1. Hendy Rachmat Primana Lubis
Departement Bedah /
KSM Orthopaedi dan Traumatologi
FK UNSRI/ RS dr. M. Hoesin
Palembang
2. The Scope of Orthopaedics
• Nicolas Andry (1741) published a
book “Orthopaedia, or the Art of
Preventing and Correcting
Deformities in Children.”
• He coined the term “orthopaedia”
from orthos (straight) and pais (child)
Orthopaedics is concerned with bones, joints, muscles, tendons and nerves – the
skeletal system and all that makes it move
3. Global Orthopaedic Issues
Orthopaedics issues in the developing world :
• Pediatric deformity
• Degenerative conditions
• Musculoskeletal oncology
• Spinal deformity
• Trauma
• Injury : Road Traffic Crashes, Conflict, Disaster
4. Epidemiology
Injuries to the limbs comprise by far the greatest
number of trauma cases, the limbs being injured in
about 85% of victims of blunt trauma.
Limb injury, in the survivors of major trauma, is a
common source of disability.
5. Anatomi dan Fisiologi
Sistem musculoskeletal merupakan penunjang bentuk tubuh, terdiri dari
sendi, tulang, otot, tendon dan ligament
A. Sendi
Sendi Fibrosa / tidak dapat bergerak
( sutura tlg. tengkorak )
Sendi Kartilago / sedikit bergerak
(simphisis, torakal )
Sendi Sinovial / dapat begerak bebas
( sendi panggul, siku )
6. B. Jaringan Penyambung
Tersusun dari sel – sel dan substansi dasar
Berperan penting dalam reaksi imunitas dan
peradangan
Terdapat serat – serat dalam substansi dasar
Adanya proteoglikan yang berfungsi sebagai
bantalan pada sendi dan dapat menahan
beban yang berat
8. Life-threatening injuries
Trauma to the musculoskeletal system may represent a
threat to life, place the limb at risk, or interfere with
eventual return to full function and activity.
9.
10. The initial assessment of the casualty should proceed
using the ABC system, identifying and treating life-
threatening injuries as they are found. This
examination identifies injuries and conditions
compromising the airway, breathing and circulation.
12. Limb-threatening injuries
Some injuries may threaten the viability of a limb, or a
portion of that limb. Such injuries often involve
compromise of the blood supply to the limb that may
arise from:
• Direct vascular damage (penetrating or blunt intimal
damage).
• Vascular occlusion in the distorted limb (for example
due to a dislocated joint or severely displaced
fracture).
• Microcirculatory compromise caused by contained
swelling (leading to compartment syndrome).
13. The limbs tolerate vascular compromise poorly, and
irreversible damage to the metabolically active
tissues such as muscle is likely to occur if the limb
remains ischaemic for more than about 6 h.
14. DISLOCATION
• Structural loss of its stability
• 3 structure that prevent normal ROM & also
prevent joint instability
– Joint shape ( joint surface )
– Capsule and ligament
– Muscle that prevent joint instability
15. Most Susceptible Joint Dislocation
• Shoulder
• Elbow
• Interphalangeal
• Hip
• Ankle
Basic Orthopaedic Tutorial
16. Types of Musculoskeletal
Injuries
• Fracture
- Bones break / Bone discontinuity
• Dislocation
- Joints “come apart”
• Soft Tissue Injury
a. Sprain
- Stretching & tearing of ligament
b. Strain
- Overexertion of muscle or tendon
17.
18. Physical factors in the production of fractures
Cortical bone
• Succeptible to tension
Cancellous bone
• Succeptible to compression
Basic Orthopaedic Tutorial
twisting
Sudden pull force
bending
19. Injury to Ekstremities
1. Fracture :
Fracture classification :
a. Open fracture
b. Closed fracture
L
R
20. Definition
• Structural break in continuity of a bone, an epiphyseal
plate, or a cartilaginous joint surface
• Produce soft tissue injury
Sometimes the associated injury may
assume much greater clinical
significance than the fracture itself.
21. Fraktur
Open Fraktur :
Ujung tulang yang patah sangat tajam
Saraf dan pembuluh darah bisa cedera
Berbahaya bagi jaringan disekitarnya
Closed Fraktur :
Mempunyai tingkat bahaya yang sama
Perdarahan yang cukup banyak khususnya
pada tulang panjang
24. THE DIAGNOSIS OF FRACTURES
• HISTORY :
–Fall, Direct Trauma.
–Mechanism of injury.
–Common symptom of # :
• Localized pain.
• Decreased function of the involved
part.
25. THE DIAGNOSIS OF FRACTURES
• PHYSICAL EXAMINATION:
– INSPECTION ( LOOKING ):
• Swelling ( edema )
• Deformity( angulations, rotation, shortening )
• Abnormal movement
• Echymosis( subcutaneous extravasations of blood )
– PALPATION ( FEELING ) :
• Localized tenderness at the # site.
• Crepitus (not necessary)
– RANGE OF MOVEMENT (MOVE):
• Limitation.
26. THE DIAGNOSIS OF FRACTURES
!!!! CAREFULL ASSESSMENT
• Patient’s General Condition
• Search for associated injuries:
– Brain
– Spinal Cord
– Peripheral Nerves
– Major vessels
– Thoraces
– Abdominal viscera
27. THE DIAGNOSIS OF FRACTURES
• RADIOGRAPHIC EXAMINATION:
# : PHYSICAL EXAMINATION
Confirmation by X-Ray Accurate Diagnosis
• To determine extent and configuration of the fracture.
• Include entire length of the bone and the joints at each
end.
• 2 Projection : AP / Lat, particularly oblique
• Spine and pelvis : (+) CT
28. Normal Healing of Fracture
Bone heals without a scar
• Primary bone healing – no stages
• Secondary bone healing – stages
• Mechanical factors
– Immobilization
• Biological factors
– Cooperate with “laws of nature” concerning biological healing
29. Normal Healing of Fracture
Secondary bone healing (AO):
1. Hematoma
2. Soft callus
3. Hard callus
4. Remodelling
30. Diagnosis of Fractures
• History
Fall, twisting injury, direct blow, MVA
Localized pain, aggravated by movement
Crepitus
• Physical Examination
General condition associated injuries
Look : deformity, swelling, abN movement
Feel : localized tenderness, muscle spasm, NVD
Move : ROM (limited or not)
• Diagnostic Imaging
Exact nature & extent of fracture
X-ray : min AP & lat (other position)
CT / MRI : spine, pelvis
31. Pada amputasi tertentu dapat
mengancam nyawa
Perdarahan yang timbul bisa masif
Bisa dilakukan torniket, tetapi
sebisa mungkin dihindari
Bawa bagian yang terpotong ke
rumah sakit
Pada suhu dingin dapat
memperlambat proses kimiawi
Re-implantasi (6-8 jam) hanya bisa
pada amputasi tertentu (bukan
Crushing)
32. Management of the Musculoskeletal
Trauma
Assessment of:
• Casualty
• Limb as a whole
• Traumatized structures and the extent of injury.
33. • Look: for deformity, discoloration, wounds, swelling,
shortening.
• Feel: for abnormal movement, crepitus, pulses,
temperature, sensation.
• Move: assess the ranges of active and passive
movement as well as joint stability.
34. Spesific Methode of Treatment
• Protection alone (no reduction or immobilization)
• Immobilization by External Splinting (no reduction)
• Closed reduction by manipulation + immobilization
• Closed reduction by continuous traction + immobilization
• Closed reduction + External skeletal Fixation
• Closed reduction + Internal Fixation
• Open reduction + Internal Fixation
35. Immediate treatment
• Orthopaedic consultation (evaluation of stable versus
unstable injury pattern)
• Temporary splintage (Mast trousers, binding feet
together, pelvic wrapping)
• Skeletal stabilization (pelvic Ex-fix, clamp)
• Assessment of related injuries (visceral, rectal,
urological)
37. Akibat dari Fraktur
Fraktur femur dapat kehilangan darah
hingga 1 ltr
Fraktur pelvis dapat menyebabkan
perdarahan di rongga abdomen dan
rongga retroperitonial
Fraktur pelvis juga dapat mencederai
buli – buli
44. Major limb haemorrhage
Immediate treatment
• Direct pressure on sites of compressible
• haemorrhage
• Dressings and compression applied to
• wounds
• Splintage of limbs
45. Large/contaminated open wound
Immediate treatment
• Sterile wound dressing
• Splintage
• Irrigation if appropriate
• Attention to tetanus immune status
46. Splintage
Splintage helping to:
Reduce haemorrhage
Prevent further tissue damage
Aid analgesia
Reduce the incidence of fat embolism.
47. Splinting – General Rules
• Immobilization of the limb, including the joint above
and below the fractured segment.
• Realignment of the limb.
• Application so as not to compromise arterial supply or
venous return.
• Application to allow examination and re-assessment
of distal neurovascular status.
58. • Sprain
- Stretching & tearing of ligament
• Strain
– Chronic Overstretching overuse
– Most common site : musculotendinous junction
• Rupture
– Severe tension on contracted muscle
– Charley horse
• Recover : 50% muscle strength
59. Tendon Injuries
• Tendon healing :
– Weakest 7-10 days
– Most original strength 21-28 days
– Maximal strength 6 months
• Closed Tendon Injuries
– Mallet finger
• Open Tendon Injuries
– Need immediate surgical repair
Salter RB.Textbook of Disorders and Injury of Musculoskeletal System
Cortical bone succeptible to tension force ex. Bending, twisting, straight pull. In young children cortical bone is like green wood in a living young tree. Consequently, an angulatory force may produce tension failure on the convex side of the bend and only bending on the concave side.
Physical forces that produce a fracture always produce some degree of soft tissue injury.
