This document provides an overview of musculoskeletal trauma, including fractures, dislocations, and soft tissue injuries. It describes the pathophysiology, manifestations, assessment, diagnosis and management of fractures. Fractures occur when there is a disruption in normal bone continuity and involve surrounding structures. They are caused by mechanical overload that provides a force greater than the bone can absorb. The document outlines the stages of fracture healing and complications to monitor for, such as compartment syndrome. It also reviews the reduction and stabilization techniques of closed manipulation, open reduction internal fixation, external fixation and traction. Dislocations and soft tissue injuries like strains and sprains are also summarized.

1. MUSCULOSKELET
AL TRAUMA

2. OVERVIEW
 Fractures
 Dislocations
 Soft tissue injury

3. FRACTURES

4. What?
Disruption in normal
continuity of bone
Also involve surrounding
structures

5. Pathophysiology
 d/t mechanical overload
 More stress than bone can absorb

6. Pathophysiology
 Force provides the stress:
 Direct force – eg. MVA
 Indirect force – eg. Epilepsy
Quality of bone effects
fracture susceptibility

7. Pathophysiology
Displacement in
fracture – d/t
different muscle pull

8. Pathophysiology
Haematom
a
Fibrocartilage
formation
Soft callus
formation
Ossification
Consolidation
FRACTURE

9. Manifestations, assessment &
diagnosis
History :
usually trauma
- MVA
- fall

10. Manifestations, assessment &
diagnosis
Physical
examination:
• tenderness
• swelling
• deformity
• shock
• neurovascular
involvement

11. Manifestations, assessment &
diagnosis
Radiographs – rule of 2
• 2 views – AP/lat
• 2 joints – above and below
Look for:
• Disrupted bone
• Disrupted joint

12. Manifestations, assessment &
diagnosis
 Diagnosis is obvious esp. with h/o
MVA or fall
 Fracture classification extensive:
e.g: Open fracture (Gustilo))
Grade I – wound <1cm, minimal
contamination
Grade II – wound >1cm, moderate
contmination
Grade III – wound >1cm with extensive
soft tissue damage and high degree
contamination

13. Clinical management
 Thorough initial management
 Reduction and stabilization of fracture
 Monitoring of complications
 Remobilization and rehabilitation

14. Thorough assessment
RESCU
ER (at
site)
ABC’s
‘life before
limb’
Cervical
collar
Splinting
Soft tissue assessment
Wounds – cover (sterile
Vessel damage:
compress /

15. Thorough assessment
A&E
Monitor for
hypovolaemic
shock
Detail on mech of injury
Open fractures:
• Irrigate
• ATT
• antibiotics
Keep pt NBM

16. Reduction & stabilization
 AIM:
 Restore alignment
 Restore position
 Restore length
 HOW?
 Closed manipulative reduction (CMR)
 Open reduction and internal fixation (ORIF)
 External fixation (ext-fix)
 Traction

17. Reduction & stabilization - CMR
 Maneuvers performed to reduce fracture witout
opening skin
A – traction
B – disengage
C – realignment
D – release traction

18. Reduction & stabilization - CMR
 Reduction held with cast
Plaster of Paris (POP) Fibreglass cast

19. Reduction & stabilization - ORIF
 Performed by surgeon
 Fracture site opened and reduced under direct
visualisation
 Fracture held with implants

20. Reduction & stabilization – ext-
fix
 Maintain alignment by external pin and bars
 To enable proper wound management
 Most in open fractures

21. Reduction & stabilization -
traction
 Application of pulling force to a body part with
a countertraction in opposite direction
 Mainly for temporary immobilization before
definitive surgery
 Types: skin traction, skeletal traction

22. to look out for….
Complications

23. Compartment syndrome
 Pressure within fascial compartment high
 Features:
 Severe pain not resolved with normal meds
 Tense swelling – may have blisters
 spO2 drop, pale, pulseless
 Treatment - fasciotomy

24. Fat embolism syndrome
 Fracture forces marrow fat into circulation
 Causes clinical syndrome
 Features
 Altered sensorium (GCS drop)
 SOB / drop spO2
 Petechia
 Treatment – supportive
 high flow O2
 fluids

25. Deep vein thrombosis (DVT)
 When thrombus forms in deep veins of the leg
 May lead to pulmonary embolism – DEATH
 Features:
 Calf tenderness
 Leg swelling
 Treatment – mainly prevention
 Compression stockings
 Anti-coagulants

26. DISLOCATIONS

27. Pathophysiology
 Occurs when the normal joint articulation is
disrupted
 Usually due to trauma / sports injury

28. Assessment
 Similar to fractures
 DEFORMITY – most prominent feature
 Most important feature to assess –
VASCULARITY
 Common dislocations:
 Shoulder
 Hip

29. Clinical management
 Main – reduction by CMR (under sedation /
GA)
 Considered an orthopaedic emergency
 If late may compromise joint circulation

30. SOFT TISSUE INJURIES

31. Strains
 Trauma to the muscle body or tendinosus part
 Can lead to tear or micro tears
 Manifests as muscle spasm and reduced ROM
 Management:
 Mainly rest
 RICE therapy

32. Sprains
 Injury to the ligaments – at body or insertion
 Common site – ankle
 Management:
 RICE therapy
 Immobilisation
 If severe – surgical repair

33. Questions?
THANK YOU…