ORTHOPEDIC

TRAUMA
AT A GLANCE

DR PERWIRA BINTANG HARI, SP.OT (K)

NAME THAT INJURY!
NAME THAT INJURY!
NAME THAT INJURY!
NAME THAT INJURY!
NAME THAT INJURY!
NAME THAT INJURY!
NAME THAT INJURY!
 ASSOCIATED CONDITIONS IN MUSCULOSCELETAL
INJURY

• Hemorrhage – Shock (~2L pelvis, 1L thigh & 500 ml tibia)

• Instability
• Loss of tissue
• Laceration with contamination
• Interrupted blood supply – Ischemia
• Nerve damage
• Long-term Disability
JOINT DISLOCATIONS

• Dislocation – Articulating surfaces of 2

bones are displaced
• Luxation – Complete dislocation
• Subluxation – Incomplete dislocation
• Rotator Cuff injuries – Usually deltoid
• Common sites
• Shoulders, elbows, fingers, knees, & ankles
• Complications
• Posterior popliteal injury
PRINCIPLES OF SPLINTING

• Splint joints and fractures above & below

injuries
• Cover open fractures
• Document pulses, sensation, motor function
before & after splinting
• Stabilize the limb with gentle in-line traction to a
position of normal alignment
• Immobilize dislocations in a position of comfort
with
• Ice, cold compresses
• Elevation – to or just below level of heart
SHOULDER INJURIES

• Dislocations
• Subluxations
• Rotator cuff tendon injuries
• Sternoclavicular strain
• Treatment
• Neurovascular status
• Splint in position found or
• Sling & secure to body
• Ice or cold compresses
ELBOW INJURIES
• Falling on an outstretched arm or flexed
elbow
• Pulled elbow – Nursemaids elbow from a
sudden lateral force
• Athletic injury
• Complications
• Volkmann’s contracture – Claw-like contraction
of hand & arm deformity from ischemia
• Laceration of brachial artery
• Ulnar nerve damage
• Treatment
• Check neurovascular status
• Splint in position found
• Ice or cold compresses
RADIAL, ULNAR, WRIST INJURIES

• Check neurovascular status

• Splint in position found (rigid
or formable
• Ice & elevation
PELVIC INJURIES

Signs & Symptoms

• Pain
• Hypovolemic shock
• Shortening or abnormal
rotation of affected extremity
• Associated with injuries to
the bladder, urethra,
reproductive organs & sacral
nerves
 PELVIC INJURIES

Treatment of Pelvic Fractures/Ring

Injuries
• Open book – Vacuum mattress,
Pelvic Binder, or sheet
• Control hemorrhage – Direct
pressure or close pelvic ring
• Fluid volume replacement – Normal
Saline
(ED - PRBC, FFP, Platelets., Factor VII
A &/or embolization)
External fixation/ORIF
CLASSIFICATION OF LONG BONE INJURIES

• Fractures
• Complete or incomplete
• Open or closed
• Comminuted – Several breaks in the bone
• Greenstick - Break in periosteum w/i bowing or
buckling
• Spiral – Twisted or circular break. ↑ child abuse
• Oblique – Diagonal, slanting break
• Transverse – Right angle fracture
• Pathological
LONG BONE FRACTURES

Pathophysiology
• Femur fractures result from major force
• Femur neck fractures common in elderly
• Blood loss into a femur
– 1,000-1,500 ml
LONG BONE FRACTURES
Signs & Symptoms
• Pain
• Ecchymosis & edema of the site
• Deformity at the site
• Shortening of affected
extremity
• Internal or external rotation
• Hypovolemia or hypovolemic
shock
LONG BONE FRACTURES

Assessment
• Circulation – Hemorrhage or ischemia
• Neurovascular status
• Pulses
• Deformity – Edema, hematoma, wounds
• Compartment Syndrome
• 6 P’s – Pain, Pallor, Parasthesia, Pulses, Paralysis,
Pressure
LONG BONE FRACTURES
Treatment
• Immobilize
• Splint
• Control pain
• Realign
• Skeletal traction. Usually temporary.
Weights must hang free, meticulous
skin care
• External fixators
• ORIF
 SPLINTING

• Types of splints
• Rigid splint – body part fit to
splint design
• Soft or formable splint –
molded to shape or
configuration of the body part
• Traction splint – (Femur
fractures) – traction to stabilize
and align
OPEN FRACTURES

Signs & Symptoms

• Evidence of skin disruption over a
fracture
• Protrusion of bone through an
open wound
• Pain
• Neurovascular compromise
• Bleeding
 OPEN FRACTURES

Treatment
• Cover the wound
• Splint
• ED or OR Wound cleansing &
debridement
• Realignment
• Splint/Cast
• External fixation
• ORIF
• Complications -osteomyelitis,
cellulitis
JUMPER SYNDROME
• Vertical deceleration
• Forces transmitted upwards
from lower extremities,
pelvis, spine, chest
• Lower extremity fractures &
spinal cord injuries
• Retroperitoneal hemorrhage
is the most common cause
of shock
 AMPUTATIONS

• Partial
• Complete
• Usually involves digits, foot,
lower leg, hand or forearm
• Life over limb considerations
AMPUTATIONS

Signs & Symptoms

• Obvious tissue loss
• Pain
• Bleeding
• Hypovolemic shock
AMPUTATIONS

Treatment
• Reattachment
• Amputation
• Rehabilitation
• Prosthesis Clinic
Assessment & Care
• Keep body part bagged
not directly on ice
COMPARTMENT SYNDROME
Signs & Symptoms
• Pain disproportionate to
injury
• Sensory deficit
• Progressive muscle weakness
• Tense swollen area
• Elevated compartment
pressures
• Loss of pulses
COMPARTMENT SYNDROME

Treatment
• Elevation of limb not above heart level
• Placement of an intracompartmental monitor
• <20 = normal
• >20 = ischemia
• > 30 = necrosis
• Fasciotomies to release the pressure
ANY QUESTIONS?