OTHER EXTREMITY OK Ilham A Irsyam, dr, SpOT

INJURIES
OUTLINE
Contusions and Lacerations
Joint Injuries
Fractures
Principle of Immobilization
Pain Control
 Contusion occur when a direct blow or
repeated blows from a blunt object strike
part of the body, crushing underlying
muscle fibers and connective tissue
without breaking the skin that causes
bleeding within the muscle or the
connective tissue
BEWARE : Check for closed degloving
TREATMENT :
R : REST
I : ICE
C : COMPRESSION
E : ELEVATION
CONTUSIONS DO NOT HARM
HEAT. ALCOHOL. RUNNING. MASSAGE
 Laceration is a cut or
tearing of the soft tissue
caused by a sharp object.
SKIN
NERVE
TENDON
MUSCLE
ARTERY
Copyright © Nucleus Medical Media,
Inc. SKIN LACERATION.
• CHECK THE DEPTH OF THE
WOUND
• PRESSURE TO STOP THE
BLEEDING

LACERATION • DEBRIDE AND PRIMARY

CLOSURE IF IT IS ABOVE THE
FASCIA
JOINT
INJURIES
Ligament
H
R -- REST
HEAT injuries
I -Sprain
A -ICING
ALCOHOL
CStrain
R - RUNNING
COMPRESSION
Rupture
M
E - -ELEVATION
MASSAGE

Subluxation/Dislocation Habitual Dislocation Treatment

 Subluxation is partially  Immediate reduction is a must

displaced articular surface.
 Dislocation is completely
displaced articular surface
Dislocation due to ligamentous
laxity
Reccurent Dislocation
Dislocation due to damaged
ligament and joint margin such
as capsule or muscle
 General anesthesia and muscle
relaxant usually required
Open Reduction is performed if
closed mean is failed
 Reduction is followed by 2
weeks immobilization for soft
tissue healing
FRACTURES
Discontinuity of the bone

R – ecognize Splinting
 Hx taking, Px exam, Dx studies  Evaluate the NVD and bleeding
 Open or Close fracture control
R – educe  Traction and reposition with
 Initial immobilization with traction and analgesia if possible
splinting
 Immobilize above and below joints,
Aim : adequate apposition and normal beware of being TOO TIGHT or
alignment STRANGULATION
R- etain
 RE-evaluate NVD
 DO NO HARM
R - ehabilitation
 FRACTURES, IS IT
ALWAYS SURGERY?
CLAVICLE
FRACTURE
• Conservative by arm sling or ransel velband
• Indication for surgery (ORIF plating, k-wire, TBW,
screwing)
• Open fracture
• Associated NVD injury
• High demand patient
• Skin tenting
• Distracted by 2 cm
• Associated Superior Suspensatory Shoulder Complex
HUMERAL • Conservative by U slab, hanging cast or
functional brace
FRACTURE • Indication for surgery (ORIF plating or nailing)
• Open fracture
• Associated NVD injury
• High demand patient
• Failed in conservative
 Conservative treatment
does not have an
excellent outcome
• Indication for surgery
(ORIF plating or nailing)
• Open fracture
• Associated NVD injury
• High demand patient
• Galeazzi fracture
• Monteggia fracture
• Both bone fracture

FOREARM FRACTURE
 FEMORAL
FRACTURE
• Conservative only in children
• Adult fracture needs surgery due to
strong deforming force
• Indication for surgery (ORIF plating and/
or nailing)
LOWER LEG
FRACTURE
• Conservative by Long Leg Cast
• Indication for surgery (External fixation or ORIF
plating, nailing, nail and plate)
• Open fracture
• Associated NVD injury
• High demand patient
• Isolated tibia fracture
• Unstable fracture
INTRA-ARTICULAR
FRACTURE
• Conservative only in low demand patients or
non-displaced fractures
• Principle of management
• Anatomical Reduction
• Absolute Stability
• Early Range of Motion Exercise

• All three principle can only be achieved by

surgery
• CT-Scan is mandatory
• Often result in post-traumatic OA and joint
stiffness

IMMOBILIZATION
Splinting, Bracing and Casting
Cast is a stress sharing device that
immobilize the joint above and below
the fractures to prevent rotation and
translation of the fracture fragment

Splint are used to immobilize and

position one or several joints
Braces are devices that stop or limit
range of motio, facilitate or guide a
joint through an arc of motion

Splints and braces are used to

protect a fractured or partially healed
fractured bones.
PAIN MANAGEMENT
 Pain is the 5th vital sign
 IV analgesia
 Start from the bottom
 Be aware of the side effect
 Inhalational analgesia
 Nerve/Regional blocks WHO Pain Ladder
 Risk of Masking of
Compartment Syndrome
THANK YOU