
• Manipulation: Doctor performs bone
alignement,with traction and corrects dislocation.
• Immobilisation of limb with cast or splinter is
necessary,for a month or more.
Rehabilitation: Physical therapy exercises
strengthen the muscles and ligaments around the
joint to help support it.
• Surgery: Doctor may recommend surgery
if:Manipulation does not work to put the bones
back in place.
• The dislocation damaged blood vessels or nerves.
• The dislocation damaged bones, tore muscles or
ligaments that need repair.