Professional Documents
Culture Documents
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
A.3.Fractures and
associated injuries
2. Definitions
1. Flexibility
2. Cortical : tension force
3. Cancellous : compression force
4. Direct injury
5. Indirect injury
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 )
closed
Osteogenic sleeve
Children adult
Thicker, stronger, osteogenic
HISTORY
PHYSICAL EXAMINATION
IMAGING
IMAGING :
X ray
Ct scan
MRI
USG
FOTO
Acetabular labrum-red
Femoral head cortex-blue
Acet cortex- yellow
Muscle
Strain
Muscle
Strain
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
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
( at site away )
radiolucent
4. Stage of consoidation
Replacement callus by mature lamellar
bone
Resorbed excess callus
Many moths
Bony union
Radiological union
Normal diameter
Remodelling
Wolffs law
rigid
No stimulus for producingcallus
Stress protected
Directly
Disuse osteoporosis
Removal of the implant
Spongelike lattice
Internal / endosteal callus
Rich blood suply
Large contact
More rapid than cortical
At the site fractured site
Limitation regenerate
Fibrous scar tissue
Fails to heal
Any irregularity - degenartive
arthritis
Next time
1.Age
2.Site
3.Configuration
4.Initial Displacement
5.Bllod suply
Clinical
radiological
1.
2.
3.
4.
Malunion
Delayed union
Non union
Fibrous union / false
joint
Complications
Complications
A. Local Complications
1. Skin
2. Vascular
3. Neurological
4. Muscular
5. Visceral
A. Remote Complications
1. Multiple injuries
2. Hemorrhagic shock.
Complications
Compartemen Syndrome
1. Gangrene
2. necrosis
Complications
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
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
Relieve pain
Good Position
Union
Function
8. TREATMENT
2. Emergency Life Support
8. TREATMENT
3. Preliminary Care of Patients
8. TREATMENT
1.
2.
3.
4.
5.
6.
7.
8.
9.
8. TREATMENT
5. Open Fracture Treatment
8. TREATMENT
6. Anaesthesia
1.
2.
3.
4.
5.
6.
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.
2. Vascular Complications
1.
2.
3. Neurological Complications
1.
4. Joint Complications
1.
2.
Infection
Stiffness
5. Bony Complications
1.
Infection
8. TREATMENT
8.
2. Late complication
1. Local
2. Remote
8.
Tatto effect
Blister / Bleb
Bed sore
Cast sores
Aterial Complication
1.
2.
3.
4.
2.
Arterial
Arterial
Arterial
Arterial
divison
spasm
Compression
Trombosis
3. Neurological
4. Joint
5. Bony complication
8.
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.
8.
Pain
Pallor
Puffiness
Paraesthesia
Tight
Tender
Passive extension pain
8.
Diagnosis
Clinical
Measure pressure
8.
Compartemnt syndrome
Treatment : Fasciotomy
8.
8.
8.
8.
8.
8.
Joint Complication
Septic arthritis
Bony complication
Osteomyelitis
A vascular necrosis of bone
Complication
Initial and Early Complication
Remote Complication
Complication
Initial and Early Complication
Remote Complication
Complication
Initial and Early Complication
Remote Complication
Complication
Initial and Early Complication
Remote Complication
Tetanus
Closttridium tetany
Incubation 10 - 14 days
An aerobic organism
Neurotoxin
Preventable
Complication
Initial and Early Complication
Remote Complication
Tetanus
Conscious
Tetanic spasme
Opisthotonus
Lock jaw
Risus sardonicus
Complication
Initial and Early Complication
Remote Complication
Treatment Tetanus
ICU
Tetanus immune globulin, IV
Sedation
intubation
Complication
Late Complication
Local Complication
1. Joint Stiffness
2. Bony complication : 10 %
3. Muscular
:Traumatic
ossificans
4. Neurological : Tardy nerve
myositis
Complication
Late Complication
Local Complication
Complication
Late Complication
Local Complication
Valgus deformity
Ulnar nerve compression
During elbow movement
Transposisiton ulmar nereve
Complication
Late Complication
Remote Complication
1. Renal Calculi
2. Accident Neurosis
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
1.Stress Fracture
2.Pathological Fracture
3.Birth fracture
4.Fracture the epiphyseal
plate
Stress
Fracture
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
injuries
10. PATHOLOGICAL FRACTURE
1.
2.
3.
4.
5.
6.
7.
2. CLASSIFICATION
Congenital
Metabolic
Disseminated
Inflamatory
Neuromuscular ( Disuse Osteoporosis )
Avascular Necrosis
Neoplasm
injuries
10. PATHOLOGICAL FRACTURE
1.
2.
3.
4.
5.
6.
7.
2. CLASSIFICATION
Congenital
Metabolic
Disseminated
Inflamatory
Neuromuscular ( Disuse Osteoporosis )
Avascular Necrosis
Neoplasm
injuries
10. PATHOLOGICAL FRACTURE
3. Clinical features and Diagnosis
Like fracture
With underlying conditions
injuries
10. PATHOLOGICAL FRACTURE
4. Prognosis
Most of them unite
Correction underlying
Amputation
ORIF
With combination
Irradiation, cement, hormone
injuries
8. General Principles of Treatment
9. Specific types of Joint injuries
10.Muscle injuries
11.Tendon injuries
Stability Joint :
1. Contour of the joint : hip joint
2. Capsule, Ligament : knee joint
3. Muscles : shoulder Joint
Ligamentum sprain
Ligamentum tear
Ligamentum avulsion
Intra articular fracture
Dislocation
Fracture dislocation
1.
2.
3.
4.
5.
A.5. EMERGENCY IN
ORTHOPAEDIC
1.OPEN FRACTURE
2.DISLOCATION
3.ACUT SEPTIC
ARTHRITIS
RUPTURE OF ACHILLES
TENDON
Muscle
Strain
Muscle
Strain
Synovial chondromatosis
SCAPOID FRACTURE
MALLET
BOUTONNIERE DEFORMITY
DR. NARIO
ANKLE SPRAIN
Nario Gunawan
108
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
PHYSICAL EXAMINATION
Tilt test
119
120
121
Classification
122
123
Splinting
for ankle injury
124
125
127
129
Medication
Nonsteroidal anti-inflammatory
drugs (NSAIDs) may be used to
control pain and inflammation.
130
Evans operation
Chrisman-Snook operation
131
Brostrm Procedure
132
Surgical Technique
Eversion Sprain
Disruption of deltoid ligament, eversion &
pronation
If excessive, eversion may fracture lateral
maleolus
134
136
ANKLE SPRAINS
137
138
LUTFI GATAM