PuntodewoPuntodewoDept. of Dept. of OrthopaediOrthopaedicscs & Traumatolog & Traumatologyy

FFaculty of Medicine, Uaculty of Medicine, UGM/ RGM/ RSS D Drr SardjitoSardjito, , YOGYAKARTAYOGYAKARTA

MUSCULOSKELETAMUSCULOSKELETAL INJURYL INJURY

Background

Swelling number of vehicles and increased speed of vehicles

No concomitant increase in traffic management system

Sports: lifestyle, hobby risk of injury

High incidence of RTA High incidence of RTA

ExtremityExtremity

Upper extremitUpper extremityyShoulderShoulder

Upper ArmUpper Arm

Lower ArmLower Arm

HandHand

Lower extremitLower extremityyHipHip

Upper legUpper leg

Lower legLower leg

FootFoot

Musculoskeletal InjuryMusculoskeletal Injury

Muscle contusionMuscle contusion Sprain, strainSprain, strain Open & closed fractureOpen & closed fracture DisloDislocation and fracture-dislocationcation and fracture-dislocation Fracture with nerve injury and/or Fracture with nerve injury and/or

vascular (bleeding)vascular (bleeding) Compartment syndromeCompartment syndrome

Musculoskeletal InjuryMusculoskeletal Injury

Thorough clinical examination is Thorough clinical examination is essentialessential

Proper investigation is essentialProper investigation is essential

AC joint injuryAC joint injury

SlingSling Surgery: Surgery:

TBW + TBW + screwscrew

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): 154–160.

Back injuriesBack injuries StrainStrain FractureFracture Bracing Bracing

G J Browne (2006). Cervical spinal injury in children’s community rugby football Br J Sports Med 2006;40:68–71.

Hamstring StrainHamstring Strain

RICERICE AnalgesicAnalgesic

s s Heiderscheit, BC. (2010). Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation and Injury Prevention.  J Orthop Sports Phys Ther. 2010 February; 40(2): 67–81.

Patellofemoral Pain Patellofemoral Pain SyndromeSyndrome

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): 558–566. 

Patella tendinitisPatella tendinitis

Activity modification

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

Meniscus injuryMeniscus injury Bracing Bracing Surgery: repair or Surgery: repair or

excisionexcision Open or ArthroscopyOpen or Arthroscopy

Suter LG et al (2009). Medical Decision Making in Patients With Knee Pain, Meniscal Tear, and Osteoarthritis. Arthritis Rheum. 2009 November 15; 61(11): 1531–1538.

Runner’s kneeRunner’s 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): 309–316.

Knee cartilage injuryKnee cartilage injury

Surgery: Surgery:

micro-micro-fracturization, fracturization, implantationimplantation

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): 725–731.

Knee Knee ligamentligamentss rupture rupture

Bracing/ Bracing/ CastingCasting

Surgery: Surgery: Repair Repair

Phisitkul P. et al. (2006). MCL Injuries of the Knee: Current Concepts Review. Iowa Orthop J. 2006; 26: 77–90.

Knee Ligament Knee Ligament Rupture (cont.)Rupture (cont.)

Han, HS et al. (2008). Anterior Cruciate Ligament Reconstruction: Quadriceps Versus Patellar Autograft. Clin Orthop Relat Res. 2008 January; 466(1): 198–204.

Shin splintsShin 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): 469–480.

Ankle sprainAnkle sprain

N. Kofotolis (2007). Ankle Sprain Injuries: A 2-Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388–394

Footballers ankleFootballers ankle BracingBracing UnloadingUnloading

N. Kofotolis (2007). Ankle Sprain Injuries: A 2-Year Prospective Cohort Study in Female Greek Professional Basketball Players. Journal of Athletic Training 2007;42(3):388–394

Achilles TendinitisAchilles Tendinitis, , Achilles tendon ruptureAchilles tendon rupture

SplintingSplinting Surgery: Surgery:

repairrepair

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 fasciitisPlantar fasciitis BracingBracing StretchingStretching Shoe Shoe

modification modification

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

((OpenOpen)) Fracture Fracture

Fracture Fracture Wound Wound microbial contaminationmicrobial contamination

General Emergency General Emergency ManagementManagement : Airway, : Airway, Breathing, CirculationBreathing, Circulation

Initial stabilizationInitial stabilization : : Splint, slab, Splint, slab, compressive dressingcompressive dressing

Open FractureOpen FracturePrinciples of ManagementPrinciples of Management

Open FractureOpen FracturePrinciples of Principles of ManagementManagement

AntibioticAntibiotic Irrigation and Irrigation and

debridement : debridement : to to decrease microbial decrease microbial conconccentrationentration

StabiliStabilizationzation/fi/fixationxation (definiti(definitiveve) : IF/EF) : IF/EF

RehabilitRehabilitationation

Dislocation Dislocation & Fracture-Dislocation& Fracture-Dislocation

Attitude Attitude Risk of Risk of

neurovascular neurovascular disdisturbanceturbance

Early reductionEarly reduction General General

anesthesiaanesthesia immobilizationimmobilization Rehabilitation Rehabilitation

Dislocated shoulderDislocated shoulder

Closed Closed reductionreduction

Surgery Surgery for for neglected neglected casescases

BleedingBleeding

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

fracture fracture – Internal fixationInternal fixation– External fixationExternal fixation

Increased fluid content in compartment

Compartment

Syndrome

External compression

Constriction of compartment

Arterial Trauma Trauma / fracture exercise (athlete) Old compression

• Edema• Bleeding

Increased pressure within the compartment

Intracompartmental pressure exceeds“Critical Closing Pressure”

Muscle ischemia Nerve ischemia

Volkmann contracture

MUSCLE INFARCTIONMUSCLE INFARCTION

FASCIOTOMYFASCIOTOMY