MUSCULOSKELETAL INJURY

Puntodewo
Dept. of Orthopaedics & Traumatology Faculty of Medicine, UGM/ RS Dr Sardjito, YOGYAKARTA

Background

Swelling number of vehicles and increased speed of vehicles No concomitant increase in traffic management system

High incidence of RTA

Sports: lifestyle, hobby risk of injury

Extremity Upper extremity

Shoulder Upper Arm Lower Arm Hand

Lower extremity
Hip Upper leg Lower leg

Foot

Musculoskeletal Injury

Muscle contusion Sprain, strain Open & closed fracture Dislocation and fracture-dislocation Fracture with nerve injury and/or vascular (bleeding) Compartment syndrome

Musculoskeletal Injury

Thorough clinical examination is essential Proper investigation is essential

AC joint injury

Sling Surgery: TBW + screw

Docimo S Jr. et al. (2008). Surgical treatment for acromioclavicular joint osteoarthritis: patient selection, surgical options, complications, and outcome. Curr Rev Musculoskelet Med. 2008 June; 1(2): 154160.

Back injuries
Strain Fracture Bracing

G J Browne (2006). Cervical spinal injury in childrens community rugby football Br J Sports Med 2006;40:6871.

Hamstring Strain

RICE Analgesics

Heiderscheit, BC. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention. J Orthop Sports Phys Ther. 2010 February; 40(2): 6781.

Patellofemoral Pain Syndrome

Activity modification Bracing

Wilson, NA. (2009). In Vivo Noninvasive Evaluation of Abnormal Patellar Tracking During Squatting in Patients with Patellofemoral Pain. J Bone Joint Surg Am. 2009 March 1; 91(3): 558566.

Patella tendinitis

Activity
Abate M, et al. (2009). Pathogenesis of tendinopathies: inflammation or degeneration?Arthritis Res Ther. 2009; 11(3): 235.

modification Bracing

Meniscus injury
Bracing Surgery: repair or excision Open or Arthroscopy

Suter LG et al (2009). Medical Decision Making in Patients With Knee Pain, Meniscal Tear, and Osteoarthritis. Arthritis Rheum. 2009 November

Runners knee

-Splinting

Fairclough J et al. (2006). The functional anatomy of the iliotibial band during flexion and extension of the knee: implications for understanding iliotibial band syndrome. J Anat. 2006 March; 208(3): 309

Knee cartilage injury

Surgery: microfracturization, implantation

THOMPSON LR et al (2009). The Knee Pain Map: Reliability of a Method to Identify Knee Pain Location and Pattern. Arthritis Rheum. 2009 June 15; 61(6): 725731.

Knee ligaments rupture

Bracing/ Casting Surgery: Repair

Phisitkul P. et al. (2006). MCL Injuries of the Knee: Current Concepts Review. Iowa Orthop J. 2006; 26: 7790.

Knee Ligament Rupture (cont.)

Han, HS et al. (2008). Anterior Cruciate Ligament Reconstruction: Quadriceps Versus Patellar Autograft. Clin Orthop Relat Res. 2008 January; 466(1): 198204.

Shin splints

Activity modification Bracing

van Gent RN et al. (2007)., Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 August; 41(8): 469480.

Ankle sprain

N. Kofotolis (2007). Ankle Sprain Injuries: A 2Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388394

Footballers ankle

Bracing Unloading

N. Kofotolis (2007). Ankle Sprain Injuries: A 2Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388394

Achilles Tendinitis, Achilles tendon rupture

Splinting Surgery: repair

Munteanu SE (2009). Efficacy of customised foot orthoses in the treatment of Achilles tendinopathy: study protocol for a randomised trial. J Foot Ankle Res. 2009; 2: 27.

Plantar fasciitis
Bracing Stretching Shoe modification

Radford JA et al. (2007). Effectiveness of calf muscle stretching for the shortterm treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. 2007; 8: 36.

(Open) Fracture

Fracture Wound microbial contamination

Principles of Management

Open Fracture

General Emergency Management : Airway, Breathing, Circulation

Initial stabilization : Splint, slab, compressive dressing

Principles of Management

Open Fracture

Antibiotic Irrigation and debridement : to decrease microbial concentration Stabilization/fixation (definitive) : IF/EF Rehabilitation

Dislocation & Fracture-Dislocation

Attitude Risk of neurovascular disturbance Early reduction General anesthesia immobilization Rehabilitation

Dislocated shoulder

Closed reduction Surgery for neglected

Bleeding

Pelvic fracture : 2 L Femur fracture : 1,5 L Fluid resuscitation Stabilization of fracture

Internal fixation External fixation

Increased fluid content in compartment Constriction of compartment

Compartment Syndrome
External compression

Arterial Trauma

Trauma / fracture

exercise (athlete)

Old compression

Edema Bleeding

Increased pressure within the compartment

FASCIOTOMY
Intracompartmental pressure exceeds Critical Closing Pressure

Muscle ischemia

Nerve ischemia
Volkmann contracture

MUSCLE INFARCTION