Dadang Rukanta,dr.SpOT,MKes
TRAUMA MUSKULOSKELETAL
DISATER RELIEF MANAGEMEN
َليِءَٰٓر ْسِإ ٓىِنَب ٰىَلَع اَنْبَتَك َكِلَٰذ ِلْجَأ ْنِم ﴾٣٢﴿
ىِف ٍدا َسَف ْوَأ ٍسْفَن ِرْيَغِب ا ًۢسْفَن َلَتَق نَم ۥُهَّنَأ
اَهاَيْحَأ ْنَمَو اًعيِمَج َساَّنلٱ َلَتَق اَمَّنَأَكَف ِضْرَ ْلأٱ اَنُل ُسُر ْمُهْتَءآ َج ْدَقَلَو ۚ اًعيِمَج َساَّنلٱ اَيْحَأ آَمَّنَأَكَف
ِضْرَ ْلأٱ ىِف َكِلَٰذ َدْعَب مُهْنِّم اًريِثَك َّنِإ َّمُث ِتَٰنِّيَبْلٱِب
َنوُفِر ْسُمَل
Oleh karena itu Kami tetapkan (suatu hukum) bagi Bani Israil, bahwa: barangsiapa yang membunuh seorang manusia, bukan karena orang itu
(membunuh) orang lain, atau bukan karena
membuat kerusakan dimuka bumi, maka seakan- akan dia telah membunuh manusia seluruhnya.
Dan barangsiapa yang memelihara kehidupan seorang manusia, maka seolah-olah dia telah memelihara kehidupan manusia semuanya. Dan sesungguhnya telah datang kepada mereka rasul- rasul Kami dengan (membawa) keterangan-
keterangan yang jelas, kemudian banyak diantara mereka sesudah itu sungguh-sungguh melampaui batas dalam berbuat kerusakan dimuka bumi.
Jenis Disasters-Bencana
Banjir. Gempa Bumi
Jenis Disaster- Bencana
Perang. Kebakaran. Tsunami
© ACS
8
Three Peaks of Trauma Related Deaths
4 weeks 2 weeks
1 hour 3 hours
First peak
Laceration of brain brainstem
aorta spinal cord
heart Second peak
Extradural Subdural
Hemopneumothorax Pelvic fractures Long bone fractures Abdominal injuries
Third peak Sepsis
Multi organ failure
DEATHS
© ACS
9
The Doctors Must Learn to Recognize the Presence of Such Injuries
ATLS ………… ?
Occur in 85 % of patients who sustain blunt trauma
(multiple trauma).
Protect from futher disability.
Prevent complications.
© ACS
10
PATIENT ACUITY CATEGORY SCALE (PACS)
ATLS: A, B, C, D, E Priority:
B1 = Breath.
B2 = Blood B3 = Brain.
B4 = Bladder.
B5 = Bowel.
B6 = Bone.
KASUS,………
• Seorang laki laki 42Th ditemukan dgn
luka di pelipis kanan tertimpa reruntuhan atap. Pasen datang sendiri (berjalan) ke Posko kesehatan dan Mengeluh pusing, luka dangkal ukuran 3cm. Ditemukan
excoriasi di tangan dan siku kanan
• Dokter Relawan, langsung menjahit luka , memberi obat dn memulangkan pasen….
Kasus.. lanjutan
• Satu hari di rumah pasen datang kembali ke Posko krn pusingnya tdk hilang dan nyeri-nyeri tubuh.
• Pemeriksaan lengkap ditemukan ; Anamnesa, pemeriksaan fisik dan Diagnostik
• Fraktur os Temporal kanan dgn EDH dan Subluksasi TMJ kanan dan Fraktur
Klavikula kanan.
KASUS TERSERING TERGANTUNG MEKANISME TRAUMA Semua kasus ada : ringan sampai berat.
PENTING : Triage kasus (Hijau, Kuning, Merah, Hitam) TRAUMA EKSTREMITAS
Fraktur, Dislokasi, Sprain/Strain
TRAUMA TULANG BELAKANG dan CERVICAL Fraktur, Frankle A-E, Sciwora
TRAUMA KEPALA
Contusio, Fraktur, EDH, SDH,
TRAUMA M.S.K pd DISASTER
• Trauma Muskuloskeletal adalah cedera pada tulang, sendi dan jaringannya, bisa berupa
cedera tumpul, tajam dan
terbuka maupun tertutup
Jenis cedera ;
• Dislocation
• Fracture
• Ligament/
tendon rupture
• Strain- Sprain
• Contusion
• Inflammatio n
R Dick, et al. (2007) Descriptive Epidemiology of Collegiate Men’s Football Injuries: National Collegiate Athletic Association Injury Surveillance System, 1988–1989 Through 2003–2004. Journal of Athletic Training;42(2):221–
233
MJ. Rauh, et al. (2007) Subsequent Injury Patterns in Girls’ High School Sports. Journal of Athletic Training;42(4):486–494
Penanganan
• Pre Hospital
• Prinsip ATLS (Mekaanisme Injury)
• Trauma ekstremitas dan tulang belakang;
Immobilisasi (spalk, traksi, colar, spineboard, sling)
• Hospital
• Immobilisasi dan analgesia
• Optimalisasi
• Terapi definitif (Surgery ; Close/open reduction)
Prinsip Penanganan ;
• Diagnosis (Clinical &
Investigations)
• Immobilization and Analgesics
• Definitive treatment (ORIF/OREF, CR)
• Rehabilitation
Immobilisasi
• Prinsip Immobilisasi
• > Menahan pergerakan organ dlm safe position. 'Fixed two joint', tetapi tdk
merusak neurovaskular/soft tissue
• Spesifikasi bahan utk immobilisasi
• > Rigid, but soft utk area tonjolan tulang
• > Lapangan : Kayu, potongan besi, karton/kertas dll.
Shoulder Dislocation
Treatment
• Closed
reduction &
immobilisation
• Surgery for
neglected cases
Fracture
and fracture dislocation
Fracture & fracture dislocatiion
Treatment
• Sling
• Surgery:
TBW ,wiring, screw ,ORIF
Trauma Spinal
• Mekanisme Injury
• Jatuh dari ketinggian,direct trauma, share/
wiplash
• Tanda dan Gejala
• Tanda lokal, Gejala jauh (neurologis)
• Prinsip Penanganan :
• Immobilisasi
• Cegah edema bertambah
• Terapi definitif
AC & CC joint injury
Rupture AC Ligament &
CC Ligament
Ruptur e Tenton,Ligament & Muscle
Treatment Repair tendon /muscle compartement
(Fixation of bone)
Primary FTSG/STSG
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: 77–90.
Knee Ligament 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.
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): 67–81.
De Quervain syndrome
• Activity
modification
• Surgery:
release
N Barton (1997). Sports injuries of the hand and wrist.
Br J Sports Med. 1997 September; 31(3): 191–196.
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): 1531–1538.
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 2007;42(3):388–394
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 Res. 2009; 2: 27.
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 Musculoskelet Disord. 2007; 8: 36.
Ankle 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
Prinsip Penanganan ;
• Diagnosis (Clinical & Investigations)
• Immobilization and Analgesics (RICE)
• Definitive treatment (ORIF/OREF, CR)
• Rehabilitation
