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PATAH TULANG DAN SENDI

Dr. Ketut Martiana


DEPT. OF ORTHOPAEDICS SURGERY AIRLANGGA UNIVERSITY/ DR. SOETOMO HOSPITAL SURABAYA
DR. KETUT MARTIANA 4/1/2013

DEFINISI PATAH TULANG


Adalah hilangnya kontinyuitas tulang Dapat diakibatkan oleh trauma maupun keadaan patologis

DR. KETUT MARTIANA

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Macam-macam fraktur

Fraktur akibat trauma yang adekwat


Akibat kecelakaan lalu lintas Kecelakaan kerja Jatuh dari ketinggian Trauma minimal pada tulang yang sudah patologis: tumor,infeksi, osteoporosis 3 4/1/2013

Fraktur patologis

DR. KETUT MARTIANA

Macam-macam fraktur

Fraktur terbuka

Fraktu yang disertai dengan luka, dimana tulang pernah atau sedang berhubungan dengan lingkungan luar Syarat: luka berjarak < 5 cm dari patahan tulang Fraktur yang tidak disertai luka
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Fraktur tertutup

DR. KETUT MARTIANA

Macam bentuk fraktur

Transverse / sederhana Oblique Spiral


Akibat trauma yang memuntir fragmen lebih dari 2 buah Khusus pada anak-anak

Comminutive

Greenstick

DR. KETUT MARTIANA

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Penyembuhan Tulang

Fase hematom Fase proliferasi sel Fase kalus Fase konsolidasi Fase remodelling

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Prinsip Perawatan Fraktur


ABC Reposisi Immobilisasi Fiksasi /stabilisasi Rehabilitasi

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Jenis Reposisi
Reposisi tertutup (close reduction) Reposisi terbuka (Open reduction)

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Jenis Imobilisasi

Cast imobilisation Traction imobilisation Instrumentation imobilisation

DR. KETUT MARTIANA

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Macam Traksi

Traksi kulit / skin traction


Dari bahan plester Tulang di tarik melalui kulit Maksimum 2 minggu dan beban 5 kg K- wire atau steinmann pin Langsung menarik tulang Beban sampai 20 kg

Traksi tulang / skeletal traction


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JENIS INSTRUMENTASI
INTERNAL FIKSASI EKSTERNAL FIKSASI

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DI NEGARA MAJU
In North America, and I suspect in most other technically advanced countries, closed methods of fracture management are in a marked decline. The ability to produce anatomical alignment and maintain it by internal fixation, particularly by interlocking nails, is apparently making such methods pass. It has been our observation during the past 5 years that orthopaedic residents are incapable of applying casts with any degree of dexterity, although they are very expert in inserting a variety of nails. Similarly, the application of traction is an arcane, antique procedure of historical interest alone Charles A. Rockwood, JR 1996

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KOMPLIKASI FRAKTUR

lokal

Nonunion and Malunion Infection Nerve Injury Vascular Injury Compartment Syndrome Refracture Muscle and Tendon Entrapment and Adherence

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KOMPLIKASI FRAKTUR

sistemik

Shock
1. Hematogenic (oligemia) 2. Neurogenic (caused primarily by nervous influences) 3. Vasogenic (initially decreased vascular resistance and increased vascular capacity) 4. Cardiogenic (caused by either failure of the heart as a pump or diminished cardiac output from various causes)

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TABLE 8-1 Classes of Acute Hemorrhage Class I Blood loss (mL) Blood loss (units) Blood loss* (%) Pulse rater (bpm) Class II 750 1-2 15 72-84 Class III 2-3 20-25 >100 118/82 36 Delayed 20-30 Class IV 3-4 30-35 >120 110/80 30 Delayed 30-40 5 40-50 >140 70-90/50-60 20-30 Delayed >35 10-20 <50-60 systolic

1000-1250 1500-1800 2000-2500

Blood pressure (mm Hg) Pulse pressure (mm Hg) Capillary blanch test Normal Respiratory rate 14-20

Urine output (mL/h)

30-35

25-30

5-15

Negligible
Mildly anxious Crystalloid + Blood Anxious and

Central nervous systemmental status confused Confused-lethargic Fluid replacement * Crystalloid

Slightly anxious Crystalloid

Crystalloid + Blood

Percentage of blood volume in a standard 70-kg man. Assume normal of 72 bpm. Assume normal of 120 / 80 mm Hg. (Alexander, R.H., and Proctor, H.J.: Shock. In Committee on Trauma (eds): Advanced Trauma life Support ManualProgram for Physicians, p. 86. Chicago, American College of Surgeons, 1993.)

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KOMPLIKASI FRAKTUR

sistemik

Fat Embolism Syndrome/Acute Respiratory Distress Syndrome


high-energy 2

long-bone fracture

or 3 days after trauma distress

respiratory

pulmonary

edema
39 to 40C

temperature Tachypnea confusion,

stupor, or coma

craniocerebral

trauma ?

Perdarahan Infeksi / Sepsis


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Prognosis

tergantung dari

Umur Lokasi fraktur Terbuka/tertutup Macam imobilisasi Komplikasi rehabilitasi

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