cedera pda muscoloskeletal

8/11/2019 CeDera Pda MUscOlosKeletal

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Aryadi KurniawanA.Dohar A. L. Tobing

Dep. of SurgeryDiv. Orthopaedics & Traumatology,FKUI/S!"

Kuliah "S # Des $%Kuliah "S # Des $%


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Musculoskeletal systemMusculoskeletal system

A system of organs thatenables man to mobilizephysically utilizing themuscular and skeletal

system.

!ones are connected oneanother on their articular

"oints bound together bythe ligaments capsulesmuscles and connecti#etissues around the "oint.


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Basic Knowledge

Anatomy

(hysiology

)istology

!iochemistri

Kinesiology

!iomechanic

Kinemathics

'gi'eeri'g


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Comprehensive understanding

on normal musculoskeletalsystem will ensure a better

knowledge on

musculoskeletal pathologies


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Musculoskeletal pathologies

in general Trauma

,nfection

-ongenital anomalies

eoplasma / tumor

Degenerati#e 0osteoporosis osteoarthritis1

Metabolic


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Forces responsible

for the injury

Mechanism of in"ury 3

Direct

,ndirect

8rientation 3

A9ial / compresion

Sheari'g

T)isti'g/ rotation


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Forces responsible

for the injury

-apacity of the forces 3

*igh e'ergy

+o) e'ergy


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FRACTUREFRACTURE

:tructural discontinuity of bone articularcartilage or epiphyseal growth plate

Depending on the skin and soft tissue co#eragearound the fracture site

6. -losed 3 intact

2. 8pen / -8M(8;D 3 The soft tissue co#erage isbreech and there is an open communication withthe outer en#ironment


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FRACTURE ETIOLOGIES

on (athological

6. SINGLE TRAUMASINGLE TRAUMA

2.


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Pattern of Complete Fracture

:,M(L4

Trans#erse

8bli=ue

:piral ,mpacted

-8M(L4> -omminuti#e

:egmental


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Incomplete Fracture

,n#ol#e only one corte9

,ntact (eriosteum

-hildren/ (aediatric ?reenstick @ torus @


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Stress Fracture / Fatigue

Fracture Mostly on tibia/fibula

8ccurs fre=uently on athlete dancer 'e)

army recruits


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Pathological fracture

ormal :tress for normal bone

Deteriorated bone microstructural 8steoporosis

Malignancy

(aget disease


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Sites associated with low BMD

HIP SPINE WRIST


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Paget I!"#!"


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$pen Fracture

ustillo& -'derso' clasification 3

rade I

rade II

rade III

III -

III

III !


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%rade I

8pen wound 6 cm

-lean

+o) e'ergy trauma


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2*

%rade II

Bound C 6 cm

o e9tensi#e soft tissue stripping

"oderate e'ergy trauma


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2+

%rade III

*igh e'ergy trauma

*igh velocity trauma

?un shot ?rosly contaminated 0farm i'0ury (ar'yard

i'0ury1

Associated euro#ascular in"ury

8pen fracture C + "am


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%rade III

,,, A 3 Ade=uate soft tissue co#erage

,,, ! 3

!one e9posed 49tensi#e periosteal strippi'g

?rosly comminuti#e

,,, - 3

Bith #ascular in"ury which otherwise repairedwill "eopardize the limb #itality


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o/ Trauma force

o/ Muscle pull

o/ ?ra#ity


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Aposition

Angulation


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)ematoma

,nflamation and cell proliferation

-allus formation

-onsolidation

emodelli'g


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PRIMARY SURVEYPRIMARY SURVEY Look 3 :welling and edema

Deformity open wound

:kin colour

eel 3 Tenderness

euro#ascular distal


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P+,!IC#) "-#MI*#'I$*

Mo#e 3

unctio Laesa

Mobilize the unin#ol#ed "oint toasses the motoric scale


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-.ray

racture configuration

urther management

ollow up

Medical record


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- ray

2 #iews 3

A(/Lat/8blik

2 "oints -onfirm no intra articular in"ury

2 e9tremities

especially in children

2 times


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IMAGING

!one scanning

-T scan 0computerized tomography1

M


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B$*" !C#*


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/ C' !C#*


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C' !C#*


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P&I*CIP)" $F M#*#%"M"*'

ecog'i1e

educe etai'

eha(ilitatio'


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&"(C'I$*


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?eneral anaesthesia

Muscle rela9ant

$ Manou#re manipulation Apply taction on the distal fragment along its

longitudinal a9is 0disengagement1


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Debridemen open fracture

-losed frakture

ailed closed reduction ,ntra articular fracture

A#ulsion fraktur


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&"'#I*M"*' 0 IM$BI)I1#'I$*

:plint

:kin traction

-ircular cast

,nternal fi9ation

49eternal fi9ation


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%IP!

E (laster

E (8( E (laster of (aris

:plint

-ircular cast


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-ontaminationhigher risk of infection

(rinciples of management eradicate infection

:tart with primary sur#ey Therapeutic ,F antibiotic 0not prophylactic1

Tetanus (rophylactic 3 To9oid AT:


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"PIP+,!"#) P)#'" I*2(&,

(aediatric

,f managed unproperly may lead to growthdisturbance or e#en cessation


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FC'(&" C$MP)IC#'I$*

4arly 3

Fiseral in"ury

Faskuler in"ury -ompartment syndrome

0 FolkmannGs ischemia1

er#e in"ury

,nfection


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C$MP#&'M"*' !,*&$M"

An increased pressure in closed osseofasialcompartment that compromise the intrinsic

#ascularization and "eopardize the #itality ofthe in#ol#ed limb

The plaster is too tight

Fascular in"ury

)aemophillia


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C$MP#&'M"*' !,*&$M"

)igh risk elbow fracture forearm tibiaproksimal

& ( :,?3 (ain

(araesthesia

(allor

(aralisis (ulselessness

T9 3 fasiotomi


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Late 3 Delayed union

onHunion

Malunion

5oint stifness

Muscle )ypotrofi/atrofi

Miositis osifikans

A#ascular ecrosis

Algodystrophy 0:udeckGs atrophy1

8steoarthritis


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Delayed Union

At the time of estimated union such fracturehealing is not attained yet

-ause 3

:e#ere soft tissue in"ury ,nfection

,nade=uate stabilization

T> 3 (o'e graft


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*on.union

racture site is filled with fibrosis

(seudoarthrosis

o sign of fracture healing process at all > ray 3 ob#ious fracture line


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Malunion

racture united in malposition leading toimpairment of fucntion


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#vascular *ecrosis Dislokation!one ischemic a#ascular

necrosis

8ccurs fre=uently 3 feoral head pro9imalscafoid lunate talus


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Fracture disease

(rolonged immobilization

Muscle hypotrofi/atrofi

Disuse osteoporosis 5oint stifness


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!prain ligament

Ligamentous in"ury without any structuraldiscontinuity

i.e. sprain ankle

-linical sign 3 tenderness swelling blueish


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!prain ankle


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!train ligament

Ligamentous in"ury with partial structuraldiscontinuity which doesnGt affect the "ointstability


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)I%#M"*'$(! &(P'(&"

(artial or total structural discontinuity

May be associated with aulsion fracture

Knee ankle )aematoma se#ere tenderness and swelling


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*7

I!)$C#'I$* Total loss of "oint contact

:e#ere pain deformity limited range ofmotion


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*6

islokasi posterior

kaput femur


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*2

islokasi

Dislok -M- 6 Dislok TM5


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!(B)(-#'I$*

(artial "oint contact is maintained


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Strain muscle


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!train Muscle


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'endon

Tendonitis 3 inflamation on the tendon sheath

e9ample 3 tendonitis achilles 0heel cord 1

tendonitis supraspinnatus

dll


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!P$*'#*"$(! &(P'(&" $F

#C+I))"! '"*$*

&upture of long head of biceps


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&upture of long head of biceps


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