1. Orthopedic Problems In Multiple Trauma Patients

2. Miss Injury Incidence 12 % Incidence 12 % Esp. in associate with Head Injury Esp. in associate with Head Injury Around large joints Around large joints Cause Cause Poor primary assessment Poor primary assessment Less experience physician Less experience physician Insufficient or non-systemic examination Insufficient or non-systemic examination

3. Unconscious patients Unconscious patients Pain : cannot evaluate Pain : cannot evaluate Crepitus Crepitus Deformity Deformity Hematoma Hematoma Swelling Swelling Joint effusion Joint effusion

4. More Information Mechanism of Injury Mechanism of Injury Deformity when injury or at ER Deformity when injury or at ER Distal pulse Distal pulse Capillary refill Capillary refill Compartment syndrome Compartment syndrome Associate Nerve Injury Associate Nerve Injury

5. Initial Management ATLS ATLS Reduction and Splint Reduction and Splint Longitudinal traction then apply splint Longitudinal traction then apply splint Reduction dislocation and splint Reduction dislocation and splint Log roll (at least 4 persons) and spinal board Log roll (at least 4 persons) and spinal board Pelvic binder or bed sheet in Fx pelvis (open book) Pelvic binder or bed sheet in Fx pelvis (open book)

8. Multiple Fractures Long bone fractures Long bone fractures Pelvic fracture Pelvic fracture Ipsilateral neck shaft fractures femur Ipsilateral neck shaft fractures femur Acetabulum fracture Acetabulum fracture Upper extremity and lower extremity Fx Upper extremity and lower extremity Fx