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FRAKTUR UMUM

DR. WAHYU EKO W, SPOT

ORTHOPAEDI DAN TULANG BELAKANG

RS BINA HUSADA
2 SMF Bedah FK UKI
 FRAKTUR
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Putusnya hubungan kesinambungan/

diskontinuitas tulang dan atau tulang
rawan

Fraktur tertutup :Bila kulit sekitar intak

Fraktur terbuka :Bila ada luka,
sehingga kemungkinan terjadi
kontaminasi atau infeksi

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 KLASIFIKASI
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I. Berdasarkan hub dengan dunia luar :

1.Fraktur 2. Fraktur
tertutup terbuka

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 KLASIFIKASI
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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

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 KLASIFIKASI
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Gustillo Anderson :

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 Fractures due to a traumatic
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incident

Caused by sudden and exessive force,

which may be tapping, crushing,
bending, twisting or pulling.

Direct violence : blow on the arm which

shatters the ulna at the point of impact
Indirect violence: forcible traction by a
tendon or ligament which literally pulls
the bone apart
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 Fatigue or stress fractures
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Due to repetitive stress

Most often seen in the tibia or fibula
or metatarsals, especially in atheletes,
dancers and army recruits.

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 Pathological fractures
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Fractures may occur even with

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

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 How fractures are
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Complete fractures
The bone is compeletely broken into 2
or more fragments.
Transverse
oblique or spiral,
Impacted fracture
Comminuted fracture

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 Incomplete fracture
The bone is incompeletely divided
and the periosteum remains in
continuity.
Greenstick fracture
Compression fracture

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KLASIFIKASI
II. Berdasarkan
garis patah

1.Komplet 2.Inkomplet

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 KLASIFIKASI
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III. Jumlah garis patah

1. Simple 2. Komunitif 3. Segmental

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 KLASIFIKASI
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IV. Arah garis patah

1. Transversal 2. Oblique 3. Spiral 4. Kompresi

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 KLASIFIKASI
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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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 KLASIFIKASI
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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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 How fractures heal
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Tissue destruction and haematoma

formation
Inflamation and cellular proliferation
Callus formation
Consolidation
Remodelling

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 Stadium Penyembuhan
18 Fraktur

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 Healing by direct repair
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Fractures of cancellous bone

Fractures treated by rigid internal
fixation

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 The time factor
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Rate of repair depends upon :

the type of bone (cancellous bone heals

faster than cortical bone.

type of fracture (transverse fracture takes

longer than spiral fracture)

Blood supply (poor circulation means slow

healing)
General constitution (healthy bone heals

faster
Age (healing is almost twice as fast in

children as in adults)
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Time table
Upper limb Lower limb
Callus visible 2-3 weeks 2 - 3 weeks
on x-ray
Union 4-6 weeks 8 - 12
(fracture weeks
firm)
Consolidation 6-8 weeks 12 - 16
(bone secure) weeks

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 Fractures that fail to unite
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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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 Most fracture will unite
23 provide the bone fragments
are
Placed in contact with each other
and
Held more or less immobile until new
bone formation is apparent

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 Anamnesa
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The fracture is not always at the site

of the injury

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 ANAMNESIS
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- Umur, jenis kelamin - Pekerjaan

- Pendidikan - Lingkungan
rumah
- Riwayat trauma:
Arah
Jenis
- Lokalisasi nyeri - Gangguan fungsi

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 Examination
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General signs
A broken bone is part of a patient. It is
important to look for evidence of :
(1) shock or haemorrhage; (2)
associted damage to brain, spinal cord
or viscera; and (3) a prediposing cause

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 Look
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Swelling,
bruising,
Deformity
Skin intact ?

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 Feel
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Local tenderness
Examine distal to the fracture in
order to feel the pulse and test the
sensation
Compartement syndrome ?

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 Move
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Crepitus and abnormal movement may

be present, but it is more important to
ask if the patient can move the joint
distal to injury

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 Pemeriksaan Fisik
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Move :
aktif
Nyeri gerak
Sensorik
pasif
Motorik

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 Bekas dukun
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 Bekas dukun
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 Xray
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 Special imaging
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Tomography
CT- scan
MRI
Radioisotope scanning

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 RADIOLOGI
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Rule of 2 :
2 proyeksi

2 sendi

2 ekstremitas

2 waktu

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 PRINCIPLES OF
FRACTURE TREATMENT

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 First aid
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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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 Assesment in hospital
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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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 Definitive treatment of closed
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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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 Reposisi
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Mengembalikan kedudukan tulang

Cara :
Manual
Traksi
Operatif

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 Fracture involving an
articular surface; this should
be reduced as near to
perfection as possible
because any irregularity will

predispose to degenerative
arthritis

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 Closed reduction
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The distal part of limb is pulled in the

line of the bone
As the fragment disengage, they are
repositioned
Alignment is adjusted in each plane

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 Reposisi
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 Reposisi
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Keberhasilan dinilai dari :

Alignment

Contact > 50 %

Rotation (-)

Discrepancy (-)

Sudut < 15

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 Indikasi konservatif
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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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 Indikasi Operasi
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Sukar reposisi tertutup

Fraktur multipel
Fraktur patologis
Fraktur intra artikular

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 HOLD REDUCTION
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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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 Immobilisasi
48 (mempertahankan reposisi)
Fiksasi eksterna
Gips
Roger Anderson
Fiksasi interna
Plate + Screw
K-nail

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 ORIF ; indications
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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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 ORIF; complications
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INFECTION
NON UNION
IMPLANT FAILURE
REFRACTURE

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 OREF (open reduction external
51 fixation) ; indications
# associated wih severe soft tissue
damage
# associated with nerve or vessel
damage
Severely comminuted and unstable #
# pelvis
Infected #

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 Fr Collim Femur
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 OREF ; Complication
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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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 OPEN FRACTURE
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EMERGENCY
GOLDEN PERIOD 6 8 HO

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 OPEN FRACTURE;
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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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 Fraktur Terbuka
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Perbaiki KU
Debridement, kultur/resistensi
ATS-Toxoid, Antibiotik
Tutup luka dengan kasa bersih
Reposisi
Imobilisasi

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 ANTIBACTERIAL
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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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 TREATMENT OF WOUND
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To cleanse the wound of foreign

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

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 Complications of fracture
60 General complication
Shock
Crush syndrome
Venous thrombosis and pulmonary
embolism
Tetanus
Gas gangrene
Fat embolism

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 Complication involving #
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Infection
Delayed union and non union
Malunion
Growth disturbance
Avascular necrosis

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 Complication involving soft
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Vascular injury
Compartement syndrome (Volkmanns
ischaemia)
Nerve injury
Visceral injury
Myositis osificans

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 Compartement syndrome
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Arterial ischaemia reduced painful

Damage blood flow pale

pulseless

paresthetic
paralysed
Direct oedema
Injury fasciotomy

incr comp pressure

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 Complication involving
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Joint stiffness
Osteoarthritis
Sudecks atrophy

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 ?
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TERIMA
KASIH

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Created by : Tepeng
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