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Dr.Wahyu Eko Widiharso, Sp.

OT

RS.BINA HUSADA 2011

SMF Bedah FK UKI

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

SMF Bedah FK UKI

DEFINITION

PICTURE

DEFINITION is break of bone, epifisis and cartilage adjacent with outside .

CAUSE BY: TRAFFIC ACCIDENT/TRAUMA

ANKLE

TIBIA

Gustilo Classification I Low energy, wound less than 1 cm II Wound greater than 1 cm with moderate soft tissue damage High energy wound greater than 1 cm with extensive soft tissue damage III IIIA IIIB IIIC Adequate soft tissue cover Inadequate soft tissue cover Associated with arterial injury

I.

Berdasarkan hub dengan dunia luar :

1.Fraktur tertutup

2. Fraktur terbuka

SMF Bedah FK UKI

COMPLETE/ UNCOMPLETE FRACTURE LINE FORM FRACTURE LINE DISPLACED /UNDISPLACED CLOSED OR OPEN FRACTURE

Anamnesa Pemeriksaan Fisik A.GENERAL EXAMINATION. B.LOCAL EXAMINATION. Pemeriksaan X`ray

TRAUMA

:KLL/ non KLL

MEKANISME TRAUMA

POLYTRAUMA, MULTIPLE FRACTURE, OR LOCAL FRACTURE. PAIN


HILANGNYA FUNGSI LUKA

ATLS ABCD C-SPINE EXAMINATION OF HEAD,CHEST,ABDOMEN MULTIPLE TRAUMA/FRACTURE SHOCK

OPEN FRACTURE

IN THE SCENE

LOOK FEEL MOVE

DEFORMITY
abnormal MOVEMENT , angulation, rotation dan discrepency

FUNGSIOLAESA lost of function

Pressure pain dan axial pain

Crepitation Pain of movement ROM and Strengt of muscle Abnormal movement.

Classical fracture easy to diagnose Non Classical Fractur need radiological examination Minimal 2 AP/Lateral projection Axial, alar and obturator. Chidren : need opposite side

Include 2 joint

TO PROMOTE HEALING AND FUNCTION OF BONE AS SOON AS POSSIBLE.

1.RELEAVE PAIN 2.GOOD REPOSITION 3.PROMOTE HEALING 4.PROMOTE FUNCTION 5.REHABILITATION

1.OPEN FRACTURE IS EMERGENCY CASE 2.INITIAL EVALUATION (ATLS) 3.ANTIBIOTIC FROM EMERGENCY ROOM, OPERATING THEATER AND POST OPERATION 4.ADEQUATE DEBRIDEMENT DAN IRIGATION 5.REPEAT DEBRIDEMEN (24-72 HOURS)

6.Fracture stabilisation 7.Open wound 5-7 days 8.Bone Graft 9.Rehabilitation

1.WOUND CLEANING MECHANICAL IRIGATION WITH Na Cl TO REMOVED STRANGE BODY

2.DEBRIDEMENT

3.STABILIZATION

TISSUE NECROTIC EXC. NO VASC.TISSUE SKIN, SUB CUTAN, FAT, FASCIA AND MUCLE BONE FRAGMENT

GRADE I INTERNAL FIKSASI

GRADE II/III EXTERNAL FIXATION TRACTION

4.WOUND CLOSURE

5.antibitic

Golden period 6-7 hours Leave it open Skin graft

Prevent infection Broad spectrum Cephalosporin Aminogcoside

3-5 days

Prevent Anti Tetanus

ATS/Toxoid Rural area accident give Penicilin procain

EARLY COMPLICATION 1.LOCAL VASKULAR : COMPARTMENT SYND


TRAUMA VARKULAR

NEUROLOGIS : LESI MED.SPINAL


2.SISTEMIC : FAT EMBOLISM ,SHOCK BLEEDING, SEPSIS AND DEATH. Tetanus Ganggren.

LATE COMPLICATION JOINT STIFFNESS/CONTRACTURE DISUSE ATROFI MALUNION NONUNION DELAYED UNION GROWTH DISTURBANCE CHRONIC OSTEOMYELITIS

DIAGNOSA FRAKTUR : Historycal examination Physical examination Radiological examination Open fracture Managemen Fracture Complication

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