Musculo-Skeletal

1
??? ???? ?????? ??????
????? ??? ??????? ????? ????? ??? ??? ???? ????
??????0 ????? ????? ????? ?? ???? ????? ?????? ??
????????0
(?????? ????? 156-157)
2
Dr. Abdullah H.A. JumaFRCS(Ed.)Associate
Professor and Consultant Orthopedic surgery
Musculo-Skeletal Trauma
3
Musculo-skeletal Trauma
Trauma

• T Taker.
• R Rural.
• A And.
• U Urban.
• M Mankind.
• A Assets.

4
Musculo-skeletal Trauma
Trauma

• Is an epidemic phenomenon with a widespread
  global distribution affecting both sexes and all
  ages.

5
Musculo-skeletal Trauma
Types

• RTA, MVA.
• Domestic.
• Sports.
• Occupational.
• Industrial.
• War.
• Natural disaster.

6
Musculo-skeletal Trauma
RTA MVA
7
Musculo-skeletal Trauma
8
Musculo-skeletal Trauma
9
Musculo-skeletal Trauma
Domestic
10
Musculo-skeletal Trauma
11
Musculo-skeletal Trauma
Sports
12
Musculo-skeletal Trauma
13
Musculo-skeletal Trauma
14
Musculo-skeletal Trauma
Occupational
15
Musculo-skeletal Trauma
16
Musculo-skeletal Trauma
Industrial
17
Musculo-skeletal Trauma
18
Musculo-skeletal Trauma
War
19
Musculo-skeletal Trauma
20
Musculo-skeletal Trauma
Natural disasters
21
Musculo-skeletal Trauma
22
Open fracture
23
Musculo-skeletal Trauma
Classification according to order of priority in
management

• Highest priority

• Cervical spine injury.
• Respiratory impairment.
• Cardiovascular insufficiency.
• Severe external haemorrhage.

Larkin J and Moylan J (1973) Priorities in
management of trauma victims. Critical Care
Medicine, 3 192-195.
24
Musculo-skeletal Trauma
Classification according to order of priority in
management(Cont.)

• High priority

• Intraperitoneal injuries.
• Retroperitoneal injuries.
• Brain and spinal cord injuries.
• Severe burns, or extensive soft tissue injuries.

(Larkin and Moylan, 1973)
25
Musculo-skeletal Trauma
Classification according to order of priority in
management (Cont.)

• Low priority

• Lower genito-urinary tract injuries.
• Peripheral vascular, nerve and tendon injuries.
• Fractures, dislocations.
• Facial and soft tissue injuries.
• Tetanus prophylaxis.

(Larkin and Moylan, 1973)
26
Musculo-skeletal Trauma
Injury Severity Score (ISS) (Baker et al., 1997)
Baker SP, Oneill B, Haddow W and Long WB (1974)
The injury severity score A method for
describing patients with multiple injuries and
evaluating emergency care. J.Trauma, 14187-196.
27
Musculo-skeletal Trauma
Triage Score (Champion et al., 1980)
Champion HR, Sacco WJ, Hannan DS, Lepper RL,
Atzinger ES, Copes WS and Proll RH(1980)
Assessment of injury severity The Triage Index.
Critical Care Medicine, 8 201-208.
28
Musculo-skeletal Trauma
Glasgow Coma Scale (Teasdale and Jennet, 1974)
Teasdale G and Jennet B (1974) Assessment of
coma and impaired consciousness. Lancet, 2 81-84.
29
Musculo-skeletal Trauma

• Polytraumatized or multiple injury patients
  possess the most critical decision and
  management.
• A trauma centre, well equipped, well staffed,
  highly experienced personnel, easy and fast
  accessibility with multi-system and
  multi-speciality medical care should be available.

30
Musculo-skeletal Trauma
CONCLUSION

• The aim of treatment will be

• Prevention of accidents and trauma to occur.
• Prevention of further damage to the human
  skeleton.
• Prevention of recurrence of trauma.

31
Musculo-skeletal Trauma
Example of an advanced trauma center
Dr. Soliman Fakeeh hospital has the full calibre
of providing medical services with all medical
and surgical specialities, taking care of injured
patients.
32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
(No Transcript)
37
Musculo-skeletal Trauma
Supportive Care

• Remember, we are human beings, having our own
  limitations, but fully responsible of providing
  our best care.

(A.Juma)

• I treated him . . . God cured him

(Ambroise Pare 1510-90)
38
Musculo-skeletal Trauma
These supportive Care Include

• Pulmonary support.
• Cardiovascular support.
• Renal support.
• Hepatic support.
• Nutritional support.
• Metabolic support.
• Musculo-skeletal and rehabilitative support.
• Psychological support.

39
Musculo-skeletal Trauma
Relationship between mean daily urine nitrogen
excretion for 7 days postoperatively, the blood
level of branched chain a.a. on the 7th after
injury and the initial ketone body levels.
40
Musculo-skeletal Trauma
The concentrated ketone bodies in the blood of
patients after injury
41
Musculo-skeletal Trauma
Changes in the blood brached chain a.a. after
injury
42
Musculo-skeletal Trauma
The mean excretion of 3-methylhistidine in the
urine in ten injured patients without
hyperketonaemia
43
Musculo-skeletal Trauma
The variation in the phases of injury according
to its nature
44
Musculo-skeletal Trauma
Some effects of burns on hormonal control
45
Musculo-skeletal Trauma
Fat can not be used as a source of glucose
46
Musculo-skeletal Trauma
Relationship between hormones and substrates in
man
47
Musculo-skeletal Trauma
Methylhistidine
48
Musculo-skeletal Trauma
Metabolic pathways of animo acids
49
Musculo-skeletal Trauma
The central position of the liver as a
transformer between fuel supply and fuel consumers
50
Musculo-skeletal Trauma
Diagrammatic representation of some changes in
body composition induced by severe injury
51
Musculo-skeletal Trauma
Musculoskeletal trauma has a special
consideration and challenges in

• Multiple fractures especially when involving long
  bones, especially in lower extremities.
• Spinal injuries with its risk to the neural
  elements.
• Pelvic injuries with its impact on the contained
  viscera.
• Complicated fractures by vascular, neurological
  and soft tissue damage.

52
Musculo-skeletal Trauma
Musculoskeletal trauma has a special
consideration and challenges in

• Open fractures especially grade II, III A,B,C.
• Contamination yielding to infections.
• Fractures involving joints.
• Fractures with bone losses.
• Mismanaged bones and joints after injury.

53
Musculo-skeletal Trauma
Musculoskeletal trauma has a special
consideration and challenges in

• Complications of fracture healing.
• Medical diseases imposing variable threats to the
  victims of bone and joint injury.
• The availability versus lack of instrumentation,
  implants, expertise, medical and paramedical
  staff.

54
Musculo-skeletal Trauma
Management will depend on

• First aid and ATLS measures provided in situ at
  the site of accident.
• Access and effective transfer into a trauma
  center.
• Thorough and careful assessment of the patient
  using different score systems.
• Detailed study of the type of fractures, plan and
  timing of intervention.

55
Musculo-skeletal Trauma
Based on this, treatment will proceed to

• Reduction (closed vs. open).
• Immobilization (closed vs. open).
• Rehabilitation.

56
Musculo-skeletal Trauma
CONCLUSION

• Prevention of the risk factors causing
  injuries.These can be accessible in 30 of the
  cases, whereas the rest of them need public and
  governmental support.

57
Musculo-skeletal Trauma
RECOMMENDATION

• A trauma center is a mandatory factor in managing
  trauma patients to improve the mortality and
  morbidity rates of injuries.

58
Thank you
FromDr. Abdullah H.A. JumaFRCS(Ed.)Associate
Professor and Consultant Orthopedic surgery