DIRECT

FORCE / LANGSUNG INDIRECT FORCE / TIDAK LANGSUNG

TWISTING/PUNTIRAN SPIRAL BENDING/TEKUKAN TRANSVERSE BENDING COMPRESSING - TEKANAN COMBINATION OF TWISTING, BENDING AND COMPRESSING PULLING/TARIKAN

I.

Berdasarkan hub dengan dunia luar :

1.Fraktur tertutup

2. Fraktur terbuka

Gustillo Anderson :
I. Luka < 1 cm II. Luka 1 10 cm III. Luka > 10 cm

A. Soft tissue coverage B. Bone exposed C. Neurovascular injury

 Gustillo

Anderson :

 Fractures

may occur even with normal stresses if the bone has been weakened (by a tumor) or if it is excessivelly brittle (pagets disease)

II.

Berdasarkan garis patah 2.Inkomplet

1.Komplet

III.

Jumlah garis patah

1. Simple

2. Komunitif

3. Segmental
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IV.

Arah garis patah

1. Transversal 2. Oblique 3. Spiral

4. Kompresi
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V.

Lokasi
1. Tulang Panjang 1/3 proksimal 1/3 tengah 1/3 distal 2. Tulang Melintang 1/4 medial 1/4 lateral

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VI.

Dislokasi Fragmen
Undisplaced Displaced

Fragmen tlg searah (ad latus) Fragmen tlg membentuk sudut (ad axim) Fragmen distal memutar (ad periferum)

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PENYEMBUHAN FRAKTUR
1. Std. Destruksi / Hematom 2. Std. Inflamasi & Proliferasi sel 3. Std. Pembentukan kalus 4. Std. Konsolidasi 5. Std. Remodelling

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Fraktur

Union

Konsolidasi

Remodelling
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 Motion

/ pergerakan Infection / infeksi Gap / celah Others (Metabolik, Umur, Keadaan umum) Gangguan vaskularisasi

Upper limb
Callus visible on x-ray 2-3 weeks

Lower limb
2 - 3 weeks 8 - 12 weeks

Union (fracture 4-6 weeks firm)

Consolidation (bone secure)

6-8 weeks

12 - 16 weeks

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Causes of non union Distraction and separation of the fragments Interposition of soft tissue between the fragments Excessive movement at fracture line Poor blood supply

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Umur, jenis kelamin Pendidikan rumah Riwayat trauma:

Arah Jenis

- Pekerjaan - Lingkungan

- Lokalisasi nyeri

- Gangguan fungsi

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- Arah, kecepatan dan kekuatan dari tenaga yang melawan tulang - Usia penderita - Kelenturan tulang - Jenis tulang

Move :
Nyeri gerak Sensorik Motorik

aktif pasif

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 Radilogy CT MRI Radioisotope

scan scanning

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PRINCIPLES OF FRACTURE TREATMENT

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 Make

sure that the airway is clear If there is a wound, cover it with clean material Stop bleeding by local compression Give something for pain If the neck or the bak is injured, prevent flexion which may damage the spinal cord If there is fracture,prevent movement

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Examine the airway and treat asphyxia Make sure the patient can breathe Note the obvious haemorrhage and stop it Assess the degree of blood loss and shock Check for spinal cord injury Look for injuries of abdominal or pelvic viscera Examine for the presence of fractures or dislocation Look for soft tissue complications, especially nerve and vascular injury Arrange for an x-ray

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 Manipulation

to improve the position of the fragments, followed by splintage to hold them together until they unite; meanwhile joint movement and function must be preserved

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Mengembalikan kedudukan tulang Cara :

Manual
Traksi

Operatif
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 Anak

dalam masa pertumbuhan Impending infeksi Jenis fraktur tidak cocok untuk ORIF Toleransi operasi tidak baik Pasien menolak operasi

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 CLOSED

TREATMENT OPEN REDUCTION INTERNAL FIXATION OPEN REDUCTION EXTERNAL FIXATION

CARA GIP

Stockingette

Padding

PLESTER SLAB

Bryant s / Gallows traction

Buck Extension

 Sukar

reposisi tertutup Fraktur multipel Fraktur patologis Fraktur intra artikular

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 In

order to unite, a fracture must be imobilized We splint most fractures, not to ensure union but (1) to alliviate pain and (2) to ensure that union takes place in good position

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# #

that cannot be reduced except by operation that inherently unstable and prone to redisplacemaent after reduction (#mid shaft forearm) # that unite poorly and take long time (# femoral neck) Pathological # Multiple # # in patients who prsent nursing difficulties (paraplegics, multiple injuries and very elderly

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Plate - screw

Fixasi External

ORIF (OPEN REDUCTION AND INTERNAL FIXATION)

 INFECTION

UNION IMPLANT FAILURE REFRACTURE

NON

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associated wih severe soft tissue damage # associated with nerve or vessel damage Severely comminuted and unstable # # pelvis Infected #

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 Overdistraction Reduced

load transmission trough bone, which delays fracture healing causes osteoporosis (EF shoul be removed after 6-8 wo,and replace) Pin tract infection

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 EMERGENCY GOLDEN

PERIOD 6 8 HO

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 Is

circulation intact ? Peripheral nerve intact ? State of skin arround the wound Does the wound communicate with # ?

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 Perbaiki

KU Debridement, kultur/resistensi ATS-Toxoid, Antibiotik Tutup luka dengan kasa bersih Reposisi Imobilisasi

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 Antibiotics

: asap, combination ampicilline and cloxacillin, given 6ho; if wound heavily contaminated, give gentamycin or metronidazole for 4-5 do Tetanus prophylaxis

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 To

cleanse the wound of foreign material Remove devitalized tissue (debridement) 4 C : Colour Consistency Contractility Capacity of bleeding

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 Shock Crush

syndrome Venous thrombosis and pulmonary embolism Tetanus Gas gangrene Fat embolism

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 Infection Delayed Malunion Growth

union and non union

disturbance Avascular necrosis

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 Vascular

injury Compartement syndrome (Volkmanns ischaemia) Nerve injury Visceral injury Myositis osificans

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Arterial Damage

ischaemia

reduced blood flow

painful pale pulseless paresthetic paralysed

Direct Injury

oedema fasciotomy incr comp pressure

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 Joint

stiffness Osteoarthritis Sudecks atrophy

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TIDAK ADA PR

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