FRACTURES and JOINT INJURIES

DARMADJI ISMONO dr, SpB, SpBO(K), FICS DEPARTMENT OF ORTHOPAEDIC SURGERY and TRAUMATOLOGY

SCHOOL of MEDICINE PADJADJARAN UNIVERSITY

MULTIPLE TRAUMA
Penggolongan gawat darurat adalah atas dasar sistim atau fungsi, bukan atas dasar spesialisasi.
B1= B2= B3= B4= B5= B6= Breath Blood Brain Bladder Bowel Bone

MULTI DISCIPLINE APPROARCH (team)

OVERLAPPED:

ORTHOPAEDIC & NEURO SURGERIES PLASTIC & THT & ORTHOPAEDIC and ORAL SURGERIES

Textbook of Disorders and Injuries of the Musculoskeletal System

Robert Bruce Salter Second Edition Tureks ORTHOPAEDICS Principles and Their Application (Fifth Ed )

General Incidence A Fracture Normal Living Bone

Fracture
Bone Epiphyseal plate Cartilagenous

Structural break in its continuity

TERM
1. Site:
Diaphyseal Metaphyseal Epiphyseal / intra articulair Complete Incomplete
Hairline Buckle greenstick

2. Extent:

TERM:
3. Configuration
Tranverse Oblique Spiral comminuted

4. Relation of the Fracture Fragments to each other:

Shifted sideways Angulated Rotated Distracted Overriding Impacted

TERM:
5. Relationship of the fracture to the external environment
open X closed fractures
From within From without

6. Complication

The Diagnosis of Fractures

1. 2. History Assesment of the patients general conditions, and local physical examination (ATLS):
Looking (inspection) Feling
Swelling Deformity Abnormal movement Echymosis crepitus

The Diagnosis of Fractures

3. Radiographic examination:
antero-posterior lateral

4. CT Scan (computed tomography)

COMPLICATION

1. Initial 2. Early
Volkmanns ischemia

3. Late
Volkmanns contractur Pseudoarthrosis Sudecks atrophy

Initial and Early Complication

A. Local
Skin complications Vascular complication . arterial spasm/ compression/ thrombosis . Compartment syndrome (pain, pallor, puffy swelling, paresthesia)

Late Complication
1. 2. 3. 4. 5.
6. 7.

Joint stiffness Bony complication Mal-union Delayed union Non-union/ pseudoarthrosis Sudecks post-traumatic painful osteoporosis Muscular complication

Volkmanns Ischemia
Slint catheter Rorabeck: Wick catheter Mubarak:
Pressures over: Normal resting intra compartment:
30 mmHG

0 8 mmHg

Absolute indication for decompression.

Initial and Early Complication

A.2:
Gangrenne Volkmanns ischemic contracture Intermittent claudication Gas gangrene ( clostridium welchii )

3. Neurological complication 4. Visceral complication 5. Joint complication

B. Remote Complication

Special Tipes of Fractures:

1. Stress fracures 2. Pathological fractures 3. Birth fractures 4. Epiphyseal plate fractures

The General Principles of Fracture Treatment

1. 2. 3. 4. 5.

Firstly do no harm. Select treatment with specific aims Cooperate with the laws of nature Be realistic and practical in your treatment Select treatment for patients as an individual

Specific Methods of Treatment for Closed Fractures

1.
2. 3.

Protection alone (without reduction / immobilization) Immobilization by external splinting (without reduction) Closed reduction by manipulation followed by immobilization:
Plaster of paris cast

4.

Closed reduction by continuous traction followed by immobilization:

1. 2. Skin traction Skeletal traction

Specific Methods of Treatment for Closed Fractures:

5. Closed reduction followed by functional fracture bracing.

6. Closed reduction by manipulation followed by external skeletal fixation.

Specific Methods of Treatment for Closed Fractures:

7. Closed reduction by manipulation followed by internal skeletal fixation.

8. Open reduction followed by internal fixation.

Specific Methods of Treatment for Closed Fractures:

9. Excision of a fracture fragment and replacement by an endoprosthesis. Moores prosthesis

Treatment for Open Fractures:

Gustilo and Anderson Type 1: < 1 cm
low energy

Type 2: < 10 cm
moderate energy

Type 3: A, B, C: > 10 cm high energy, high velocity gunshot, segmental fracture, neurovascular injury Type 4: amputation.

Treatment for Open Fractures:

1. 2. 3. 4. 5. 6.

Cleansing of the wound Excision of devitalized tissue (debridement) Treatment of the fracture Closure of the wound Antibacterial drugs Prevention of tetanus

Healing of a fracture:
1. Stage of clinical union 2. Stage of consolidation (radiographic union) AO (arbeitsgemein shaft fr osteosynthese fragen) ASIF(association for osteosynthesis) primary bone healing secondary bone healing

Abnormal Healing of Fractures

1. Mal union
2. Delayed union 3. Non-union = pseudoarthrosis

THANK YOU