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MSK TRAUMA ATLS 9th Ed
Transcript of MSK TRAUMA ATLS 9th Ed
Open vs Closed
Classification of Open Fracture Type - Gustillo Anderson POST debridement
Skin opening of 1 cm or less, quite clean.
Laceration more than 1 cm long, with extensive soft tissue damage, flaps, or avulsion.
Extensive soft tissue damage including muscles, skin, and neurovascular structures. Often a high-velocity injury with severe crushing component.
Type IIIA Extensive soft tissue laceration,
adequate bone coverage.
Type IIIB Extensive soft tissue injury with
periosteal stripping and bone exposure.
Vascular injury requiring repair.
Explain the significance of musculoskeletal in patients with multiple injuries.
& C-spine control
& Haemorhage Control
Chest, Pelvic Xray
A condition where the pressure within an enclosed anatomical compartment rises sufficiently to obstruct the micro-vascular circulation causing tissue ischemia and, if left untreated, necrosis.
Tissue pressures > 35 to 45 mm Hg
Radiographs do not show severed nerves, crushed muscles, ruptured blood vessels or torn ligaments, any more than they tell whether a wound is contaminated, how the injury occurred or how it should be treated.
Injuries to the appendicular musculoskeletal system occur in many patients who sustain blunt trauma; they often appear dramatic, but rarely cause an immediate threat to life or limb.
Pelvic fractures and femur fractures are an important and often unrecognized source of shock.
ATLS 9 Edition
Identify Life and Limb Threatening Injuries
What are the Strategies for MX MSK Inuries?
A wall collapses on a 44-year-old male worker
Blood pressure: 130/75;
Pulse: 110 Respiratory rate: 22
GCS score: 15
Painful, bruised, deformed left leg
What are your priorities?
Is this life- or limb-threatening?
What impact do musculoskeletal injuries have on the primary survey?
Stop and Splint
Prevents further blood loss and injury
Can restore or maintain perfusion
Important during evaluation
Do not delay
Preinjury status and predisposing factors
Mechanism of injury
Time of injury
Associated factors (e.g., environment)
Prehospital observations and care
Assess by doppler
Ankle / brachial index
Obtain vascular input
Apply appropriate splint
Photo. Betadine dressing.
Consider time factor
Obtain orthopaedic input
Antibiotic / tetanus status
When do you get an X-ray?
When the pt is haemodynamically N
What X-ray do I Need?
Any area - one joint above, and one below.
When shall I wait?
If life-threatening injuries take priority
If patient transfer will be delayed
What injuries can cause
Tibia, forearm fractures
Vascular and bony injuries
Injuries immobilized in tight dressings or casts
Severe crush injuries
Musculoskeletal injuries may pose delayed threats to life and limb.
Stop the bleeding!
Reduce and immobilise fractures and dislocations
Recognise open #s & vascular compromise
Consider compartment syndrome
ATLS 9th Edition
Remember to Document
Crush injuries / myoglobinuria
Occult fractures / soft tissue injuries
Rej Bhumbra PhD FRCS (Tr & Orth)
Consultant Orthopaedic Surgeon
Barts Health NHS Trust