FRAKTUR UMUM
DR. WAHYU EKO W, SPOT
ORTHOPAEDI DAN TULANG BELAKANG
RS BINA HUSADA
FRAKTUR
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KLASIFIKASI
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I.
1.Fraktur
tertutup
2. Fraktur
terbuka
KLASIFIKASI
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Gustillo Anderson :
I.
II.
III.
Luka < 1 cm
Luka 1 10 cm
Luka > 10 cm
A. Soft tissue coverage
B. Bone exposed
C. Neurovascular injury
KLASIFIKASI
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Gustillo Anderson :
Pathological fractures
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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
KLASIFIKASI
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III.
1. Simple
2. Komunitif
SMF Bedah FK UKI
3. Segmental
KLASIFIKASI
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IV.
4. Kompresi
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
KLASIFIKASI
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Dislokasi Fragmen
VI.
Undisplaced
Displaced
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Stadium Penyembuhan
Fraktur
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Time table
Upper limb
Callus visible 2-3 weeks
on x-ray
Union
4-6 weeks
(fracture
firm)
Consolidation 6-8 weeks
(bone secure)
SMF Bedah FK UKI
Lower limb
2 - 3 weeks
8 - 12
weeks
12 - 16
weeks
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are
Placed in contact with each other
and
Held more or less immobile until new
bone formation is apparent
Anamnesa
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ANAMNESIS
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- Pekerjaan
- Lingkungan
Arah
Jenis
- Lokalisasi nyeri
- Gangguan fungsi
SMF Bedah FK UKI
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
Look
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Swelling,
bruising,
Deformity
Skin intact ?
Feel
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Local tenderness
Examine distal to the fracture in
order to feel the pulse and test the
sensation
Compartement syndrome ?
Move
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Pemeriksaan Fisik
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Move :
Nyeri gerak
Sensorik
Motorik
aktif
pasif
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
RADIOLOGI
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Rule of 2 :
2 proyeksi
2 sendi
2 ekstremitas
2 waktu
PRINCIPLES OF
FRACTURE TREATMENT
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First aid
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Assesment in hospital
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Reposisi
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Cara :
Manual
Traksi
Operatif
SMF Bedah FK UKI
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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Reposisi
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Reposisi
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Indikasi konservatif
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Indikasi Operasi
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HOLD REDUCTION
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Immobilisasi
(mempertahankan reposisi)
Fiksasi eksterna
Gips
Roger Anderson
Fiksasi interna
Plate + Screw
K-nail
SMF Bedah FK UKI
ORIF ; indications
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ORIF; complications
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INFECTION
NON UNION
IMPLANT FAILURE
REFRACTURE
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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
OPEN FRACTURE
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EMERGENCY
GOLDEN PERIOD 6 8 HO
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OPEN FRACTURE;
assesment
Is circulation intact ?
Peripheral nerve intact ?
State of skin arround the wound
Does the wound communicate with
# ?
Fraktur Terbuka
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Perbaiki KU
Debridement, kultur/resistensi
ATS-Toxoid, Antibiotik
Tutup luka dengan kasa bersih
Reposisi
Imobilisasi
ANTIBACTERIAL
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TREATMENT OF WOUND
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Consistency
Contractility
Capacity of bleeding
SMF Bedah FK UKI
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Complications of fracture
General complication
Shock
Crush syndrome
Venous thrombosis and pulmonary
embolism
Tetanus
Gas gangrene
Fat embolism
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Complication involving #
bone
Infection
Delayed union and non union
Malunion
Growth disturbance
Avascular necrosis
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Vascular injury
Compartement syndrome (Volkmanns
ischaemia)
Nerve injury
Visceral injury
Myositis osificans
Compartement syndrome
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Arterial
ischaemia
Damage
reduced
blood flow
painful
pale
pulseless
paresthetic
paralysed
Direct
Injury
oedema
fasciotomy
incr comp pressure
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Complication involving
joints
Joint stiffness
Osteoarthritis
Sudecks atrophy
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?
SMF Bedah FK UKI
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TERIMA
KASIH
Created by : Tepeng
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