Nguyen tacxutrichanthuong

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Nguyen tacxutrichanthuong

  1. 1. “ BASIC PRINCIPLES OF MUSCULOSKELETAL TRAUMA MANAGEMENT“ HERMANSYAH, MD
  2. 2. TRAUMA A. HARD TISSUE:  BONE/SKELETON  FRACTURE B. SOFT TISSUE:  LIGAMENT  MUSCLE  TENDON
  3. 3. PRINCIPLES  FIRSTLY DO NO HARM  COOPERATE WITH THE “LAWS OF NATURE”
  4. 4. FRACTURE A. OPERATIVE : - OPEN REDUCTION - INTERNAL FIXATION: RIGID/STABLE B. CONSERVATIVE: - “FUNCTIONAL FRACTURE BRACING SYSTEM” - EXTERNAL FIXATOR - TRACTION
  5. 5. FUNCTIONAL FRACTURE BRACING SYSTEMS  EARLY MOBILISATION AND WEIGHT-BEARING”  CONCEPT “FITTING PROSTHESIS”  TIBIA : “PATELLAR TENDON BEARING”  FEMUR : “QUADRILATERAL ISCHIAL-BEARING”
  6. 6. SOFT TISSUE TRAUMA LIGAMENT AND JOINT CAPSULE – PARTIAL TEAR:  PARTIAL LIGAMENT  STABLE JOINT – COMPLETE TEAR:    COMPLETE LIGAMENT UNSTABLE JOINT DISLOCATION – BLEEDING
  7. 7. DIAGNOSTIC :  BLEEDING: EDEMA, PAIN, BRUISING  PAIN IN MOVEMENT  HAEMARTHROSIS  JOINT STABLE OR UNSTABLE
  8. 8. THERAPY  ACUTE : – – – – REST ICE COMPRESS ELASTIC BANDAGE ELEVATION  EXAMINATION OF JOINT STABILIZATION: – STABLE : STRAPPING – UNSTABLE:  IMMOBILIZATION / STRAPPING  OPERATIVE
  9. 9. DISLOCATION EARLY REDUCTION TO PREVENT:  AVASCULAR/ ASEPTIC NECROTIC  RECURRENT DISLOCATION  REDUCE OPERATIVE
  10. 10. HIP DISLOCATION  POSTERIOR: -  FLEXION ADDUCTION INTERNAL ROTATION REDUCTION:    STIMSON ALLIS BIGELOW
  11. 11. Stimson Methode
  12. 12. Allis Method
  13. 13. Bigelow Method
  14. 14. Shoulder Dislocation  ANTERIOR :  DELTOID FLAT  SUPPORTED ARM WITH OTHER HAND  REDUCTION:  STIMSON  HIPOCRATES  KOCHER
  15. 15. Hipocrates
  16. 16. Stimson
  17. 17. Traction and counter traction
  18. 18. ELBOW DISLOCATION  POSTERIOR - : OLECRANON PROMINENCE - PARTIAL FLEXION
  19. 19.  Reduction:  TRACTION  PUSH  FLEXION
  20. 20. MUSCLE INJURY: STRAINS  DIRECT TRAUMA (IMPACT) : “ COMPRESSION RUPTURES”  INDIRECT TRAUMA (OVERLOADING, OVER STRECHING)  “ DISTRACTION RUPTURES”
  21. 21. RUPTURE SITE:     ORIGO MUSCLE BELLY MUSCLE – TENDON JUNCTION INSERTION RUPTURE TYPE:   PARTIAL TOTALY
  22. 22. DIAGNOSTIC: • “ A SHARP OR STABBING PAIN” • DEFECT AT MUSCLE • “ LUMP “ • PAIN AND EDEMA • “ BRUISING “ AND “ MUSCLE SPASM “
  23. 23. TRAUMA IMPACT: MUSCULAR HAEMATOMA INTRA MUSCULAR HAEMATOMA “ACUTE COMPARTMENT SYNDROMES“   INTER MUSCULAR HAEMATOMA
  24. 24. THERAPY: STOP BLEEDING  REST  ICE PACK  ELASTIC BANDAGE  ELEVATION EXTREMITY  PREVENT LOADING  FASCIOTOMY
  25. 25. PARTIAL RUPTURE: • • • • EALSTIC BANDAGE ATER 72 HOURS: HOT PACK ACTIVE MUSCLES EXERCISES REPAIRE TOTAL RUPTURE :
  26. 26. TENDON INJURY FREQUENTLY: – ACHILLES – BICEPS – QUADRICEPS RUPTURE : – PARTIAL – TOTALY
  27. 27. DIAGNOSTIC:  “ SUDDEN SNAP” + PAIN  HAEMATOM + EDEMA  UNABLE TO MOVE THE JOINT  DEFCT  “ LUMP”  THOMSON/SQUEEZ TEST
  28. 28. THERAPY:  ACUTE : - REST - COOLING - ELASTIS BANDAGE  TOTAL RUPTURE : ADULT= REPAIR OLD : - IMMOBILIZATION - EXERCISE  PARTIAL RUPTUR : - IMMOBILIZATION - EXERCISE
  29. 29. COMPARTMENT SYNDROME
  30. 30. COMPARTMENT SYNDROMES
  31. 31. 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
  32. 32. SIGNS: 4 P’S  PAIN  PALLOR  PARESIS - PARALYSIS  PULSELESSNESS  Intra-compartmental PRESSURE
  33. 33. THERAPY:  Decompression 6 - 12 jam  Release all bandage/ casting  Fasciotomy
  34. 34. Fat embolism syndrome  LONG BONE FRACTURE  ACUTE RESPIRATORY DISTRESS SYNDROMES:  Breathless  Headache, – DELIRIUM – COMA  TACHICARDIA – B.P.  PETECHIAE  Chest XRAY: “SNOW STORM APPEARANCE”
  35. 35. Therapy:  Balance electrolyte  Corticosteroid  LOW MOLECULAR WEIGHT DEXTRANS  INTUBATION OR TRACHEOSTOMY  MECHANICAL RESPIRATION SUPPORT

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