KONSEP DAN JURNAL FRAKTUR

DOSEN PENGAMPU :

Ns, Dewi Masyitah Sp.KepMB

Disusun Oleh :

Agnes Rahayu Putri ( PO71201180001 )

Annisa Mappario ( PO71201180003 )
Aquardo Leo Valentino ( PO71201180004 )
Berliana Sapitri ( PO71201180005 )
Diah Ayu Anjani ( PO71201180006 )
Dian Apdal ( PO71201180007 )
Dwi Kartika Maharani ( PO71201180008 )
Indah Krisdyanti ( PO71201180009 )

POLITEKNIK KESEHATAN KEMENKES JAMBI

PRODI SARJANA TERAPAN KEPERAWATAN

TAHUN AKADEMIK 2018/2019

1
 KATA PENGANTAR

Puji syukur kami ucapkan kepada Tuhan Yang Maha Esa , karena berkat rahmat serta hidayah-
Nya kami dapat menyelesaikan makalah dengan judul “konsep Dan Jurnl Fraktur” dalam
rangka untuk memenuhi tugas mata kuliah Kegawatdaruratan. Meskipun banyak hambatan dan
kendala dalam proses pengerjaannya,tetapi kami berhasil menyelesaikan makalah ini tepat pada
waktunya.

Tidak lupa kami sampaikan Terimakasih atas bantuan dari banyak pihak yang telah ikut serta
dalam pengerjaan makalah ini. Kami juga mengucapkan Terimakasih kepada Dosen bidang
study keperawatan kegawatdaruratan yang telah membantu dan membimbing kami dalam
mengerjakan Makalah ini, serta tidak terlepas juga kami mengucapkan Terimakasih kepada
orang tua yang telah memberikan segala fasilitas dan sarana untuk pengerjaan makalah ini

Kami menyadari bahwa pada makalah ini masih terdapat banyak kekurangan mengingat
keterbatasan kemampuan kami. Oleh sebab itu, kami sangat mengharapkan adanya kritik dan
saran yang membangun dari pembaca sebagai masukan bagi kami. Akhir kata kami berharap
karya tulis ini dapat bermanfaat bagi pembaca pada umumnya dan kami sebagai penulis pada
khususnya.Atas segala perhatiannya kami mengucapkan terima kasih.

Jambi,31 Agustus 2020

Penulis,

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  DAFTAR ISI

COVER...............................................................................................................................

KATA PENGANTAR.......................................................................................................

DAFTAR ISI......................................................................................................................

BAB I PENDAHULUAN

A. Latar belakang.............................................................................................
B. Rumusan Masalah........................................................................................
C. Tujuan..........................................................................................................
D. Manfaat........................................................................................................

BAB II PEMBAHASAN

A. Definisi Fraktur..............................................................................................
B. Etiologi Fraktur..............................................................................................
C. Manifestasi Klinis.........................................................................................
D. Klasifikasi Fraktur..........................................................................................
E. Proses Penyembuhan Tulang........................................................................
F. Konsep Dasar Penanganan Fraktur...............................................................
G. Komplikasi.....................................................................................................
H. Penatalaksanaan ..........................................................................................

BAB III PENUTUPAN

A. Kesimpulan...................................................................................................
B. Saran..............................................................................................................

DAFTAR PUSTAKA……………………………………………………………………….

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 BAB I
PENDAHULUAN
A.    LATAR BELAKANG

Fraktur adalah suatu keadaan dimana terjadi putusnya kontinuitas tulang atau jaringan
tulang rawan sebagian atau seluruhnya yang menyebabkan nyeri dari ringan sampai berat. Selain
rasa pasca operasi dapat disebabkan oleh faktor-faktor seperti karakteristik pasien, riwayat
operasi sebelumnya, kecemasan dan penggunaan obat pereda nyeri.

Data dari Organisasi Kesehatan Dunia (WHO) melaporkan bahwa 50% dari patah tulang paha
(femur fractures) akan menyebabkan kecacatan dan menyebabkan kematian mencapai 30% pada
tahun pertama akibat komplikasi imobilisasi (WHO, 2015). Data ini tidak termasuk patah tulang
belakang dan lengan bawah serta mereka yang tidak menerima perawatan medis di rumah sakit.
Berdasarkan data Sistem Informasi Rumah Sakit (SIRS) di Indonesia tahun 2015, angka
kejadian patah tulang tercatat sekitar 240 / 100.000 kasus pada wanita dan pria di atas40
tahun(Kementerian Kesehatan RI, 2015).

Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia

tahun 2013 yang melaksanakan Riset Kesehatan Dasar (Riskesdas) menemukan kasus patah
tulang sebesar 5,8% disebabkan oleh trauma benda tajam (7,7%) kecelakaan lalu lintas (56,7%)
dan jatuh (3,7%) dengan kasus tertinggi ditemukan di

Provinsi Papua (8,3%). Nyeri patah tulang pasca operasi dapat menyebabkan ketidaknyamanan
(Ratnasari, 2012). Bentuk nyeri yang dialami pasien pasca operasi adalah nyeri akut (Wake &
Nuaraeni, 2013). Nyeri pada fraktur disebabkan oleh peningkatan tekanan interstisial di ruang
tertutup, yang mengakibatkan penurunan perfusi jaringan dan tekanan oksigen jaringan. Gejala
utamanya adalah nyeri yang semakin parah terutama pada gerakan pasif dan nyeri tidak hilang
akibat narkotika. Hal ini terjadi karena sel lemak masuk ke aliran darah dan menyebabkan kadar
oksigen darah rendah yang ditandai dengan gangguan pernafasan, tekanan nadi cepat, hipertensi,
sesak nafas, demam. Serangan nyeri biasanya 2-3 hari setelah cedera (Reliance, 2012).

B. RUMUSAN MASALAH

A. Apa Definisi Fraktur ?

B. Apa Etiologi Fraktur ?
C. Apa Manifestasi Klinis ?

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 D. Apa Klasifikasi Fraktur ?
E. Bagaimana Proses Penyembuhan Tulang ?
F. Bagaimana Konsep Dasar Penanganan Fraktur ?
G. Apa Komplikasi fraktur ?
H. Bagaimana penatalaksanaan ?

C. TUJUAN
A. Untuk Mengetahui Definisi Fraktur
B. Untuk Mengetahui Etiologi Fraktur
C. Untuk Mengetahui Manifestasi Klinis
D. Untuk Mengetahui Klasifikasi Fraktur
E. Untuk Mengetahui Proses Penyembuhan Tulang
F. Untuk Mengetahui Konsep Dasar Penanganan Fraktur
G. Untuk Mengetahui Komplikasi fraktur
H. Untuk Mengetahui penatalaksanaan

D. Manfaat
A. Agar Mahasiswa Mengetahui Definisi Fraktur
B. Agar Mahasiswa Mengetahui Etiologi Fraktur
C. Agar Mahasiswa Mengetahui Manifestasi Klinis
D. Agar Mahasiswa Mengetahui Klasifikasi Fraktur
E. Agar Mahasiswa Mengetahui Proses Penyembuhan Tulang
F. Agar Mahasiswa Mengetahui Konsep Dasar Penanganan Fraktur
G. Agar Mahasiswa Mengetahui Komplikasi fraktur
H. Agar Mahasiswa Mengetahui penatalaksanaan

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 BAB II

PEMBAHASAN

A. TINJAUAN TEORI

Patah tulang merupakan potensi ancaman sekaligus keutuhan seseorang yang

sebenarnya, sehingga akan mengalami gangguan fisiologis maupun respons psikologis berupa
nyeri. Rasa sakit merupakan suatu kondisi subjektif dimana seseorang menunjukkan
ketidaknyamanan verbal dan ketidaknyamanan verbal.

Fraktur adalah suatu kondisi dimana ada kerusakan kelangsungan jaringan tulang atau
tulang rawan baik sebagian atau seluruhnya (Mansjoer,dkk., 2012; Martha., Et al, 2013).

Fraktur adalah patah tulang, biasanya disebabkan oleh trauma atau tenaga fisik kekuatan
dan sudut dari tenaga tersebut, keadaan tulang itu sendiri, dan jaringan lunak disekitar tulang
akan menentukan apakah fraktur yang terjadi itu lengkap atau tidak lengkap. (Price and Wilson,
1995 : 1183)

Fraktur menurut Rasjad (1998 : 338) adalah hilangnya konstinuitas tulang, tulang rawan
sendi, tulang rawan epifisis, baik yang bersifat total maupun yang parsial.

B. ETIOLOGI

Penyebab patah tulang bisa disebabkan oleh trauma yang menyebabkan patah tulang berupa
trauma langsung (cedera dan kecelakaan) dan bisa juga trauma tidak langsung akibat
pengeroposan tulang (osteoporosis) akibat kekurangan kalsium dan usia tua (Kementerian.
Kesehatan, 2010).

C. MANIFESTASI KLINIS

a. Nyeri lokal
b. Pembengkakan
c. Eritema
d. Peningkatan suhu
e. Pergerakan abnormal

D. KLASIFIKASI FRAKTUR

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a) Fraktur komplet : Fraktur / patah pada seluruh garis tengah tulang dan biasanya mengalami
pergeseran dari posisi normal.
b) Fraktur tidak komplet : Fraktur / patah yang hanya terjadi pada sebagian dari garis tengah
tulang.
c) Fraktur tertutup : Fraktur yang tidak menyebabkan robeknya kulit, jadi fragmen frakturnya
tidak menembus jaringan kulit.
d) Fraktur terbuka : Fraktur yang disertai kerusakan kulit pada tempat fraktur (Fragmen
frakturnya menembus kulit), dimana bakteri dari luar bisa menimbulkan infeksi pada tempat
fraktur (terkontaminasi oleh benda asing)
1) Grade I : Luka bersih, panjang <>
2) Grade II : Luka lebih besar / luas tanpa kerusakan jaringan lunak yang ekstensif
3) Grade III : Sangat terkontaminasi dan mengalami kerusakan jaringan lunak yang
ekstensif, merupakan yang paling berat.
e) Jenis khusus fraktur
1) Greenstick : Fraktur dimana salah satu sisi tulang patah, sedang sisi lainnya membengkok.
2) Tranversal : Fraktur sepanjang garis tengah tulang.
3) Oblik : Fraktur membentuk sudut dengan garis tengah tulang.
4) Spiral : Fraktur memuntir seputar batang tulang
5) Kominutif : Fraktur dengan tulang pecah menjadi beberapa fragmen
6) Depresi : Fraktur dengan fragmen patahan terdorong kedalam (sering terjadi pada tulang
tengkorak dan tulang wajah)
7) Kompresi : Fraktur dimana tulang mengalami kompresi (terjadi pada tulang belakang)
8) Patologik : Fraktur yang terjadi pada daerah tulang berpenyakit (kista tulang, penyakit
pegel, tumor)
9) Avulsi : Tertariknya fragmen tulang oleh ligament atau tendon pada perlekatannya
10) Epifiseal : Fraktur melalui epifisis
11) Impaksi : Fraktur dimana fragmen tulang terdorong ke fragmen tulang lainnya.

E. PROSES PENYEMBUHAN TULANG

a. Stadium Pembentukan Hematoma

Hematoma terbentuk dari darah yang mengalir dari pembuluh darah yang rusak, hematoma
dibungkus jaringan lunak sekitar (periostcum dan otot) terjadi 1 – 2 x 24 jam.
b. Stadium Proliferasi

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Sel-sel berproliferasi dari lapisan dalam periostcum, disekitar lokasi fraktur sel-sel ini menjadi
precursor osteoblast dan aktif tumbuh kearah fragmen tulang. Proliferasi juga terjadi dijaringan
sumsum tulang, terjadi setelah hari kedua kecelakaan terjadi.
c. Stadium Pembentukan Kallus
Osteoblast membentuk tulang lunak / kallus memberikan regiditas pada fraktur, massa kalus
terlihat pada x-ray yang menunjukkan fraktur telah menyatu. Terjadi setelah 6 – 10 hari setelah
kecelakaan terjadi.
d. Stadium Konsolidasi
Kallus mengeras dan terjadi proses konsolidasi, fraktur teraba telah menyatu, secara bertahap-
tahap menjadi tulang matur. Terjadi pada minggu ke 3 – 10 setelah kecelakaan.
e. Stadium Remodelling
Lapisan bulbous mengelilingi tulang khususnya pada kondisi lokasi eks fraktur. Tulang yang
berlebihan dibuang oleh osteoklas. Terjadi pada 6 -8 bulan.

F. KONSEP DASAR PENANGANAN FRAKTUR

Ada empat konsep dasar dalam menangani fraktur, yaitu :

a. Rekognisi
Rekognisi dilakukan dalam hal diagnosis dan penilaian fraktur. Prinsipnya adalah mengetahui
riwayat kecelakaan, derajat keparahannya, jenis kekuatan yang berperan dan deskripsi tentang
peristiwa yang terjadi oleh penderita sendiri.
b. Reduksi
Reduksi adalah usaha / tindakan manipulasi fragmen-fragmen seperti letak asalnya. Tindakan ini
dapat dilaksanakan secara efektif di dalam ruang gawat darurat atau ruang bidai gips. Untuk
mengurangi nyeri selama tindakan, penderita dapat diberi narkotika IV, sedative atau blok saraf
lokal.
c. Retensi
Setelah fraktur direduksi, fragmen tulang harus dimobilisasi atau dipertahankan dalam posisi
dan kesejajaran yang benar sampai terjadi penyatuan. Immobilisasi dapat dilakukan dengan
fiksasi eksterna atau interna. Metode fiksasi eksterna meliputi gips, bidai, traksi dan teknik
fiksator eksterna.
d. Rehabilitasi
Merupakan proses mengembalikan ke fungsi dan struktur semula dengan cara melakukan ROM
aktif dan pasif seoptimal mungkin sesuai dengan kemampuan klien. Latihan isometric dan
setting otot. Diusahakan untuk meminimalkan atrofi disuse dan meningkatkan peredaran darah.
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G. Komplikasi
Komplikasi fraktur dapat dibagi menjadi :
a. Komplikasi Dini
1) Nekrosis kulit
2) Osteomielitis
3) Kompartement sindrom
4) Emboli lemak
5) Tetanus
b. Komplikasi Lanjut
1) Kelakuan sendi
2) Penyembuhan fraktur yang abnormal : delayed union, mal union dan non union.
3) Osteomielitis kronis
4) Osteoporosis pasca trauma
5) Ruptur tendon

F. PENATALKSANAAN
Penatalaksanaan farmakologis adalah penatalaksanaan kerjasama antara dokter dan
perawat yang menekankan pada pemberian obat yang mampu menghilangkan sensasi nyeri,
sedangkan penatalaksanaan non farmakologis adalah penatalaksanaan untuk menghilangkan
nyeri dengan menggunakan teknik penatalaksanaan.
Hasil penelitian menunjukkan bahwa responden yang mendapat obat nyeri jenis non narkotik
lebih rendah merasakan nyeri dibandingkan dengan responden yang mendapat obat nyeri jenis
narkotik.
Tatalaksana dari fraktur terbuka setelah melakukan stabilisasi ABCDE adalah dengan
imobilisasi yang sesuai dengan lokasi fraktur. Beri suntikan anti tetanus sebagai profilaksis
dengan dosis 250 U tetanus imunoglobulin. Semua pasien dengan fraktur terbuka harus
diberikan antibiotik intravena sesegera mungkin.
Saat ini cephalosporin generasi pertama diberikan pada semua pasien fraktur terbuka dan
aminoglikosida atau antibiotik untuk bakteri gram negatif lainnya dapat diberikan pada luka
yang lebih berat. Antibiotik diberikan setelah berkonsultasi dengan ahli bedah
Pada fraktur tertutup penatalaksanaan awal tetap sama yaitu stabilisasi ABCDE,
kemudian lakukan imobilisasi pada lokasi fraktur. Imobilisasi dengan pembidaian dapat
dilakukan pada secondary survey kecuali bila luka tersebut mengancam nyawa.
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Namun, setiap fraktur harus diimobilisasi sebelum transportasi pasien. Selalu evaluasi status
neurovaskular dari ekstremitas setelah melakukan reduksi dan pembidaian.

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 BAB III
PENUTUP

A. KESIMPULAN
Fraktur adalah suatu keadaan dimana terjadi putusnya kontinuitas tulang atau jaringan
tulang rawan sebagian atau seluruhnya yang menyebabkan nyeri dari ringan sampai berat. Selain
rasa pasca operasi dapat disebabkan oleh faktor-faktor seperti karakteristik pasien, riwayat
operasi sebelumnya, kecemasan dan penggunaan obat pereda nyeri. Penyebab patah tulang bisa
disebabkan oleh trauma yang menyebabkan patah tulang berupa trauma langsung (cedera dan
kecelakaan) dan bisa juga trauma tidak langsung akibat pengeroposan tulang (osteoporosis)
akibat kekurangan kalsium dan usia tua

B. SARAN
1. Bagi mahasiswa
Bagi mahasiswa untuk lebih menambah wawasan dan pengetahuan agar dapat
melahirkan inovasi-inovasi terbaru dalam askep kegawatdaruratan pada klien dengan fraktur.
2. Bagi dosen
Bagi dosen untuk membimbing dan mengarahkan serta memfasilitasi mahasiswa untuk
menambah wawasan dan pengetahuan dalam ilmu asuhan keperawatan kegawatdaruratan
khususnya askep kegawatdaruratan fraktur.

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 DAFTAR PUSTAKA

Musliha, (2010). Keperawatan Gawat Darurat. Yogyakarta. Nuha Medika.

Purwadianto, Agus, dkk. (2000). Kedaruratan Medik. Jakarta Barat. Binarupa Aksara.

Thomas, Mark A.(2011). Terapi dan rehabilitasi Fraktur. Jakarta. EGC.

1
The Factors Affecting Pain Intensity to Patient Post Operative Fracture at
Jayapura Public Hospital
WempiOswoldJanggo1, Yermia Msen2, A.L. Rantetampang3, Anwar Mallongi41Magister

Program of Public Health, Faculty of Public Health, Cenderawasih University,Jayapura.

2,3
Lecturer of Postgraduate Program. Faculty of Public Health, Cenderawasih University,Jayapura
4
Environmental Health Department, Faculty of Public Health, Hasanuddin University, Makassar

Corresponding Author: WempiOswoldJanggo

ABSTRACT work status with p-value = 0,001 and

Background: Fracture is a condition where
there is a break in continuity of bone or
cartilage tissue in part or in total which causes
pain from mild to severe. In addition to
postoperative taste can be caused by factors
such as patient characteristics, previous surgery
history, anxiety and use ofpainkillers.
Research objectives: To determine what factors
are associated with the pain intensity of
postoperative fracture patients in Jayapura
Hospital
Research Method: Observational analysis with
cross sectional study design. The study was
conducted in July 2018 in the Surgery Room of
Jayapura Hospital with a population of 71
patients post fracture surgery as samples based
on consecutive sampling. Data were obtained
using a questionnaire, measurement of anxiety
using State Anxiety Inventory (S-AI) form Y and
Visual Analog Scale (VAS) combined with
Numeric Rating Scale (NRS). Data analyzed by
chi square and regressionlogistic.
Results: There is correlation between work
status (p value = 0,002; RP = 7,833; CI95%=
(2,233 – 27,845) with intensity post-operative
fracture in public hospital Jayapura and not
correlation is age (ρ-value = 0,257; RP = 2,229;
CI95%= (0,737 – 6,778), sexual (ρ-value = 0,146;
RP = 2,593; CI95%= (0,864 –7,777),
studies (ρ-value = 0,292; RP = 0,462; CI95%=
(0,129 – 1,657), ethnic (ρ-value = 0,294; RP=
rasioprevalebce RP = 7,833 (2,233 – 27,485).
Keywords: Pain Intensity, Post Fracture Surgery
1. INTRODUCTION
Fracture is a condition where thereis
a breakdown of continuity of bone tissue or
cartilage either in part or in total (Mansjoer,
etal., 2012; Martha., Et al, 2013). The cause
of the fracture can be caused by trauma that
causes a broken bone to be in the form of
direct trauma (injury and accident) and can
be indirect trauma due to bone loss
(osteoporosis) due to lack of calcium and
old age (Ministry of Health, 2010). Data
from the World Health Organization
(WHO) reports that 50% of broken thigh
bones (femur fractures) will causelifelong
disability and cause mortality to reach 30%
in the first year due to complications of
immobilization (WHO, 2015). This data
does not include vertebral and forearm
fractures and those who do not receive
medical care at the hospital. Based on data
from the Hospital Information System
(SIRS) in Indonesia in 2015, the incidence
of fracture was recorded at around 240 /
100,000 casesin women and men over40
yearsof age due to osteoporosis (RI Ministry
of Health,2015).
Health Research and Development
Agency, Ministry of Health of the Republic
of Indonesia in 2013 conducting Basic
Health Research (Riskesdas) found fracture
cases of 5.8% caused by sharp object trauma
(7.7%) traffic accidents (56.7%) and fell
(3.7%) with the highest cases found in
1
sual Analog Scale (VAS) combined with
thePapua Province (8.3%). Postoperative
fracture pain can cause discomfort
(Ratnasari, 2012). The form of pain
experienced by postoperative patients is
acute pain (Wake &Nuaraeni, 2013). Pain in
the fracture is caused by an increase in
interstitial pressure in a confined room,
3. RESULTS
BivariateAnalysis
a. Relationship between age and pain
intensity of postoperative fracture
patients in Jayapura GeneralHospital
Table 1. Age Relationship with pain intensity of post-fracture
surgery patients in Jayapura General Hospital

resulting in reduced tissue perfusion and No Age Pain intensity Number

tissue oxygen pressure. The main symptom Pain Not pain
n % n % n %
is pain that gets worse especially in passive 1 < 30year 39 79,6 10 20,4 49 100
movements and the pain isnot lost by 2 > 30year 14 63,6 8 36,4 22 100
Total 53 74,6 18 25,4 71 100
narcotics. This happens because fat cells p-value = 0,257; RP = 2,229; CI95%= (0,737 – 6,778)
enter the bloodstream and cause low blood Source: Primary Data, 2018
oxygen levels which are characterized by
respiratory problems, rapid pulse pressure,
hypertension, shortness of breath, fever. Based on Table 1, it shows that of 49
Pain attacks are usually 2-3 days after injury people aged <30 years as many as 39 people
(Reliance,2012). (79.6%) experienced pain and as many as 10
Retrieval of preliminary data in people (20.4%) had no pain. While from 22
Jayapura Public Hospital, obtained fracture people aged >30 years as many as 14 people
data in 2017 as many as 847 people (63.6%) experienced pain and as many as 8
averaged as many as 71 people. Patients people (36.4%) did not experience pain. Chi
who experience pain are generally treated square test results obtained ρ-value =0.257
with analgesic drugs, but from several >0.05. This means that there is no
observations some patients experience relationship between the age of the patient
moderate to severe pain that is unbearable, and the intensity of pain in post-fracture
so that the patient yells and cries surgery patients in Jayapura Regional
uncontrollably towards the recovery of the Hospital. The prevalence ratio test results
results of the surgery he has done. From the wereobtainedRP=2,229;CI95%=(0.737
results of the interview due to the patient's - 6.778) does not include 1 which is
pain there was a move, so that the surgical interpreted that age is not significant with
wound was open. The purpose of the study the intensity of pain in patients after fracture
is to know the factors that are related to Pain surgery.
Intensity of Fracture Postoperative Patients
in Jayapura GeneralHospital. b. Sex relations with pain intensity of post-
fracture surgery patients in Jayapura
2. MATERIALS ANDMETHODS GeneralHospital
Observational analysis with cross Table 2. Sex relations with pain intensity of post-fracture
sectional study design. The study was surgery patients in Jayapura Regional Hospital
carried out in July 2018 in the Surgical Pain intensity
No Sex Number
Room of the Jayapura Regional Hospital Pain Not pain
with a population of 71 postoperative n % n % n %
1 Male 33 82,5 7 17,5 40 100
fracture patients as samples based on 2 Female 20 64,5 11 35,5 31 100
consecutive sampling. Data were obtained Total 53 74,6 18 25,4 71 100
p-value = 0,146; RP = 2,593; CI95%= (0,864 – 7,777)
using questionnaires, measurement of Source: Primary Data, 2018
anxiety using the State Anxiety Inventory
(S-AI) form-Y and Vi Numeric Rating Scale
(NRS). Data was analyzed using chi square Based on Table 2, it shows that out
and logisticregression. of 40 people who were male as many as 33
people (82.5%) experienced pain and as
International Journal of Science and Healthcare Research 2
(www.ijshr.com) Vol.3; Issue: 4; October-December
many as 7 people (17.5%) had no pain.
While from 31 people who were female as
many as 20 people (64.5%)experienced

International Journal of Science and Healthcare Research 2

(www.ijshr.com) Vol.3; Issue: 4; October-December
pain and as many as 11 people (35.5%) people (69.6%) experienced pain and as
experienced no pain. Chi square test results many as 14 people (30.4%) had no pain.
obtained ρ-value = 0.146> 0.05. This means While from 25 people from the Non Papuan
that there is no relationship between the sex tribe as many as 21 people (84%)
of the patient and the intensity of pain in experienced pain and as many as 4 people
post-fracture surgery patients in Jayapura (16%) experienced no pain. The chi square
Regional Hospital. The prevalence ratio test test results obtained ρ-value = 0.294> 0.05.
results were obtained RP = 2,593; CI95% = This means that there is no relationship
(0,864 - 7,777) with a lower value not between patients with pain intensity in post-
including 1 which was interpreted to mean fracture surgery patients in Jayapura
that gender was not significant with the Regional Hospital. The prevalence ratio test
intensity of pain in patients after fracture results obtained from RP = 0.435; CI95% =
surgery. (0.1126 - 1.505) does not include 1 which is
interpreted to mean that the tribe is not
c. Educational relationship with the significant for the intensity of pain after
intensity of pain in post-fracture surgery fracture surgery.
patients in Jayapura RegionalHospital
Table 4. Tribal relationships with pain intensity of post- fracture
Table 3. Educational Relationships with pain intensity of post- surgery patients in Jayapura General Hospital
fracture surgery patients in Jayapura General Hospital
No Tribe Pain intensity Number
Pain Not pain
No Education Pain intensity Numbe n % n % n %
Pain Not pain 1 Papua 32 69,6 14 30,4 46 100
n % n % n % 2 Non Papua 21 84 4 16 25 100
1 Low 8 61,5 5 38,5 13 100 Total 53 74,6 18 25,4 71 100
2 High 45 77,6 13 22,4 58 100 p-value = 0,294; RP = 0,435; CI95%= (0,1126 – 1,505)
Total 53 74,6 18 25,4 71 100
Top of Form
p-value = 0,292; RP = 0,462; CI95%= (0,129 – 1,657)
Source: Primary Data, 2018 Source: Primary Data, 2018

Based on Table 3, it shows that out of 13
people with low education 8 people (61.5%)
experienced pain and as many as 5 people
(38.5%) had no pain. Whereas from 58
highly educated people as many as 45
people (77.6%) experienced pain and as
e. Job relationship with pain intensity of
post-fracture surgery patients in
Jayapura GeneralHospital
Table 5. Employment Relationships with pain intensity in post-
fracture surgery patients in Jayapura General Hospitalmprove
this

many as 13 people (22.4%) experienced no No Occupation Pain intensity Number

pain. The chi square test results obtained ρ- Pain Not pain
n % n % n %
value = 0.292> 0.05. This means that there 1 Not work 47 83,9 9 16,1 56 100
is no relationship between patient education 2 Work 6 40 9 60 15 100
Total 53 74,6 18 25,4 71 100
and pain intensity in post-fracture surgery p-value = 0,002; RP = 7,833; CI95%= (2,233 – 27,845)
patients in Jayapura General Hospital. The Source: Primary Data, 2018
prevalence ratio test results were obtained
fromRP=0.462;CI95%=(0.129-1.657)
does not include 1 which is interpreted that Based on Table 5, it shows that of 56
education is not significant with the people who did not work or work irregularly
intensity of pain in patients after fracture as many as 47 people (83.9%) experienced
surgery. pain and as many as 9 people (16.1%) were
not painful. While from 15 people who
worked permanently as many as 6 people
Jayapura General Hospital
d. Tribal relationship with the intensity of
pain in post-fracture surgery patients in Based on Table 4, it shows that of 46
people with Papuan tribes as many as 32
(40%) experienced pain and as many as9
people (60%) did not experience pain. The
chi square test results obtained ρ-value=
0.002 <0.05. This means that there is a
relationship between the work of patients
with pain intensity in post-fracture surgery
patients in Jayapura Regional Hospital. The
prevalence ratio test results were obtained Total 53 74,6 18 25,4 71 100
p-value = 0,086; RP = 3,370; CI95%= (0,980 – 11,587)
Rp. 7.833; CI95% = (2,233 - 27,845) Source: Primary Data, 2018
interpreted that patients who did not work or
did not work but experienced higher pain
7,833 times than patients who worked
permanently.

f. Relationship to surgical history with

pain intensity in post-fracture surgery
patients in Jayapura RegionalHospital
Table 6. Relationship between surgical history and pain intensity
of post-fracture surgery patients in Jayapura GeneralHospital

No surgical history Pain intensity Number

Pain Not Pain
n % n % n %
1 Never 39 69,6 17 30,4 56 100
2 Ever 14 93,3 1 6,7 15 100
Total 53 74,6 18 25,4 71 100
p-value = 0,124; RP = 0,164; CI95%= (0,020 – 1,348)
Source: Primary Data, 2018

Based on Table 6, it shows that out

of 56 people who have never had surgery,
39 people (69.6%) experience pain and 17
people (30.4%) have no pain. While from
15 people who had a history of surgery as
many as 14 people (93.3%) experienced
pain and as many as 1 person (6.7%) had no
pain. The chi square test results obtained ρ-
value = 0.124> 0.05. This means that there
is no correlation between the patient's
surgical history and pain intensity in post-
fracture surgery patients in Jayapura
Regional Hospital. The prevalence ratio test
results were obtained Rp. 0.164; CI95% =
(0,020 - 1,348) didnot include 1 which
interpreted that the history of surgery was
not significant for the intensity of pain after
fracture surgery.

g. Relationship of attitudes and beliefs

about pain with pain intensity in post-
fracture surgery patients in Jayapura
GeneralHospital
Table 7. Relationship between attitudes and beliefs about pain
with the intensity of pain in post-fracture surgery patients in
Jayapura General Hospital

No beliefs about pain Pain intensity Number

Pain Not Pain
n % n % n %
1 Less 26 86,7 4 13,3 30 100
2 Good 27 65,9 14 34,1 41 100
 Based on Table 7, it shows that of which was interpreted that the levelof
the 30 people with less attitudes and beliefs
about pain, 26 people (86.7%) experienced
pain and as many as 4 people (13.1%) had
no pain. While from 41 people whose
attitude and belief in good pain were 27
people (65.9%) experienced pain and as
many as 14 people (34.1%) had no pain.
The chi square test results obtainedρ-value
= 0.086> 0.05. This means that there is no
relationship between attitudes and beliefs
about the pain of patients with pain
intensity in post-fracture surgery patients in
Jayapura Regional Hospital. The
prevalence ratio test results were obtained
Rp. 3,370; CI95% = (0,980 - 11,587) with
a lower value not including 1 which
interpreted that attitudes and beliefs about
pain were not significant for the intensity
of pain after fracture surgery.

h. Relationship between anxiety level and

pain intensity of post-fracture surgery
patients in Jayapura GeneralHospital

Table 8. Relationship between the level of anxiety and the

intensity of pain in post-fracture surgery patients in Jayapura
Regional Hospital

No Level of anxiety Pain intensity Number

Pain Not Pain
N % n % n %
1 Anxiety 32 80 8 20 40 100
2 Not anxiety 21 67,7 10 32,3 31 100
Total 53 74,6 18 25,4 71 100
p-value = 0,367; RP = 1,905; CI95%= (0,647 – 5,611)
Source: Primary Data, 2018

Based on Table 8, it shows that out

of 40 non-anxious people 32 people (80%)
experienced pain and as many as 8 people
(20%) had no pain. While from 31 people
who were not anxious as many as 21
people (67.7%) experienced pain and as
many as 10 people (32.3%) did not
experience pain. The chi square test results
obtained ρ-value = 0.367> 0.05. This
means that there is no correlation between
the patient's anxiety level and pain intensity
in post-fracture surgery patients in Jayapura
General Hospital. The prevalence ratio test
results
wereobtainedRP=1,905;CI95%=(0.647
- 5.611) with a lower value not including 1
 anxiety was not significant for the intensity and elderly patients as many as 105 people.
of pain after fracture surgery. The results of the study showed that younger
i. The relationship between the type of patients experienced greater pain than older
pain medication and the pain intensity patients. Same is the research presented by
of post-fracture surgery patients in Lueck (1992) which aims to assess the
Jayapura RegionalHospital intensity and quality of postoperative pain in
laparotomy fracturesin respondents aged> 30
Table 9. Relationship between types of pain medication with pain
years. The number of respondents after the
intensity in post-fracture surgery patients in Jayapura
GeneralHospital fracture operation
No types of pain Pain intensity Number
Pain Not Pain was<30yearsold(69%)and>30yearsold
n % n % n % (31%).
1 Non Narcotic 29 76,3 9 23,7 38 100
2 Narcotic 24 72,7 9 27,3 33 100 The results showed that the average
Total 53 74,6 18 25,4 71 100 painintensityat<30yearsand>30yearsat
p-value = 0,942; RP = 1,208; CI95%= (0,414 – 3,525)
24 hours postoperatively. Further analysis
Source: Primary Data, 2018
showed no significant relationshipbetween
Based on Table 9, it shows that of of young patient respondents was 95people
the 38 people with the type of non-narcotic
anti-pain medication as many as 29 people
(76.3%) experienced pain and as many as 9
people (23.7%) had no pain. While from 33
people there were 24 narcotics pain types
(72.7%) experienced pain and 9 people
(27.3%) had no pain. The chi square test
results obtained ρ-value = 0.942> 0.05. This
means that there is no relationship between
the type of patient's anti-pain medication
and the pain intensity in post-fracture
surgery patients in Jayapura Regional
Hospital. The prevalence ratio test results
wereobtainedRP=1,208;CI95%=(0,414
- 3,525) with a lower value that does not
include 1 which is interpreted that the type
of pain medication is not meaningful to the
intensity of pain after fracturesurgery.

4. DISCUSSION
Relationship of age with Pain Intensity
after fracture surgery

The results showed that the

relationship between age and the intensity of
postoperative fracture pain (p value =
0.257> 0.05). The results of the study
showed that the pain intensity was higher in
patients> 30 years old than patients <30
years old, in accordance with research from
Gagliese and Katz (2013) which aimed to
see differences in opiate use among young
patients with elderly patients. The number
age and the intensity of postoperative
fracture pain (p = 0.257). The explanation
above provides an overview in this study
and it can be concluded that the expression
of pain associated with age is caused more
by psychological barriers, so that the
individual covers the pain sensation that is
actually felt. According to Smeltzer and
Bare (2012) states that the assessment of
pain and the accuracy of treatment must be
based on the patient's pain report rather
than based on the patient'sage.
Relationship between Gender and Pain
Intensity after fracture surgery
The results showed that the
intensity of postoperative fracture pain in
men was lower than that of women. Further
analysis showed that there was no
significant relationship between
respondent's sex with the intensity of
postoperative fracture pain (p value
<0.146). The results of the study showed
that men experienced lower pain intensity
than women, according to research
conducted by Uchiyama, et al. (2006)
aimed at examining gender differences in
postoperative pain with cholecystectomy
revealed that female patients had higher
pain scale values than men at 24 hours after
fracture surgery. Different results from
Yuan-Yi, et al. (2002) regarding the
correlation of patient characteristics, and
postoperative relationships with morphine
needs and assessment of pain at rest and
movement. The study was conducted witha
total number of respondents of 2,298 who
received morphine.
The absence of a relationship
between pain intensity between men and
women in the results of this study can also
be influenced by differences in the types of
fractures experienced by male and female
patients. Many women do it. The different
types of surgery affect the magnitude of
tissue damage due to incisions made during
surgery, so that the intensity of
postoperative fracture pain in women is
higher than that of men.
2. Relationship between Education Levels
and Post Pain Post-fracture Intensity
The results showed that the pain intensity in
respondents with secondary education was
higher compared to patients with low and
high education. Further analysis showed that
there was no significant relationship
between the level of education and the
intensity of postoperative fracture pain (p
value = 0.4462). The results of this study are
in accordance with the study by Moddeman
(2000) which aims to look at the factors that
influence the experience of postoperative
fracture pain in adult women with the
number of respondents as many as 85
patients after cesarean section surgery. The
results showed that there was no significant
relationship between the level of pain and
the level of education.
Tribal relationship with Pain Intensity
after fracturesurgery
The results showed that the Papuan
tribe had the highest post-fracture pain
intensity among non-Papuan tribes. Further
analysis showed that there was no
significant relationship between culture and
the intensity of postoperative fracture pain
(p value >0.292). The results of this study
are also not in accordance with the existing
theory that race and ethnicity are important
factors for someone in responding to pain
(Smeltzer& Bare, 2012). Everyone with a
different culture will deal with pain in
different ways. People who experience the
same pain intensity may not report or
respond to pain in the same way. There are
differences in the meanings andattitudes
associated with pain in various cultures.
Culture influences a person how to tolerate
pain, interpret pain, and react verbally or
non-verbally to pain (LeMone& Burke,
2008).
Patients from Non Papuan tribes
who accept pain, so they must feel strong
and patient about the pain they feel.Different
from the results of this study which shows
that Papuan tribes have higher pain intensity
than other tribes. The reason for the
differences in the results of the research
with the theory is that there has been a
mixture of respondents' cultures that are not
pure anymore in accordance with their
cultural background. This mixture of
cultures can cause respondents to adopt the
values, beliefs, culture, and lifestyle in
which the individual lives, so it is important
to know how long the respondent has
assimilated to the localculture
Job relationship with Pain Intensity after
fracture surgery
The results showed that there was a
relationship between the work of patients
with pain intensity in post-fracture surgery
patients in Jayapura Public Hospital (ρ-
value = 0.002). This research is in line with
previous research conducted by Nurhafizah
(2014) which revealed that there is a
relationship between work and pain
intensity. Data analysis showed that patients
who did not work or work irregularly as
much as 83.9% experienced pain, while
patients who worked still as much as 40%
did not experience pain. The prevalence
ratio test results were interpreted that
patients who did not work or did not work
but experienced higher pain 7,833 times
than patients who workedpermanently.
The existence of a work relationship
with the intensity of pain due to patients
who are not working will think of additional
costs incurred even though they have
followed health insurance, but there are
some costs beyond the calculation of health
insurance, so that patients face the cost
problems they face. In addition, patients
think about how their survival in earning
income because they affect theirincome
because they cannot work optimally in
earning income.
Relationship to Operational History with
Postoperative Intensity Pain Fractures
The results showed that respondents
who had never undergone surgery had lower
pain intensity than respondents who had
never experienced a previous operation.
Further analysis showed that there was no
significant relationship between previous
surgical history and the intensity of
postoperative fracture pain (p value =
0.124> 0.05). The results of this study are
consistent with the research conducted by
Perry, et al. (1994), found that 29% of
women with abdominal surgery
hysterectomy had more severe pain than the
experience of previous abdominal surgery
pain. The remaining 71% of women who
have hysterectomy experience mild pain or
the same as previous pain experience.
There is no relationship between
previous pain experience and the intensity
of postoperative fracture pain, because
previous pain experience does not
necessarily mean that the individual will
receive pain with easier in the future. If
individuals have long experienced a series
of painful episodes without ever recovering
or suffering from severe pain, anxiety can
arise. Conversely, if individuals experience
pain of the same type over and over again,
but the pain is successfully eliminated, it
will be easier for individuals to interpret the
pain sensation. The impact of the client will
be ready to take measures to relieve pain. If
someone has never felt pain before, then the
first perception of pain can interfere with
coping with pain (Potter & Perry,2012).
The experience of previous pain has
implications for assessment nursing. If the
patient never feels pain, then the first
perception of pain can interfere with coping
with pain. For example, post fracture
surgery is common for patients to
experience severe incision pain for several
days. If the patient is not aware of this, the
patient will see the onset of pain as a serious
complication, so that the patient then lies
down on the bed and breathesshallowly,
because the patient is afraid something bad
will happen, when in fact patients can
actively participate in post breathing
exercises surgery. The nurse must make an
effort to prepare the patient by explaining
clearly the type of pain to be experienced
and the method that reduces the pain. For
patients who have experienced pain before,
caregivers need to know whether the
experience of pain can be managed properly
or not. If the patient has long experienced
pain without ever recovering or suffering
from severe pain, anxiety or even fear can
arise. Conversely, if the patient can deal
with pain well, then the patient is better
prepared to take the actions needed to
relieve pain.
Relationship of Attitudes and Beliefs in
Pain with Intensity of Pain Post fracture
surgery
The results showed that respondents
with less attitudes and beliefs about pain
had higher pain intensity than respondents
with good attitudes and beliefs about pain.
Further analysis showed that attitudes and
beliefs about pain had a significant
relationship with the intensity of
postoperative fracture pain (p value =
0.086> 0.05). The absence of a relationship
between attitudes and beliefs about pain
with the intensity of pain after fracture
surgery is not in accordance with the theory
states that attitudes and beliefs about pain
can have strong influence on how pain is
felt and how to manage pain. Based on this,
nurses need to have positive nurse and
patient relationships and effective
therapeutic communication, where nurses
must take the time to talk and listen to
patients, respond to patients individually
and give consideration to patients who
experience limitations incommunication.
Relationship of Anxiety Level with
Fracture Pain Intensity Postoperatively
The results showed that respondents
with severe anxiety levels had higher pain
intensity than respondents with moderate
anxiety and mild anxiety. Further analysis
showed that the level of anxiety was related
to the intensity of postoperativefracture
pain (p value = 0.367> 0.05) and was a
factor that was not related to the intensity of
pain after fracture surgery. The results
showed that the anxiety score was
significantly related to pain. Unlike the case
in the study of Pan, et al. (2006) which aims
to look at the relationship between acute
anxiety and pain, which was carried out on
34 women who performed section. Pain is
measured at rest and activity. Based on the
results of this study and supported by
several studies and theories that show that
the level of anxiety affects the intensity of
pain, the level of anxiety has implications in
nursing studies. The nurse should be able to
find out the patient's anxiety level during the
assessment. An instrument that can be used
to determine the patient's anxiety level is
using the Y-form State Anxiety Inventory
(S-AI) developed by Spielbeger. By
knowing the patient's anxiety level, the
nurse can do several things that can reduce
patientanxiety.
Some things that can be done to
reduce patient anxiety are by explaining
nursing actions that can increase pain such
as procedures related to discomfort
(invasive action), fostering relationships
with patients, and providing health
education for pain experienced by patients
(Smeltzer& Bare, 2012). In addition, nurses
can show concern in various ways such as
carefully managing the position of the
patient, paying attention to friendliness,
trustworthiness, and showing the impression
that the patient can accept, trying to keep
paying attention and being responsible for
the patient's requests, and taking care
personal (Potter & Perry,2012).
Relationship to the type of pain
medication with fracture post-operative
pain intensity
The results showed that respondents
who received lower non-narcotic type pain
medication felt pain compared to
respondents who received narcotic drugs for
pain. Further analysis showed that there was
no significant relationship between the type
of pain medication and the intensity of
postoperative fracture pain (p value =
0.942> 0.05). The results showed that
patients aged <30 years used opiates rather
than younger ones and scores of Visual
Analog Scale (VAS) in older people were
lower than those younger.
The absence of different types of
anti-pain medication is given, because in the
fixed procedure given in Jayapura Public
Hospital the patients who experience
moderate and severe pain are given narcotic
drugs while the patients who experience a
negative and no pain are given bobbakrotic
drugs, so that by giving this drug the same -
the same has the same opportunities as pain
intensity.
The dominant factor with pain intensity
Multivariate test results obtained that
the dominant factor in post-operative pain
intensity is that this work is caused by costs
that mustbe borne and the impact after
leaving the hospital to get income,
especially for patients who do not work or
those who do not workpermanently.
5.CONCLUSION
a. There is no relationship between the
age of the patient and the intensity of
pain in post-fracture surgery patients in
Jayapura Public Hospital (ρ-value =
0.257; RP = 2.29; CI95% = (0.737 -
6.778).
b. There was no relationship between
patient gender and pain intensity in
post- fracture surgery patients in
Jayapura Public Hospital (ρ-value =
0.146; RP = 2.593; CI95% = (0.864
-7.777).
c. There is no correlation between patient
education and pain intensity in post-
fracture surgery patients in Jayapura
General Hospital (ρ-value = 0.292; RP =
0.462; CI95% = (0.129 -1.657).
d. There is no relationship between the
patient's patient with pain intensity in
post-fracture surgery patients in
Jayapura General Hospital (ρ-value =
0.294; RP = 0.435; CI95% = (0.1126 -
1.505).
e. There is a relationship between the
work of patients with pain intensity in
post- fracture surgery patients
inJayapura
 General Hospital (ρ-value = 0.002; RP = Soedirman Journal of Nursing) Volume 8,
7.833; CI95% = (2,233-27,845). No.2, Juli 2013. Available from: http://www.
f. There is no correlation between the jurnalnursing.co.id. Diakses 23 Februari 2018
patient's surgical history and pain
intensity in post-fracture surgery
patients in Jayapura Hospital (ρ-value =
0.124; RP = 0.164; CI95% = (0.020 -
1,348)
g. There is no relationship between
attitudes and beliefs about the pain of
patients with pain intensity in post-
fracture surgery patients in Jayapura
Public Hospital (ρ-value = 0.086; RP =
3.370; CI95% = (0.980 -11.587).
h. There is no correlation between
patient's anxiety level and pain intensity
in post- fracture surgery patients in
Jayapura General Hospital (ρ-value =
0.367; RP = 1.905; CI95% = (0.647
-5.611).
i. There is no relationship between the
type of anti-pain medication for
patients with pain intensity in post-
fracture surgery patients in Jayapura
Hospital (ρ- value = 0.942; RP = 1.208;
CI95% = (0.414 -3.525).
j. The dominant factor in postoperative
pain intensity is work with a p-value=
0.001 with a prevalence ratio of Rp =
7.833 (2,233-27,485).

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