emergency scoring system

2. Emergency in Orthopaedic
• Life Threatening
• Major pelvic ring injuries
• Crush injury syndrome
• Vascular injuries
• Limb Threatening
• Trauma
• Open fractures
• Compartment syndrome
• Dislocation
• Non Trauma
• Septic arthritis
• Acute Hematogenous Osteomyelitis

3. Early Total Care vs Damage Control Surgery
• Early Total Care (ETC) is the definitive stabilization of all long bone
fractures within 24 hours of injury once the patient is physiologically
stable
• ETC is the most appropriate treatment for the majority of injured
patients
• Damage Control surgery / damage control orthopaedics (DCO) is
immediate surgery is required to save life and limb, other
reconstructive procedures being deferred until the patient’s
physiological condition has improved after a period of resuscitation in
the ICU

4. Early Total Care vs Damage Control Surgery

5. Open Fracture
• An open fracture is defined as an injury where the fracture and the
fracture hematoma communicate with the external environment
through a traumatic defect in the surrounding soft tissues and
overlying skin.
• One-third of patients with open fractures are multiply injured.
• Any wound occurring on the same limb segment as a fracture must be
suspected to be a consequence of an open fracture until proven
otherwise.

8. MESS Score
• The MESS, originally designed to address limbs with vascular damage, is
frequently used to predict the likelihood of amputation in Gustilo IIIb
injuries.
• The system is based on four criteria :
- the energy of trauma that decides the extent of skeletal and soft
tissue injury,
- the presence and duration of limb ischemia,
- the presence of shock,
- the age of the patient
• A score of >7 has been reported to predict amputation accurately in both
retrospective and prospective

10. INJURY SEVERITY SCORE (ISS)
• This anatomic scoring system provides an overall score for patients with
multiple injuries.
• It is based on the Abbreviated Injury Scale (AIS), a standardized system of
classification for the severity individual injuries from 1 (mild) to 6 (fatal).
• Each injury is assigned an AIS score and is allocated to one of six body
regions (head, face, chest, abdomen, extremities including pelvis, and
external structures).
• The total ISS score is calculated from the sum of the squares of the three
worst regional values
• The ISS ranges from 1 to 75, with any region scoring 6 automatically giving
a score of 75.

11. INJURY SEVERITY SCORE (ISS)

12. Splinting
The purpose of splinting is immobilize the fracture, and :
• Relieve the pain
• The union of fracture in good alignment
• Early mobilization

13. Key Principles for Splinting
• Anatomical position
• Including 2 joints
• Give the padding
• Tie the splint above or below the fracture site
• Use 3 pcs of spalk on the lower extremity to prevent rotation