Muskuloskeletal trauma for General Practitioners

1. Muskuloskeletal Trauma
for
General Practitioners
By Kareem Hamimy
Resident of Orthopedics and Traumatology
Cairo University, Student’s Hospital

2. Case Scenario
• You are In your GP Clinic, and a Road Traffic Accident happened
infront of your clinic, you heard Shouts “ Doctor, Doctor, Help us ”,
• You got out of your clinic, you see a 25 years old man, fully conscious,
with severe Pain in both legs, one leg has a 10 cm wound, where you
can see bone edges
• What are you going to do ??

3. Transfer
• Transfer the Patient, that is the Perfect Decision, but before Transfer

4. Set Priorities
• Care for yourself First
• Take care of the scene first, try to transfer the patient to a safer area in the street,
we don’t need more victims
• Wear Protective equipment if available, ( gloves, Mask )

5. Set Priorities
• ABCDE
• Don’t get distracted by the open leg wound, and don’t get pushed by
the crowd into managing open wound first
• ABCDE is way more Important
• Life before Limb

6. C
• Musculoskeletal Trauma affect mainly the C
• Pelvis Fx 2-3 L blood is lost
• Femur Fx 1-1.5 L
• Tibia Fx 500cc
• Asses Pulse, B.P, and give 1-2L crystalloid

7. 2ry Survey
• After Fully assessing the ABCDE
• Ample History and Head to toe Examination

8. Fracture First aid
• Any Fracture Needs Reduction and Fixation
• Why ?
• To protect soft tissues ( Neurovascular ) from Fractured Bony ends

9. Principles of Reduction
• Traction and counter traction for 1 min
• To decrease muscle spasm, which prevent bony alignment
• For Ligamento-taxis ( the stretched soft tissue, align the bony ends
• Manipulation
• By pushing the bone in opposite direction of the deformity seen

10. Fixation
• To fix the reduced bone in place, using any of Available tools
• First Aid Fixation is an External Fixation using Either:
• Cardboard
• Slab ( Gips Slab )

11. Slab or Cast
• Cast if done, and edema occurs, that can cause Compartment
Syndrome, so Slab is better for First Aid Fixation

12. Open Fracture First Aid
• Antibiotics ( 1.5 gm Amoxicillin clavulanic acid IM )
• Antitetanus
• Antisepsis
• By Copious Saline or Clear water Irrigation
• 1cm  1 L Saline
• The Principles of Pollution is Dilution
• Covering the wound by Saline dressing

13. Transfer
• Now you can safely Transfer the Patient to the Hospital for Definite
Management

14. Thanks
kareemhamimy89@yahoo.co.uk