Musculoskeletal Injury

an overview
General Features and Principles of Management

dr. mirna phandu Sp.OT

 Learning Objective
Know the definition, causes, and clinical signs of
fracture, dislocation, strain, sprain, and muscle cramps
Explain the proper principles of initial management for
musculoskeletal injuries
Be able to identify methods of assessment and outline
measures to stabilize, treat, and transfer patients with
musculoskeletal injuries.
Be able to list criteria for the transfer of patients
withmusculoskeletal injuries.
1. Fracture
2. Dislocation
3. Soft tissue injury
I. FRACTURE
 Fractures & Associated Injuries

Definition :
Structural break in continuity of a
bone, an epiphyseal plate, or a
cartilaginous joint surface
Produce soft tissue injury

Cause :
Direct injury
Indirect injury

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Fractures Description
Site Extent

Relation to external
environment Configuration
Relationship to each other

Complication
Salter RB. Textbook of Disorders and Injury of Musculoskeletal System
 Fractures Description

Closed Fracture
Open Fractures

Brinker MR. Review of Orthopaedic Trauma,2001

 Diagnosis of Fractures

History
Fall, twisting injury, direct blow, MVA
Localized pain, aggravated by movement
Crepitus
Physical Examination
General condition associated injuries
Look : deformity, swelling, abN movement,
wound, bone exposed
Feel : localized tenderness, muscle spasm, NVD
Move : ROM, loss of function
Diagnostic Imaging
Exact nature & extent of fracture
X-ray : min AP & lat (ocassional : oblique)
CT / MRI : spine, pelvis

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Specific Methods of Treatment (Closed Fractures)

Protection alone (w/out reduction or immobilization)

Immobilization by External Splinting (w/out reduction)
Closed reduction by manipulation + immobilization
Closed reduction by continuous traction + immobilization

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Specific Methods of Treatment (Closed Fractures)

Closed reduction + External skeletal Fixation

Closed reduction + Internal Fixation
Open reduction + Internal Fixation

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

II. DISLOCATION
 Dislocation & Associated Injuries

Definition :
Structural loss of its stability

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Physical Factors & Descriptive Term in Joint Injuries

Degree of Joint Instability :

Occult joint instability
Subluxation
Dislocation
+ intra/extra articular fracture : fracture-dislocation

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Diagnosis of Joint Injuries

History
Gone out of place
Pain, muscle spasm, decreased function
Physical Examination
Swelling (unless deep : hip), deformity, abN movement, local
tenderness
Radiograph Examination
X-ray : AP and Lateral
Occult joint instability stressed joint

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

SPRAIN :
an injury to ligaments that is caused by being
stretched beyond their normal capacity and
result in tears in it, or it can be completely
torn apart.
-localized swelling
- localized pain
- Pain on joint movement
 Treatment for Joint Injuries

Perfect reduction
Analgesia : NSAIDs

Sprain ligament
Protection from further stretching
Adhesive strapping
Dislocation / subluxation
Closed / open reduction
Torn ligaments
Surgical repair : complete tear
major knee ligament
Immobilization : lateral ankle
ligament, collateral finger
ligament

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

III. SOFT TISSUE INJURY
 Muscle Injuries

Strain
Chronic Overstretching overuse
Most common site : musculotendinous junction
Rupture
Severe tension on contracted muscle
Charley horse
Recover : 50% muscle strength

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

 Tendon Injuries

Closed Tendon Injuries

Mallet finger
Open Tendon Injuries
Need immediate surgical repair

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System

INITIAL MANAGEMENT
P Protection

R Rest

I Ice

C Compression

E Elevation
SPLINTING
any device used to immobilize a body part :It may be soft or
rigid
 Aim of splinting are :

To prevent motion of bone fragment or

dislocated joints,
to minimize damage to surrounding tissues,
nerves, blood vessels & injured bone,
to help control bleeding & swelling,
to help prevent shock, and
to reduce pain & suffering.
 Type of splinting

Rigid splint
Traction splint
Circumferential splint
Improvised splint

Multi direction Immobilization

 Type of splinting

Rigid splint
Traction splint
Circumferential splint
Improvised splint

Multi direction Immobilization

Rigid splint (wire ladder type) Circumferential splint (Air
splint)

Traction splint Improvised Splint i

splint

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Splint

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 General rules of splinting are

SELF PROTECTION
Manual Stabilization before applying splinting
do not release manual stabilization of an injured
extremity until it is properly & completely
immobilized,
 General rules of splinting are

never intentionally replace protruding

bones or push them back below the skin,
control bleeding & dress all open wounds
before applying a splint,
If a long bone is injured, immobilize it
across proximal and distal joints

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 If a limb is severely deformed by the injury or
if the limb has no pulse or cyanotic below the
injury site align it with gentle by manual
traction,
pad a splint before applying it,
before & after applying a splint, assess pulse,
movement and sensation below the injury site.
Open fracture

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Splint

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 Splint

Straight, strong, flat + padding

Stable
secure
Immobilization
Cover two joints
Three dimention
Alignment / anatomical
position
Neurovascular condition

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Splint in the field

Apply traction
 Upper extremity splint

Clavicle : arm sling / mitella, figure of 8 bandage

Shoulder joint: dislocation splint in injured position

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Humerus : elbow in flexion / extention
Elbow : post injury position:
flexion/extention
Upper extremity splint

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 Upper extremity splinting

Forearm and wrist : elbow in flexion and extention

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Hand and fingers : 1 finger / >1 fingers
 Splinting complications

Neurovascular and other soft-tissue entrapment

Bad fixation can injure soft tissue
ischemia/Blood flow disturbance caused by tight
splinting /
Longer transportation time due to prolonged splinting
application

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Circulation

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Thank You
 Reference
Apleys System of Orthopedics and Fractures; 9th ed
Textbook of disorder and injuries of the
musculoskeletal system; Robert B Salter; 3rd ed
AO principles of Fracture management
Other sources..