Nur Rachmat Lubis: Divisi Orthopaedi Dept Bedah FK UNSRI/ RS Dr. M. Hoesin Palembang

Nur Rachmat Lubis
Divisi Orthopaedi Dept Bedah

FK UNSRI/ RS dr. M. Hoesin
Palembang
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.
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.
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.
Types of Musculoskeletal
Injuries
• Fracture
- Bones break
• Dislocation
- Joints “come apart”
• Sprain
- Stretching & tearing of ligament
• Strain
- Overexertion of muscle.
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).
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.
Threats to limb function
The limb that is skeletally unstable, has a compromised
vascular supply, or has major neurological damage
cannot be expected to function properly. Small, low-
energy injuries, often situated peripherally in the limb,
can bring about a major impairment to function. Such
injuries include:
• digital nerve injuries;
• dislocation of small (for example carpal/tarsal or
phalangeal) joints;
• tendon injuries; and peri-articular and ligamentous
injuries.
Management of the Musculoskeletal
Trauma
 Assessment of:
• Casualty
• Limb as a whole
• Traumatized structures and the extent of injury.
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.
Types of injury
 Pelvic fracture
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)
Pelvic Fracture Stabilization
Fast Splinting
Leg Splint
Mast trousers
pelvic Ex-fix
 Major limb haemorrhage
Immediate treatment
• Direct pressure on sites of compressible
• haemorrhage
• Dressings and compression applied to
• wounds
• Splintage of limbs
 Large/contaminated open wound
Immediate treatment
• Sterile wound dressing
• Splintage
• Irrigation if appropriate
• Attention to tetanus immune status
Splintage
 Splintage helping to:

 reduce haemorrhage
 prevent further tissue damage
 aid analgesia
 reduce the incidence of fat embolism.
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.
Types of Splints
Long-Bone Splinting
Stabilize extremity manually.
Assess distal PMS.
Make sure splint extends several inches
beyond joints above/below injury.
Apply splint. Immobilize joints
above/below injury.
Secure extremity to splint.
Secure foot or hand in the position
of function.
Reassess distal PMS.
Pelvic Wrap
Prepare backboard.
Pelvic Wrap
Logroll patient & bring sheets around
patient.
Pelvic Wrap
Secure sheets without over-compressing.
Sling should be
triangular
Form sling.
Assess PMS; position sling.
Secure corner of sling.
Leave fingertips exposed. Check distal
PMS.
Splint for Injured Finger

Nur Rachmat Lubis: Divisi Orthopaedi Dept Bedah FK UNSRI/ RS Dr. M. Hoesin Palembang

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Nur Rachmat Lubis

Divisi Orthopaedi Dept Bedah

 Injuries to the limbs comprise by far the greatest

 Limb injury, in the survivors of major trauma, is a

Trauma to the musculoskeletal system may represent a

 Splintage helping to:

• Immobilization of the limb, including the joint above

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