SPORTS INJURY I Dr.RAJAT JANGIR JAIPUR #aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur #allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon To Know more about ACL Injury, Click the links below: 1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all" https://youtu.be/oWkIr8IXvr8 2. Everything about ACL Injury tear surgery in Hindi I https://youtu.be/bqpjkAkwZ14 3. Best Screw for ACL tear surgery in Hindi https://youtu.be/1LGpU1NHiIs 4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir https://youtu.be/SIAPWiMbOqs 5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ? https://youtu.be/NEJRPKskJTI 6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ? https://youtu.be/EXpgy19Jxzw 7. PRP injection therapy in Partial ACL TEARs https://youtu.be/qyG1EYgS87E Dr.RAJAT JANGIR(Asso Prof.) Senior Consultant Arthroscopy and Joint Replacement (Specialist in Shoulder Knee Hip Surgery) Ligament and Joints Clinic 67/34 Mansarovar Jaipur Whatsapp: shorturl.at/gnAEP Appointment: +91 8104855900 Email: ligamentsurgeon@gmail.com Google Page: https://g.page/KNEE-Shoulder-SURGERY?... Facebook: https://www.facebook.com/Ligamentandj... * Vast experience and specialisation in the field of Arthroscopy and sports surgery. * M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad * Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea * Diploma in Sports Medicine from InternationaI Olympic Committee * Invited as Athlete Medical Doctor at Rio Olympic 2016 * Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'

1. IMMOBILIZATION AND SHIFTINGIMMOBILIZATION AND SHIFTING
OF INJURED ATHELETEOF INJURED ATHELETE
Dr.RAJAT JANGIR
Consultant Arthroscopy and Orthopedic Surgeon
Saket Hospital, Mansarovar
Assistant Professor
Mahatma Gandhi Medical College, Jaipur
Fellowship In Arthroscopy(South Korea)
International Olympic Committee Diploma Sports Medicine(UK)
Sports Physician RIO Olympic 2016

2. Basic life support (BLS)
Advanced cardiac life support (ACLS)

3. What is the most dangerous sport?
Cheerleading

5. OVERALL APPROACHOVERALL APPROACH
Anticipate the worst
Never make any assumptions
History and Exam have to make
sense
Don’t take short cuts
Document frequently
TEAMWORK

6. INITIAL APPROACH INJUREDINITIAL APPROACH INJURED
ATHELETEATHELETE
Initial primary assessment
Rapid resuscitation
A more thorough secondary assessment
Followed by diagnostic tests and
disposition.

7. What will we see
1) Head and Spinal Trauma
2) Bony Injuries / Dislocations
3) Sprains and Strains
4) Soft Tissue Injuries
4Also, non traumatic problems including cardiac
problems, dehydration, asthma exacerbations

8. PRIMARY SURVEYPRIMARY SURVEY

9. PRIMARY SURVEYPRIMARY SURVEY
Collapsed athlete
Choking
Seizures
Motionless or moving patient - Grossly
deformed limb
Major bleed

10. On arrival – “Hello, are you OK”
RESPONSIVE (awake, can move, opens
eyes, moans, grunts, movement) or
UNRESPONSIVE
Breathing Normal or Breathing Abnormal

11. Unresponsive Breathing

12. Unresponsive not breathing

14. SECONDARY SURVEYSECONDARY SURVEY
History
Physical exam: head to toe
“Tubes OR fingers in every orifice”
Complete neurological exam
Special diagnosis tests
Re-evaluation

15. Glasgow Coma ScaleGlasgow Coma Scale
 EyesEyes
 ““Open your eyes”Open your eyes”
 VerbalVerbal
 ““What happened to you?”What happened to you?”
 Add “T” to score if intubatedAdd “T” to score if intubated
 MotorMotor
 ““Hold up two fingers”Hold up two fingers”

16. Secondary surveySecondary survey
History
“AMPLE”
A:Allergies
M:Medication currently being taken
P:Past illness and operations,pregnancy
L:Last meal
E:Event/Environment related to the injury

17. Secondary surveySecondary survey
HEAD
 Signs of skull base
fracture
 Pupillary size
 Hemorrhages of
conjunctiva/fundi
 Visual acuity
 Ocular movement
 Posterior scalp
laceration

18. Secondary surveySecondary survey
NECK
Cervical tenderness, subcutaneous
emphysema
Oesophageal injury
Tracheal/laryngeal injury
Carotid injury (penetrating/blunt)

19. Secondary surveySecondary survey
CHEST
 Inspect
 Palpate
 Percuss
 Auscultate
 Obtain x-rays

20. Secondary surveySecondary survey
ABDOMEN
 Inspect
 Auscultate
 Palpate
 Percuss
 Reevaluate
 Special studies

21. Secondary surveySecondary survey
Perineum:contusion,hematoma, laceration,urethral
blood
Rectum:sphincter tone,high riding prostate,pelvic
fracture,rectal wall integrity,blood
Vagina:blood,laceration

22. Secondary surveySecondary survey
Musculoskeletal
 Contusion, deformity
 Pain
 Perfusion
 Peripheral
neurovascular status
 X-ray

23. Head Trauma/Concussions
What is important for this patient?
What should we be assessing very carefully?

24. COLLISION
FALL ON HEAD

25. ConcussionConcussion
TRAUMATIC BRAIN INJURY
Most patients will not have LOC
No need for a head blow
to develop a concussion

26. History: SymptomsHistory: Symptoms
• Dizziness
• “Stunned”
• Confusion
• Forgetfulness
• Behavior or
mood changes

27. Physical examPhysical exam
Palpation
– Head, neck and upper
shoulders
– No need to do exertion
testing.
 If in doubt, sit out

28. Mental statusMental status
Orientation
– Place, time, situation
 Period, score, opponent
– Concentration
 Months of the year in reverse order
 Name 3 objects

29. Neurologic examNeurologic exam
Cranial nerves
Reflexes
Babinski
Balance Error Scoring System (BESS)
– Check balance in 2 legs, tandem and 1 leg
 Flat surface and high density foam

30. History: SymptomsHistory: Symptoms
Headache
Nausea
Double vision
Sensitivity to light or sounds

31. SECONDARY SURVEYSECONDARY SURVEY
The complete
history and
physical
examination

32. Principles of TreatmentPrinciples of Treatment
Protect spinal cord from secondary injury
We have little or no effect on primary
injury
Focus on prevention of secondary injury

33. Head/Neck Trauma Treatment
1) Careful attention to ABCs
1) Full Trauma Assessment
1) Careful attention to LOC, GCS
1) Maintain C-Spine
2) Complete Spine board immobilization
3) Watch for changes in mental status and vital signs

34. C CollarsC Collars
Philadelp
hia
Soft
Miam
i J
Aspen

35. Spine boardsSpine boards

36. Immobilize Everyone!Immobilize Everyone!
ATLS- Standard of care. Part of ABCDE
ACS (Published new guideline in 2013)
Prehospital Trauma Life Support (Until
2011)
National Association of Emergency
Medical Technicians

38. LogrollLogroll

40. LogrollLogroll

41. Good or bad?Good or bad?
Patients still should get spinal immobilization
because the benefits outweigh the risk
…......… right?

42. C-Spine Immobilization

43. Definitive Care in the FieldDefinitive Care in the Field
 PackagingPackaging
 Spinal immobilization if indicatedSpinal immobilization if indicated
 Splint musculoskeletal injuriesSplint musculoskeletal injuries
 Dress woundsDress wounds

44. TransportationTransportation
 ClosestClosest appropriateappropriate facilityfacility
 to reach trauma centerto reach trauma center
 Receiving facilities should be determined by localReceiving facilities should be determined by local
protocolprotocol
 ModeMode
 GroundGround
 AeromedicalAeromedical

45. Bony Injuries
1) Fractures/Breaks
A) Open
B) Closed
2) Dislocations

46. Fractures Treatment?
Open and Closed Fractures

47. Fractures Treatment?
1)Cover an open wound with dressing,
control bleeding and
do not try to push the bone back in

50. Fractures Treatment?
2) Elevation for if appropriate for wound
control

51. Fractures Treatment?
3) Immobilize the injury, checking for
distal pulses, motor function, and
sensation before and after splinting
(DNVS)

52. Fractures Treatment?
4) Fractures should not be reduced in the
field, but we can apply traction to one
type of fracture.

53. Dislocation Treatment?
1) Assess DNVS
1) Immobilize affected in position of comfort
1) Reassess DNVS
1) Apply Ice
1) Do not try to reduce the dislocation

54. 1) Be Creative (not overly creative)
1) Immobilization in a position - comfortable for the
patient, yet maintains stabilization and is safe for
transport
1) Loss of any aspect of DNVS is a bad splint
1) Immobilize proximal and distal joints if possible
1) There is never just one “right” splint
General Immobilisation Splinting Tips

55. Sprains and Strains
Strains (pulled muscle): tearing of the muscle fiber
from excessive stretch
Sprains: a stretch of tear of a ligament
Signs and Symptoms?
Pain
Swelling
Redness
Limited mobility

56. How bad can they be?

57. Treatment Sprains and Strains
1) Splinting affected area if necessary
2) Assess DNVS before and after
splinting
3) Ice/elevation
4) Discontinue activity

58. Methods of immobilizationMethods of immobilization
Splinting; wooden, commercial
Brace or support
Strap
Slab immobilization
 Cast immobilization
 Traction
 External fixation
 Open reduction and internal fixation

59. Purpose of immobilizationPurpose of immobilization
Temporary
Definite

62. A. Taylor brace
B. Chairback

63. C. Jewett hyperextension brace
D. Lumbosacral support

64. Strap immobilizationStrap immobilization
Figure of eight strap
Gibney’s strap
Velpeau’s strap
A band or slip used in attaching parts to each others

67. GibneyGibney’’s straps strap
Nondisplaced fracture of ankle
Ankle Sprain

70. VelpeauVelpeau’’s straps strap
Injury of
shoulder
region

71. Take Home MessageTake Home Message
ABCDE
Cervical Collar Application
Logroll Shifting