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(البقرة الآية: 156-157)

بسم الله الرحمن الرحيم. الذين اذا أصابتهم مصيبة قالوا انا لله وانا اليه راجعون0 أولئك عليهم صلوات من ربهم ورحمة وأولئك هم المهتدون0. (البقرة الآية: 156-157). Musculo-Skeletal Trauma. Dr. Abdullah H.A. Juma FRCS(Ed.) Associate Professor and Consultant Orthopedic surgery. Trauma:.

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(البقرة الآية: 156-157)

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  1. بسم الله الرحمن الرحيم الذين اذا أصابتهم مصيبة قالوا انا لله وانا اليه راجعون0 أولئك عليهم صلوات من ربهم ورحمة وأولئك هم المهتدون0 (البقرة الآية: 156-157)

  2. Musculo-Skeletal Trauma Dr. Abdullah H.A. JumaFRCS(Ed.)Associate Professor and Consultant Orthopedic surgery

  3. Trauma: Musculo-skeletal Trauma • T = Taker. • R = Rural. • A = And. • U = Urban. • M = Mankind. • A = Assets.

  4. Musculo-skeletal Trauma Trauma: • Is an epidemic phenomenon with a widespread global distribution affecting both sexes and all ages.

  5. Musculo-skeletal Trauma Types: • RTA, MVA. • Domestic. • Sports. • Occupational. • Industrial. • War. • Natural disaster.

  6. Musculo-skeletal Trauma RTA & MVA

  7. Musculo-skeletal Trauma

  8. Musculo-skeletal Trauma

  9. Musculo-skeletal Trauma Domestic

  10. Musculo-skeletal Trauma

  11. Musculo-skeletal Trauma Sports

  12. Musculo-skeletal Trauma

  13. Musculo-skeletal Trauma

  14. Musculo-skeletal Trauma Occupational

  15. Musculo-skeletal Trauma

  16. Musculo-skeletal Trauma Industrial

  17. Musculo-skeletal Trauma

  18. Musculo-skeletal Trauma War

  19. Musculo-skeletal Trauma

  20. Musculo-skeletal Trauma Natural disasters

  21. Musculo-skeletal Trauma

  22. Open fracture

  23. Musculo-skeletal Trauma Classification according to order of priority in management: • Highest priority: • Cervical spine injury. • Respiratory impairment. • Cardiovascular insufficiency. • Severe external haemorrhage. Larkin J and Moylan J: (1973): Priorities in management of trauma victims. Critical Care Medicine, 3: 192-195.

  24. Musculo-skeletal Trauma Classification according to order of priority in management:(Cont.) • High priority: • Intraperitoneal injuries. • Retroperitoneal injuries. • Brain and spinal cord injuries. • Severe burns, or extensive soft tissue injuries. (Larkin and Moylan, 1973)

  25. Musculo-skeletal Trauma Classification according to order of priority in management: (Cont.) • Low priority: • Lower genito-urinary tract injuries. • Peripheral vascular, nerve and tendon injuries. • Fractures, dislocations. • Facial and soft tissue injuries. • Tetanus prophylaxis. (Larkin and Moylan, 1973)

  26. Musculo-skeletal Trauma Injury Severity Score (ISS) (Baker et al., 1997): Baker SP, O’neill B, Haddow W and Long WB (1974): The injury severity score : A method for describing patients with multiple injuries and evaluating emergency care. J.Trauma, 14:187-196.

  27. Musculo-skeletal Trauma Triage Score (Champion et al., 1980): Champion HR, Sacco WJ, Hannan DS, Lepper RL, Atzinger ES, Copes WS and Proll RH(1980): Assessment of injury severity: The Triage Index. Critical Care Medicine, 8: 201-208.

  28. Musculo-skeletal Trauma Glasgow Coma Scale (Teasdale and Jennet, 1974) Teasdale G and Jennet B (1974): Assessment of coma and impaired consciousness. Lancet, 2: 81-84.

  29. Musculo-skeletal Trauma • Polytraumatized or multiple injury patients possess the most critical decision and management. • A trauma centre, well equipped, well staffed, highly experienced personnel, easy and fast accessibility with multi-system and multi-speciality medical care should be available.

  30. Musculo-skeletal Trauma CONCLUSION: • The aim of treatment will be: • Prevention of accidents and trauma to occur. • Prevention of further damage to the human skeleton. • Prevention of recurrence of trauma.

  31. Supportive Care: Musculo-skeletal Trauma • “Remember, we are human beings, having our own limitations, but fully responsible of providing our best care. (A.Juma) • “I treated him . . . God cured him” (Ambroise Pare’ 1510-90)

  32. These supportive Care Include: Musculo-skeletal Trauma • Pulmonary support. • Cardiovascular support. • Renal support. • Hepatic support. • Nutritional support. • Metabolic support. • Musculo-skeletal and rehabilitative support. • Psychological support.

  33. Musculo-skeletal Trauma Relationship between mean daily urine nitrogen excretion for 7 days postoperatively, the blood level of branched chain a.a. on the 7th after injury and the initial ketone body levels.

  34. Musculo-skeletal Trauma The concentrated ketone bodies in the blood of patients after injury

  35. Musculo-skeletal Trauma Changes in the blood brached chain a.a. after injury

  36. Musculo-skeletal Trauma The mean excretion of 3-methylhistidine in the urine in ten injured patients without hyperketonaemia

  37. Musculo-skeletal Trauma The variation in the phases of injury according to its nature

  38. Musculo-skeletal Trauma Some effects of burns on hormonal control

  39. Musculo-skeletal Trauma Fat can not be used as a source of glucose

  40. Musculo-skeletal Trauma Relationship between hormones and substrates in man

  41. Musculo-skeletal Trauma Methylhistidine

  42. Musculo-skeletal Trauma Metabolic pathways of animo acids

  43. Musculo-skeletal Trauma The central position of the liver as a transformer between fuel supply and fuel consumers

  44. Musculo-skeletal Trauma Diagrammatic representation of some changes in body composition induced by severe injury

  45. Musculo-skeletal Trauma Musculoskeletal trauma has a special consideration and challenges in: • Multiple fractures especially when involving long bones, especially in lower extremities. • Spinal injuries with its risk to the neural elements. • Pelvic injuries with its impact on the contained viscera. • Complicated fractures by vascular, neurological and soft tissue damage.

  46. Musculo-skeletal Trauma Musculoskeletal trauma has a special consideration and challenges in: • Open fractures especially grade II, III A,B,C. • Contamination yielding to infections. • Fractures involving joints. • Fractures with bone losses. • Mismanaged bones and joints after injury.

  47. Musculo-skeletal Trauma Musculoskeletal trauma has a special consideration and challenges in: • Complications of fracture healing. • Medical diseases imposing variable threats to the victims of bone and joint injury. • The availability versus lack of instrumentation, implants, expertise, medical and paramedical staff.

  48. Musculo-skeletal Trauma Management will depend on: • First aid and ATLS measures provided in situ at the site of accident. • Access and effective transfer into a trauma center. • Thorough and careful assessment of the patient using different score systems. • Detailed study of the type of fractures, plan and timing of intervention.

  49. Musculo-skeletal Trauma Based on this, treatment will proceed to: • Reduction (closed vs. open). • Immobilization (closed vs. open). • Rehabilitation.

  50. Musculo-skeletal Trauma CONCLUSION: • Prevention of the risk factors causing injuries.These can be accessible in 30% of the cases, whereas the rest of them need public and governmental support.

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