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TRAUMA

MUSKULOSKELETAL
BASUKI SUPARTONO

Reference
1. Salter, RB. Textbook of disorder and
injuries of the muskuloskeletal
syastem.3rd ed.1999
2. Apley, AG. System of orthopaedics
and fractures.7ed.1993

CONTENT
1. FRACTURES AND JOINT INJURIES
GENERAL FEATURES
2. THE MANAGEMENT OF OPEN
FRACTURES
3. SPECIFIC FRACTURES AND
JOINT INJURIES IN CHILDREN
4. SPECIFIC FRACTURES AND
JOINT INJURIES IN ADULT

A. GENERAL FEATURES
1.Reactions of m.s. tissues to
injuries
2.Fractures and associated
injuries
3.Dislocation and associated
injuries
4.Emergency in orthopaedic

A. GENERAL FEATURES
1.Reactions of m.s. tissues to
injuries :
Local death
An alteration of bone deposition
An alteration of bone resorption
Mecahanical failure ( fracture )

A. GENERAL FEATURES
3. Fractures and associated
injuries
1. Incindence
2. Definitions
3. Physical Factors in the production of fractures
4. Descriptive Terms Pertaining to Fractures
5. Associated injury to the periosteum
6. Diagnosis of fractures and associated injuries
7. Normal healing of fractures
8. Complications
9. Treatment
10.Special types of fractures
11.Pathological fracture

A. GENERAL FEATURES
3. Fractures and associated
injuries
1. Incidence

Trauma one killer


2/3 of it = musculoskeletal injury
Low mortality, high morbidity
Psycho, Social, Economical problem

A.3.Fractures and
associated injuries
2. Definitions

1. Fractures : structural break in continuity


2. Associated injury : it involved other organ
3. Intraarticular fracture : a fracture that
involves the articular cartilage of a joint
4. Dislocations : structural loss of its stability
5. Fracture dislocation : fracture with a
dislocation of the ajacent joint
6. Subluxation
7. Rupture

Fractures and associated injuries


3. Physical Factors in the production of
fractures

1. Flexibility
2. Cortical : tension force
3. Cancellous : compression force
4. Direct injury
5. Indirect injury

Fractures and associated injuries


4.. Descriptive Terms Pertaining to Fractures

1.
2.
3.
4.

SECRRC
S : SITE ( dia,meta,epiphyseal, fracture
dis )
E : EXTEND ( incomplete , Complete )
C: CONFIGURATION ( simple complex )
R: RELATION BETWEEN FRAGMEN (un
dislaced )

5. R: RELATION TO ENVIRONMENT (
open )

6. C : COMPLICATION ( Local Remote )

closed

Fractures and associated injuries


5. Associated injury to the periosteum

Osteogenic sleeve
Children adult
Thicker, stronger, osteogenic

Fractures and associated injuries


6. Diagnosis of fractures and associated injuries

HISTORY
PHYSICAL EXAMINATION
IMAGING

Fractures and associated injuries


5.

Diagnosis of fractures and associated injuries

IMAGING :
X ray
Ct scan
MRI
USG

Fractures and associated injuries


5.

Diagnosis of fractures and associated injuries


IMAGING : X ray

FOTO

MRI OF THE HIP JOINT

Acetabular labrum-red
Femoral head cortex-blue
Acet cortex- yellow

MRI OF THE MUSCLE STRAIN

Muscle
Strain

Muscle
Strain

Fractures and associated injuries


6. Normal healing of fractures

1. General features
2. Healing of a fracture in cortical bone
3. Healing of a fracture in cortical bone with rigid
internal fixation
4. Healing of a fracture in cancellous bone
5. Healing of a fracture in articularcartilage
6. Healing of a fracture involving the epiphyseal
plate ( the physis )
7. Time required for uncomplicated fracture
healing
8. Assestment of fracture healing in patients
9. Abnormality Healing of fractures

A.3. Fractures and associated


injuries
6. Normal healing of fractures
1. General features

Healing without scar


Biological process
TGF B :
IGF
PDGF
BMP
Rh BMP 2
IL

A.3. Fractures and associated


injuries
6. Normal healing of fractures
2. Healing of a fracture in cortical bone

Cortical bone = Diaphyseal bone,


Tubular Bone
Stages :
1. Initial effect
2. Early stages of Healing from soft
tissues
3. Stage of clinical Union
4. Stage of Consolidation

A.3. Fractures and associated


injuries
6. Normal healing of fractures
2. Healing of a fracture in cortical bone

1. Initial effect
Torn blood vessel
Local internal bleeding
Normal clotting / HEMATOMA
Loss of blood suply
Osteocyte die
Ring of avascular
Dead bone
Replacement of dead bone by living bone
Simultaneous processs resosption and
deposition

A.3. Fractures and associated


injuries
6. Normal healing of fractures
2. Healing of a fracture in cortical bone

2. Ealy stages of healing from soft tissue

Reaction of soft tisue due to fracture hematoma


Fracture callus at the ends of the first few
weeks.

Soft , fluid consistency

Osteogenic cells osteoblastsNew bone


formation

( at site away )

Osteogenic cells chondroblast cartilage

( at the fracture site )

radiolucent

A.3. Fractures and associated


injuries
6. Normal healing of fractures
2. Healing of a fracture in cortical bone

3. Stage of Clinical Union


Replacement fracture callus to bone
Endochondral ossification
No fracture movement
Clinical union
Not yet already original its strength
Ro : evidence bone in the callus
Fracture line : +
Hi : primary woven bone, cartilage,
endochondral ossification

A.3. Fractures and associated


injuries
6. Normal healing of fractures
2. Healing of a fracture in cortical bone

4. Stage of consoidation
Replacement callus by mature lamellar
bone
Resorbed excess callus
Many moths
Bony union
Radiological union
Normal diameter
Remodelling
Wolffs law

Fractures and associated injuries


6. Normal healing of fractures
Healing of a fracture in cortical bone with rigid internal fixation

rigid
No stimulus for producingcallus
Stress protected
Directly
Disuse osteoporosis
Removal of the implant

Fractures and associated injuries


6. Normal healing of fractures
Healing of a fracture in cancellous bone
METAPHYSEAL & CUBOIDAL BONE

Spongelike lattice
Internal / endosteal callus
Rich blood suply
Large contact
More rapid than cortical
At the site fractured site

Fractures and associated injuries


6. Normal healing of fractures
Healing of a fracture in articular cartilage

Limitation regenerate
Fibrous scar tissue
Fails to heal
Any irregularity - degenartive
arthritis

Fractures and associated injuries


6. Normal healing of fractures
Healing of a fracture in the epiphyseal plate ( the physis )

Next time

Fractures and associated injuries


6. Normal healing of fractures
7. Time required for uncomplicated fracture healing

1.Age
2.Site
3.Configuration
4.Initial Displacement
5.Bllod suply

Fractures and associated injuries


6. Normal healing of fractures
8. Asssetment

Clinical
radiological

Fractures and associated injuries


6. Normal healing of fractures
9. Abnormal Healing of Fractures

1.
2.
3.
4.

Malunion
Delayed union
Non union
Fibrous union / false
joint

Fractures and associated injuries


7.

Complications

I. Initial ( immediate ) complications


A. Local Complications
B. Remote Complications
II. Early complications
A. Local Complications
B. Remote Complications
III. Late Complications
A. Local Complications
B. Remote Complications

Fractures and associated injuries


7.

Complications

I. Initial ( immediate ) complications

A. Local Complications
1. Skin
2. Vascular
3. Neurological
4. Muscular
5. Visceral
A. Remote Complications
1. Multiple injuries
2. Hemorrhagic shock.

Fractures and associated injuries


7.

Complications

II. Early complications


A. Local Complications
1. Sequele
1.

Compartemen Syndrome

1. Gangrene
2. necrosis

2. Joint Complications : Infection


3. Bony Complications : Infection / AVN
A. Remote Complications
1. Fat embolism
2. Pulmonary embolism
3. Pneumonia
4. Tetanus
5. Delirium tremens

Fractures and associated injuries


7.

Complications

III. Late Complications


1.

A. Local Complications
Joint Complications ( stifness, degenerative0
2. Bony complications :
1.
2.
3.

3.

Muscular complications
1.

4.

Abnormal healing
Growth disturbance
Chronic osteomyelitis
4.
Osteoporosis
5.
Suddecks
6.
Refracture

Myositis ossificans

Neurological complications
Tardy Nerve palsy
B. Remote Complications
1.
Renal Calculi
2.
Accident Neurosis

Fractures and associated injuries


8.

1.
2.
3.
4.
5.
6.
7.
8.

TREATMENT

General Principles
Emergency Life support
Preliminary Care for Patients Fractures
Specific Methods of Definitive Fracture
Tx
Open Fracture Treatment
Anesthesia
Aftercare and Rehabilitation
Complications of Treatment

8. TREATMENT
1. GENERAL PRINCIPLES OF FRACTURE
TREATMENT

1. First Do Not Harm


2. Base treatment on an Accurate Diganosis dan
Prognosis
3. Select treatment with specific aims
1.
2.
3.
4.

Relieve pain
Good Position
Union
Function

4. Cooperated with the laws of nature


5. Make treatment realistic and practical
6. Select treatment for your patients as an individual

8. TREATMENT
2. Emergency Life Support

ADVANCE TRAUMA LIFE


SUPPORT

8. TREATMENT
3. Preliminary Care of Patients

1.Immediate care out of


hospital
2.Care during transportation
3.Emergency care in hospital

8. TREATMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.

4. SPECIFIC METHODS OF DEFINITIVE


TREATMENT

Protection Alone without Reduction or immobilization


Immoblization by external splinting without reduction
Closed reduction by manipulation followed by immobilization
Closed reduction by continous traction followed by
immoblization
Closed reduction by followed by Functional fracture bracing
Closed reduction by followed by External skeletal fixation
Closed reduction by manipulation & Internal skeletal fixation
Open reduction Internal fixation
Excision and replacement by Endoprosthesis

8. TREATMENT
5. Open Fracture Treatment

8. TREATMENT
6. Anaesthesia
1.
2.
3.
4.
5.
6.

Without anaesthesia : first hour


Vocal anaesthesia
Local anaesthesia
Block anaesthesia
Regional anaesthesia
General anaesthesia

8. TREATMENT
7. Aftercare and Rehabilitation
To restore of function :
Prevent edema
RICE
Exercise
Rehabilitation program
Psychological consideration

8. TREATMENT
8. Complication of Treatment
1. Skin Complications
1.
2.

Tatto efect from abrasions


Pressure lesions ( Bed Sores & Cast Sores )

2. Vascular Complications
1.
2.

Traction and pressure lessions


Volkmans S Ischemia ( Compartemen Syndrome )

3. Neurological Complications
1.

Traction and pressure lesions

4. Joint Complications
1.
2.

Infection
Stiffness

5. Bony Complications
1.

Infection

8. TREATMENT
8.

Recognition and Treatment of


Complication ,
from both the initial injury and its treatment

1. Initial and Early Complication


1. Local
2. Remote
1. Fat embolism Syndrome

2. Late complication
1. Local
2. Remote

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

1. Skin Complication : debridemant


1.
2.
3.
4.

Tatto effect
Blister / Bleb
Bed sore
Cast sores

2. Vascular Complication : exploration and repair


surgery
1.

Aterial Complication
1.
2.
3.
4.

2.

Arterial
Arterial
Arterial
Arterial

divison
spasm
Compression
Trombosis

Compartemen Syndrome : fasciotomy

3. Neurological
4. Joint
5. Bony complication

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Compartment Syndrome
A condition in which increased
tissue pressure with in lilited space
osteofascial that compromises the
circulation
and
therefore
neuromuscular
and
vascular
function.

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

1. Displaced supracondylar fractures of


the humerus with damage to the
brachial artery in children
2. Excessive longitudinal traction in the
treatment of femoral shaft in
children
3. Fractures of proximal tibia
4. Drug induced coma

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Warning in Impending Compartment


Syndrome

Pain

Pallor

Puffiness
Paraesthesia

Tight

Tender
Passive extension pain

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Diagnosis
Clinical
Measure pressure

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Compartemnt syndrome
Treatment : Fasciotomy

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Sequelae of arterial complication


1. Gangrene
2. Comparment syndrome / Volkmans
Ischemic contracture
3. Intermitten Claudication
4. Gas Gangrene

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Venous trombosis and Pulmonary


embolism
Morbidity
Mortality
Lower limbs and pelvis
Adult more susceptible

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Diagnosis Venous trombosis


Calf :
Local pain
Tenderness
Homans signs
Venogram

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Diagnosis Pulmonary Embolism


Chest pain
dyspnea
Hemoptysis
Friction rub
Chest X ray :

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Prevention Pulmonary Embolism


Avoiding constant local pressure
Actively contract all muscle
Treatment Pulmonary Embolism
Heparinisasi
Thrombectomy

8.

Recognition and Treatment of


Complication
Initial and Early Complication
Local Complication

Joint Complication
Septic arthritis
Bony complication
Osteomyelitis
A vascular necrosis of bone

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Fat embolysm syndrome


9%
Fat interavascular
Fat embolization
Respiratory distress syndrome
Hours 2,3 days
Petechial hemorrhages

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Prevention Fat embolysm


syndrome
Good general care
Early ORIF

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Fat embolysm syndrome


9%
Fat interavascular
Fat embolization
Respiratory distress syndrome
Hours 2,3 days
Petechial hemorrhages

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Tetanus
Closttridium tetany
Incubation 10 - 14 days
An aerobic organism
Neurotoxin
Preventable

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Tetanus
Conscious
Tetanic spasme
Opisthotonus
Lock jaw
Risus sardonicus

8. Recognition and Treatment of

Complication
Initial and Early Complication
Remote Complication

Treatment Tetanus
ICU
Tetanus immune globulin, IV
Sedation
intubation

8. Recognition and Treatment of

Complication
Late Complication
Local Complication

1. Joint Stiffness
2. Bony complication : 10 %
3. Muscular
:Traumatic
ossificans
4. Neurological : Tardy nerve

myositis

8. Recognition and Treatment of

Complication
Late Complication
Local Complication

Traumatic myositis ossificans


Post traumatic ossification
Injury in elbow joint
Enlarging tendermass
Heterotophic ossification
New bone formation in abnormal site
Severe head inuries
Paraplegia
Limitation of Movement
Preventable
Local rest
Resorbed spontaneously
Mi : like osteosarcome

8. Recognition and Treatment of

Complication
Late Complication
Local Complication

Tardy nerve Palsy

Malunion / non union fracture of lateral condyle humerus


in children

Valgus deformity
Ulnar nerve compression
During elbow movement
Transposisiton ulmar nereve

8. Recognition and Treatment of

Complication
Late Complication
Remote Complication

1. Renal Calculi
2. Accident Neurosis

8. Recognition and Treatment of

Complication
Late Complication
Local Complication

1. Bony complication : 10 %
1.
2.
3.
4.
5.
6.
7.

Malunion
Delayed union
Non union
Pseudoarthrosis
Persisten Infection
Post traumatic Osteoporosis
Suddecks
Post
traumatic
Painful
Osteoporosis / Reflex Symphatetic
Dystrohy

Fractures and associated injuries


9. Special types of fractures

1.Stress Fracture
2.Pathological Fracture
3.Birth fracture
4.Fracture the epiphyseal
plate

Fractures and associated


injuries
9. Special types of
fractures
.
Stress
Fracture

Stress
Fracture

Fractures and associated injuries


9. Special types of fractures
1. Stress fracture
Fatigue fracture
Repeated stress
Crack
Not proceed to a displaced fracture
Metatarsal , II,III,IV ( March Fr. )
Distal fibula ( runners )
Tibia Proksimal ( ballet dance,jumper )
Local pain
No fracture line
Local Rest until healed

A.3.Fractures and

associated injuries
10. PATHOLOGICAL
1. Definition FRACTURE
Classification
2. Clinical Features and diagnosis
3. Prognosis

A.3.Fractures and

associated injuries
10. PATHOLOGICAL
1. Definition
Classification
FRACTURE
Fractures of the abnormal bone

A.3.Fractures and associated

injuries
10. PATHOLOGICAL FRACTURE
1.
2.
3.
4.
5.
6.
7.

2. CLASSIFICATION
Congenital
Metabolic
Disseminated
Inflamatory
Neuromuscular ( Disuse Osteoporosis )
Avascular Necrosis
Neoplasm

A.3.Fractures and associated

injuries
10. PATHOLOGICAL FRACTURE
1.
2.
3.
4.
5.
6.
7.

2. CLASSIFICATION
Congenital
Metabolic
Disseminated
Inflamatory
Neuromuscular ( Disuse Osteoporosis )
Avascular Necrosis
Neoplasm

A.3.Fractures and associated

injuries
10. PATHOLOGICAL FRACTURE
3. Clinical features and Diagnosis
Like fracture
With underlying conditions

A.3.Fractures and associated

injuries
10. PATHOLOGICAL FRACTURE
4. Prognosis
Most of them unite
Correction underlying
Amputation
ORIF
With combination
Irradiation, cement, hormone

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
1.
2.
3.
4.
5.
6.
7.

Normal Joint Stability


Physical factors
Descriptive terms
Associated injuries to the fibrous capsule
Diagnosis of Joint injuries
Normal healing of ligament
Complication of dislocations and associated

injuries
8. General Principles of Treatment
9. Specific types of Joint injuries
10.Muscle injuries
11.Tendon injuries

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
1. Normal Joint Stability

Stability Joint :
1. Contour of the joint : hip joint
2. Capsule, Ligament : knee joint
3. Muscles : shoulder Joint

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
1. Joint Stability

1. The contours of the opposing joint


surface
2. The integrity of joint capsule and
ligament
3. The power of muscle joint

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
2. Physical Factors

Structural loss of stability


Tension force : Indirect injury

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
3. Descriptive Terms Pertaining to Joint
surface

Ligamentum sprain
Ligamentum tear
Ligamentum avulsion
Intra articular fracture
Dislocation
Fracture dislocation

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
3. Descriptive Terms Pertaining to Joint
surface

Degree of instability of the Joint


1. Occult
2. Subluxation
3. Dislocation

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
4. Associated injury to the Fibrous capsule

Stripped out : intra articular dislocation


Torn : extra capsular dislocation
Buttonhole dsilocation

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
5. Diagnosis
History : gone out of place
Physical examination :
Swelling
Loss of contour
Deformity
Local tenderness
Imaging :
X ray
MRI

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
6. Normal Healing Of Ligament
Fibrous scar tissue
Not as strong as normal
Partial : heal well
Complete : elongated, weakness
3 weeks
3 months

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
7. Complication
Like fracture
Joint Stiffness
Joint isntability
Recurrent dislocation
Post traumatic arthritis

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
8. Treatment
Principles like the fracture

1.
2.
3.
4.
5.

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
9. Specific Types
Contusion
Ligamnetous sprain
Subluxation
Dislocation
Torn ligament

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
10. MUSCLE INJURY
Strain
At musculotendineous junction
Surgery
conservative

A.4. DISLOCATIONS AND


ASSOCIATED INJURIES
11. TENDON INJURY
Injury
Avulsion fracture
Degenerative
Open
Closed
Recontructive operation
Mallet finger

A.5. EMERGENCY IN
ORTHOPAEDIC

1.OPEN FRACTURE
2.DISLOCATION
3.ACUT SEPTIC
ARTHRITIS

RUPTURE OF ACHILLES
TENDON

MRI OF THE MUSCLE STRAIN

Muscle
Strain

Muscle
Strain

Avascular necrosis of hip

Synovial chondromatosis

Hook of Hamate fracture


Golfers can break their
hamate, or wrist bone, with
a "fat" shot or in cold
weather when the hand
strikes the hard ground with
the club, the force is
transmitted to the bone
Early, this fracture will
heal in a cast.
Late , removing the
bone to relieve the pain
this bone is closely related
to important structures of
the hand, including the
ulnar artery and ulnar

SCAPOID FRACTURE

Fifth metacarpal bone fracture


(boxers fracture).

Detecting rotation in middle phalanx


fractures.

MALLET

CENTRAL SLIP EXTENSOR TENDON INJURY

BOUTONNIERE DEFORMITY

Stable UCL injuries are treated with


splinting using a thumb spica cast or
splint

DR. NARIO

ANKLE SPRAIN

Nario Gunawan
108

Los Angeles Lakers' Kobe


Bryant holds his right ankle
after rolling it during the fourth
quarter of a first round Western
Conference NBA playoff game
Tuesday, April 24, 2007 at U.S.
Airways Center in Phoenix. The
Suns
won
126-98.
(AP Photo/Matt York)
109

Ankle Injuries
Ankle injuries fall into the same basic
categories as do all athletic injuries:
Contusions
Sprains
Fractures

110

ANATOMY

111

112

ANATOMY ANKLE
Group of ligament
supporting ankle joint
:
Syndesmotic lig
Lateral collateral
Medial collateral
113

ANATOMY

114

ANATOMY

115

CLINICAL FEATURES

pain or tenderness
swelling
bruising
stiffness
inability to walk or
bear weight on
the joint
116

TYPES of SPRAIN

External sprain
Large bruise
No haemarthrosis
Lateral swelling

Internal sprain
Minimal bruise
Haemarthrosis
Posterior swelling

117

Physical Examination
Anterior Drawer Test

SENS : 73% SPEC : 97%


118

PHYSICAL EXAMINATION
Tilt test

119

Stress Radiographs of Ankle

120

Stress Radiographs of Ankle

121

Classification

122

ANKLE SPRAIN Grade 1


R.I.C.E
Rest ankle by not walking on it.
Ice should be immediately applied. It keeps
the swelling down. It can be used for 20
minutes to 30 minutes, three or four times
daily. Combine ice with wrapping to decrease
swelling, pain and dysfunction.
Compression
dressings,
bandages
immobilize and support the injured ankle.
Elevate ankle above heart level for 48 hours.

123

Splinting
for ankle injury

124

ANKLE SPRAIN Grade 2


RICE guidelines can also be
used.
Use a device to immobilize or
splint the ankle.
Allow more time for healing to
occur.

125

ANKLE SPRAIN Grade 3


Associated with permanent
instability.
A short leg POP cast or a cast-brace
may be used for two weeks to three
weeks.
Surgery ? rarely needed
Primary
Late reconstruction (10% - 20%)
126

How to wrap a sprained ankle?


Start by cutting out a horseshoeshaped pad. Put this pad around the
outside of ankle joint on both sides of
foot, with the open end facing up.
Then wrap an elastic bandage, in a basket-weave "figure-ofeight" pattern. Reinforce wrap with adhesive tape over the
elastic bandage.

127

Functions of ankle tape :


1. Reduction of ligamentous laxity
2. Limitation of extreme ankle motion
3. Shortening of reaction time of
peroneal muscle by affecting the
proprioceptive
function
of
ligaments and joint capsule
128

Ankle Tape or Brace ?


Tape is NOT a substitute for normal soft tissue
function
Tape MUST be used as part of rehabilitation
aimed at restoring normal ROM
Tape : 40% loss of supporting force after 10
exercise
Tape and brace are effective in protecting
ankle joint during rehabilitation phase

129

Medication
Nonsteroidal anti-inflammatory
drugs (NSAIDs) may be used to
control pain and inflammation.

130

Surgical Treatment of Chronic


Ankle Instability

Evans operation

Chrisman-Snook operation

131

Anatomical Reconstruction for


Chronic Lateral Instability

Brostrm Procedure
132

Surgical Technique

Modified Brostrm-Evans Procedure


133

Eversion Sprain
Disruption of deltoid ligament, eversion &
pronation
If excessive, eversion may fracture lateral
maleolus

Same treatment as Inversion Sprain

134

Ankle instability may depend on


joint configuration

The tibial coverage of the


talus was smaller and the
talar radius was larger in the
patients with instability

Frigg AM, et al. (2005)


135

136

ANKLE SPRAINS

85% of all ankle sprains involve some


plantar flexion of the ankle and inversion
of the foot.
The remaining 15% consist of eversion
mechanisms which are often the result of an
outside force .

137

138

LUTFI GATAM

Patah Tulang Pinggul