MUSCULOSKELETA

L INJURY
Puntodewo
Dept. of Orthopaedics & Traumatology
Faculty of Medicine, UGM/ RS Dr
Sardjito, YOGYAKARTA

Background

Swelling number of vehicles and

increased speed of vehicles

No concomitant increase in traffic

management system

High
High incidence
incidence of
of RTA
RTA

Sports: lifestyle, hobby risk of injury

Extremity
Upper extremity
Shoulder
Upper Arm
Lower Arm
Hand

Lower extremity
Hip
Upper leg
Lower leg
Foot

Musculoskeletal Injury
Muscle contusion
Sprain, strain
Open & closed fracture
Dislocation and fracture-dislocation
Fracture with nerve injury and/or
vascular (bleeding)
Compartment syndrome

Musculoskeletal Injury
Thorough

essential

Proper

clinical examination is

investigation is essential

AC joint injury

Sling
Surgery:

TBW +
screw

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):

Back injuries
Strain
Fracture
Bracing

G J Browne (2006). Cervical spinal

injury in childrens community
rugby football Br J Sports Med

Hamstring Strain

RICE
Analgesics
Heiderscheit, BC. (2010). Hamstring Strain Injuries:
Recommendations for Diagnosis, Rehabilitation
and Injury Prevention. J Orthop Sports Phys
Ther.2010 February;40(2): 6781.

Patellofemoral Pain
Syndrome

Activity

modification

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): 558566.

Patella tendinitis

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

modification
Bracing

Meniscus injury
Bracing
Surgery:

repair or

excision
Open 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

Runners 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

Knee cartilage injury

Surgery:

microfracturization,
implantation

THOMPSON LR et al (2009). The Knee Pain Map:

Reliability of a Method to Identify Knee Pain
Location and Pattern. Arthritis Rheum.2009 June

Knee ligaments rupture

Bracing/

Casting
Surgery: Repair

Phisitkul P. et al. (2006). MCL Injuries of

the Knee: Current Concepts Review.
Iowa Orthop J.2006;26: 7790.

Knee Ligament Rupture (cont.)

Han, HS et al. (2008). Anterior

Cruciate Ligament
Reconstruction:Quadriceps
Versus Patellar Autograft. Clin
Orthop Relat Res.2008

Shin 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): 469480.

Ankle sprain

N. Kofotolis (2007). Ankle Sprain Injuries:

A 2-Year Prospective Cohort Study in
Female Greek Professional Basketball
Players. Journal of Athletic Training

Footballers ankle

Bracing
Unloading

N. Kofotolis (2007). Ankle Sprain Injuries:

A 2-Year Prospective Cohort Study in
Female Greek Professional Basketball
Players. Journal of Athletic Training

Achilles Tendinitis,
Achilles tendon rupture

Splinting
Surgery:

repair

Munteanu SE (2009). Efficacy of customised foot orthoses in the treatment of

Achilles tendinopathy: study protocol for a randomised trial. J Foot Ankle

Plantar fasciitis
Bracing
Stretching
Shoe
modification

Radford JA et al. (2007).

Effectiveness of calf muscle
stretching for the short-term
treatment of plantar heel pain: a
randomised trial. BMC

(Open) Fracture
Fracture
Wound microbial contamination

Open Fracture

Principles of Management

General Emergency
Management : Airway,
Breathing, Circulation

Initial stabilization :
Splint, slab,
compressive dressing

Open Fracture
Principles of
Management

Antibiotic
Irrigation and
debridement : to
decrease microbial
concentration
Stabilization/fixation
(definitive) : IF/EF
Rehabilitation

Dislocation
& Fracture-Dislocation

Attitude
Risk of
neurovascular
disturbance
Early reduction
General
anesthesia
immobilization
Rehabilitation

Dislocated shoulder

Closed
reduction
Surgery for
neglected
cases

Bleeding
Pelvic fracture : 2 L
Femur fracture : 1,5 L
Fluid resuscitation
Stabilization of
fracture

Internal fixation
External fixation

Increased fluid content in

compartment
Constriction of
compartment

Compartme
nt
Syndrome

External compression

Arterial Trauma

Trauma / fracture

exercise (athlete)

Old compression

Edema
Bleeding
Increased pressure within the
compartment
FASCIOTOMY
Intracompartmental pressure exceeds
Critical Closing Pressure
Muscle ischemia

Nerve ischemia
Volkmann contracture

MUSCLE INFARCTION