MUSCULOSKELETAL

TRAUMA
DIVISI TRAUMA AND ACUTE SURGERY
OBJECTIVES

ESTABLISH THE PRINCIPLES FOR

ASSESSING THE PATIENT WITH
MUSCULOSKELETAL INJURIES.
ESTABLISH TREATMENT PRIORITIES.
IDENTIFY THE IMPORTANCE OF
MUSCULOSKELETAL INJURIES IN THE
MULTIPLY INJURED PATIENT.
 KEY
QUESTIONS
HOW DO MUSCULOSKELETAL INJURIES
IMPACT ON THE PRIMARY SURVEY?
WHAT ARE MY PRIORITIES?
WHAT ARE MY MANAGEMENT
PRINCIPLES?
IMPACT ON PRIMARY
SURVEY
A B C D E
EXTERNAL BLEEDING
OCCULT BLOOD LOSS
LONG BONE FRACTURES
PELVIC FRACTURES
 PRIMARY SURVEY
MANAGEMENT?
THE 3 SS
STOP THE BLEEDING!

SPLINT THE EXTREMITY

STABILIZE THE PELVIS

 WHY IS SPLINTING
USEFUL?
PREVENTS FURTHER BLOOD LOSS AND
INJURY
MAY RESTORE OR MAINTAIN
PERFUSION
RELIEVES PAIN
IMPORTANT DURING
EVALUATION
 WHAT ARE MY EARLY
CONCERNS?
VASCULAR COMPROMISE
OPEN FRACTURES
 ASSESS AND MANAGE
VASCULAR
COMPROMISE?
REDUCE FRACTURE(S)
SPLINT FRACTURE(S)
ASSESS BY DOPPLER
OBTAIN CONSULT (TIME IS CRITICAL)
CONSIDER ANGIOGRAPHY
 INFORMATION TO
HELP MY
ASSESSMENT?
MECHANISM OF INJURY
ENERGY FORCES INVOLVED
ASSOCIATED FACTORS
TIME OF INJURY
LOCATION OF INJURY
 HOW DO I MANAGE
OPEN FRACTURES?
APPLY APPROPRIATE SPLINT
CLEANSE / DEBRIDE (NOW OR LATER)
CONSIDER TIME FACTOR
OBTAIN ORTHOPAEDIC CONSULT
 SECONDARY
SURVEY
LOOK
FEEL
LISTEN
For What?
FOR WHAT?
LOOK FEEL
DEFORMITY CREPITUS

PAIN SKIN FLAPS

TENDERNESS NEUROLOGIC
DEFICIT
WOUND(S)
PULSES
Listen
Doppler signals
Bruit
SECONDARY SURVEY
WHAT X-RAYS DO I NEED?
ANY SUSPECTED AREA
ONE JOINT ABOVE AND
BELOW
WHEN DO I OBTAIN THEM?
PATIENT IS
HEMODYNAMICALLY
NORMAL
 SECONDARY
SURVEY
WHEN SHOULD I DELAY GETTING X-
RAYS?
IF LIFE-THREATENING
INJURIES TAKE PRIORITY
IF PATIENT TRANSFER
WILL BE DELAYED
WHAT INJURIES MAY
CAUSE
COMPARTMENT
SYNDROME?
 WHAT INJURIES MAY
CAUSE COMPARTMENT
SYNDROME?
TIBIA AND FOREARM FRACTURES
VASCULAR AND BONY INJURIES
INJURIES IMMOBILIZED IN TIGHT
DRESSINGS OR CASTS
SEVERE CRUSH INJURIES TO
MUSCLE
BURNS
HOW DO I RECOGNIZE
COMPARTMENT
SYNDROME?
PAIN
PARESTHESIA
PALLOR
PARALYSIS
PULSE LOSS (LATE)
TISSUE
PRESSURES >35
TO 45 MM HG
 WHAT ARE THE
PITFALLS?
OCCULT FRACTURES
VASCULAR INJURY
COMPARTMENT SYNDROME
MINOR INJURIES
ANTICOAGULATION
ALTERED SENSORIUM
SUMMARY
MANAGE LIFE-THREATENING INJURIES
FIRST
STOP THE BLEEDING!
REDUCE AND IMMOBILIZE FRACTURES
AND DISLOCATIONS
RECOGNIZE VASCULAR COMPROMISE
AVOID DELAY IN MANAGEMENT