Presentation on theme: "DIAGNOSIS OF MUSKULOSKLETAL TRAUMA"— Presentation transcript:
1DIAGNOSIS OF MUSKULOSKLETAL TRAUMA Dwikora Novembri UtomoLab/SMF Orthopaedi & Traumatologi FK Unair-RS dr SutomoS U R A B A Y A
2TIUPADA AKHIR MODUL PPGD INI,MAHASISWA FK SEMESTER 5 AKAN MAMPU MERENCANAKAN AWAL SECARA MANUAL MAUPUN MENGGUNAKAN ALAT, OBAT PADA KEGAWATDARURATAN TRAUMA MUSKULOSKLETAL SECARA TEPAT,CERMAT ,CEPAT, SEBELUM TINDAKAN DEFINITIF /SPESIALISTIK DILAKSANAKAN.
3TIKMAMPU MELAKSANAKAN TATACARA PENANGANAN TRAUMA MUSKULOSKLETAL DENGAN CEPAT,CERMAT DAN CEPAT
4POKOK BAHASAN DIAGNOSA TRAUMA MUSKULOSKLETAL JENIS TRAUMA MUSKULOSKLETALa. TRAUMA MSK SEDERHANAb. TRAUMA MSK MENGANCAM JIWAc. TRAUMA MSK YG MENGANCAMEKSTREMITASPERTOLONGAN BEDAH AWAL PADA TRAUMA MSKHAL HAL YANG MEMPERBURUK PROGNOSISINDIKASI KONSULTASI
10Definition Emergency : Trauma : A situation that involves a potential disabling or life threatening condition.Trauma :A physical wound or injury to living tissue caused by an extrinsic agentFracture : discontinuity of cortex or cartilageDislocation : discontinuity of jointluxation – subluxationMultitrauma : emergency, life threatening more than one organ requiring immediate treatment intervention
11PRIMARY SURVEYThe ABCDEs of muskuloskletal trauma care identify life threatening condition.Airway maintenance w/ cervical spine protectionBreathing and ventilationCirculation w/ hemorrhage controlDisability : neurological statusExposure : completely undress but prevent hypothermialife threatening conditions are identified and simultaneous management is instituted
12SECONDARY SURVEY Done after the patient “stable” Head to toe ! Every orificiums/ every tubes!!
13Early Intervention on trauma/multitrauma patient (included MSK trauma problems) A Airway and cervical spine protection, protec the cervical : inline imobilisation,collar brace ( head injury,C Circulation w/ hemorrhage control (pelvic stabilisationD Disability, neurological status(GCS), paraparese or paralysis…..spine fractures suspected…..inline imobilisation!!!Exposure : deformity of extremity….imobilisation/splinting!!!
14Early Intervention on trauma/multitrauma patient (included MSK trauma problems)
15Early Intervention on trauma/multitrauma patient (included MSK trauma problems)
16The first step toward cure is to know what the disease is (latin proverb)
17Solving the mysteri of a diagnosis is the “detective work of medicine” (Sherlock Holmes)
18How to diagnose the muskuloskletal trauma problems? CLINICAL HYSTORY(not for the multitrauma patients)PHYSICAL EXAM : LOOK, FEEL, MOVE,MEASUREMENTDIAGNOSTIC IMAGING
42AO Principles of Fracture Management, 2000, pp 671
43Gustilo, Burgess, Tscherne, the AO-ASIF group, recommended the following steps for open injuries: Treat OF as emergenciesInitial evaluation to diagnose life & limb-threatening injuriesAppropriate antibiotic tx in the emergency OR and continue treatment for 2 to 3 days onlyImmediately debride the wound of contaminated and devitalized tissue, copiously irrigate, repeat debridement within 24 to 72 hoursStabilize the fracture with the method determined at initial evaluationLeave the wound openRehabilitate the involved extremity aggressively
44Principles of Management Prevention of infectionSoft tissue healing and bone unionRestoration of anatomyFunctional recoveryAO Principles of Fracture Management, 2000,
45Prevention of infection Soft tissue healing and bone unionRestoration of anatomyFunctional recoveryGolden 6 hours - Bacterial colonization and subsequent wound infectionOnce the skin barrier is disrupted, bacteria enter from the local environment and attempt to attach and growAssess contamination - appropriate antibioticsRadical Debridement - dead tissue is culture media( can’t be replaced /prolonged GP by anykind of AB)Copious lavage > 10 litres - decrease bacterial load
46ORTHOPAEDIC INFECTION:Diagnosis and treatment,1989 pp8
48Prevention of infection Soft tissue healing and bone union Restoration of anatomyFunctional recoveryAvoid further soft tissue damage reduce and splint fracturesZones of Injury - Repeated DebridementGentle handlingBony stabilityEarly coverage < 1 weekDelay closureReduction & Splinting alleviate pressure on injured ischemic soft tissueHaematoma spread controlled by sterile dressingZones of injuryTissues of questionable viability left over from previous debridement might be dead on the next debridement.
64COMPARTEMENT SYNDROME Compression of nerve & bloodvesselsWithin enclosed anatomic space (osteofacial)Leading to impaired bloodflow
65Pathophysiology 2 main pathways* Increasing fluid content within the compartment (ex : haemorrhage, oedema)Decreasing the compartment size(ex : external compression)* Whitesides, Acute compartment syndr, J Am Acad Orthop Surg 1996;4
66How to Diagnosed ?Mainly by clinical examination!!!
67Sign & Symptoms Classic signs 5 P Pain Severe extremity pain out of proportion to injuryEarly sign, worse with passively stretching involved muscle
68Pallor Paresthesia or anesthesia to light touch Paralysis PulselessnessNot present in early casesPallor
75FACTORS THAT MAKE THE PROGNOSIS BECOME WORSE Bad pre hospital management* no imobilisation/splint* improper transfer of patients (ex : to transfer spine fract w/o inline imobilisation)*delayed transfer (over golden periode,under diagnosis of vascular injury)
76Pre Hospital Airway Circulation Immobilization Transportation Control :AirwayCirculationImmobilizationTransportation
77INDICATION OF CONSULTATION ALL FRACTURES & DISLOCATION ARE PATOLOGIC CONDITION.IMOBILISATION /SPLINT FIRSTSTRICTLY NO DELAY OF TRANSFERING PATIENTS W/ FRACT + NEUROVASCULAR INJURY, OPEN FRACTURES , DISLOCATION.DO NOT DO HARM
78SUMMARY 30% of OF ARE POLYTRAUMA PATIENTS. FRACTURES IS NOT ONLY LESION ON THE BONE.EARLY INTERVENTION OF MSK TRAUMA SHOULD BE DONE PROPERLY, FOR BETTER PROGNOSIS.TO KNOW THE BASIC KNOWLEDGE FOR MAKING DIAGNOSIS OF MSK TRAUMA IS MANDATORY BEFORE TREATING PATIENTS.DO NOT DO HARM