ORTHOPEDIC
ORTHOPEDICAND
ANDTRAUMATOLOGY
TRAUMATOLOGY
MEDICAL
MEDICALFACULTY
FACULTYof
ofDIPONEGORO
DIPONEGOROUNIVERSITY
UNIVERSITY
2010
2010
MIND
MIND MAPPING
MAPPING
DEFINITION
TYPES &
CLASSIFICATION
DEFORMITY
FRACTURE HEALING
FRACTU
RES
DIAGNOSIS
FRACTURE
TREATMENT
SPECIFIC FRACTURE
D
D EE FF II N
N II TT II O
ON
N
Break
in continuity
trauma
( directand
indirect
of bone
its
force )
structures
stress
pathologic
fractures
MIND
MIND MAPPING
MAPPING
DEFINITION
TYPES &
CLASSIFICATION
DEFORMITY
FRACTURE HEALING
FRACTU
RES
DIAGNOSIS
FRACTURE
TREATMENT
SPECIFIC FRACTURE
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES of FRACTURES
COMPLETE FRACTURE
bone divided into 2 fragments
fractures can be oblique, spiral, impact, or
comminuted in
its configuration
INCOMPLETE FRACTURE
bone incompletely divided, with periosteum still
remain
Ex : greenstick fractures
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
Special Classification
fractures have some variety, through their specific
division
1. Ethiology
Traumatic fractures
caused by sudden force
Pathologic fractures
Stress fractures
caused by long-time force / stress on certain location
multiple repetitive strain cycle, result in microcracks of bone
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
Traumatic
fractures
Pathologic fractures
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
2. Clinical Classification
Simple fractures
closed fractures
no communication between bone and external surface of body
Compound fractures
open fractures
have communication between bone and external surface of body
Complicated fractures
followed by complication, e.g : union, delayed union, nonunion,
bone infection
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
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3. Radiologic Classification
Localization
Configuration
Bone existence
Diafisial
Metafisial
Intra-artikuler
Fracture w/
dislocation
Transversal
Fracture
Oblik Fracture
Spiral Fracture
Z Fracture
Segmental
Fracture
Wedge Fracture
Avulsion Fracture
Depresion Fracture
Impaction Fracture
Burst Fracture
Epifiseal Fracture
Total Fracture
Crack Fracture
Buckle / torus
Fracture
Hair line Fracture
Greenstick
Fracture
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
11
4. fragmen-to-fragmen connection
Undisplaced
Displaced
displece of bone can be run in 6 ways :
- Apposition
- Rotation
- Overriding
- Angulation : valgus, varus, ant, post
- Impaction
TYPES
TYPES and
and CLASSIFICATION
CLASSIFICATION
12
MIND
MIND MAPPING
MAPPING
DEFINITION
TYPES &
CLASSIFICATION
DEFORMITY
FRACTURE HEALING
FRACTU
RES
DIAGNOSIS
FRACTURE
TREATMENT
SPECIFIC FRACTURE
FRACTURE
FRACTURE HEALING
HEALING
Fracture healing depends on types of bone and amount of movement
FRACTURE
FRACTURE HEALING
HEALING
FRACTURE
FRACTURE HEALING
HEALING
Fracture healing abnormalities :
oMalunion
oDelayed union
oNonunion
FRACTURE
FRACTURE HEALING
HEALING
FRACTURE
FRACTURE HEALING
HEALING
MIND
MIND MAPPING
MAPPING
DEFINITION
TYPES &
CLASSIFICATION
DEFORMITY
FRACTURE HEALING
FRACTU
RES
DIAGNOSIS
FRACTURE
TREATMENT
SPECIFIC FRACTURE
D
D II A
AG
GN
NO
O SS II SS
o History
o General Features
o Local Features
D
D II A
AG
GN
NO
O SS II SS
History
Anamnesa
Age ( pathological fracture ?? )
Symptomps
pain
sensory loss
motor loss
pale
haematuri
abdominal pain
unconsciousness
neurovascular status of extremity distal to the fractures
D
D II A
AG
GN
NO
O SS II SS
General Features
Early Physical Examination
Shock / anemia / bleeding ??
injury of organs within bodys cavity
predispose factors ( e.g : pathological factors )
Local Features
Local Examination
Inspection ( Look )
Palpation
( Feel )
Movement exam.
Neurological exam.
D
D II A
AG
GN
NO
O SS II SS
Inspection
Compare with normal site
Extremity position
Face expression ( pain )
Palpation
Anemic signs (
local temperature
bleeding )
pain
Subcutan extravasasion
Deformity of bone
fragments
site
D
D II A
AG
GN
NO
O SS II SS
Movement
allow patient to move at
the site of injury
must be done carefully, to
Neurologic Examination
examination
other neuroligic
consideration :
neuropraksia
aksonotmesis
neurotmesis
D
D II A
AG
GN
NO
O SS II SS
D
D II A
AG
GN
NO
O SS II SS
Radiograph examination
Define :
o Normal structure of bone and joints
o Confirm of fracture
o Fragments structure and movements
o Medical treatments
o Fractures types
o Pathological conditions of bone
o Presence of alienete body ( projectile, etc )
Principles :
Two sides projection Two joints affected Two extremities Two times of radiograph imaging -
D
D II A
AG
GN
NO
O SS II SS
D
D II A
AG
GN
NO
O SS II SS
Lateral view
Superior view
D
D II A
AG
GN
NO
O SS II SS
MIND
MIND MAPPING
MAPPING
DEFINITION
TYPES &
CLASSIFICATION
DEFORMITY
FRACTURE HEALING
FRACTU
RES
DIAGNOSIS
FRACTURE
TREATMENT
SPECIFIC FRACTURE
FRACTURE
FRACTURE TREATMENT
TREATMENT
Early stage treatment :
1. First Aid
- ABC Assesment
- wound closing
- immobilize to relief pain
2. Clinical evaluation
- bone injury ?
- neurovascular injuries ?
- find other condition : DM ? ; Cardiovascular
disease ? ; Allergic ?
3. Resusitation
- patient w/ shock
FRACTURE
FRACTURE TREATMENT
TREATMENT
BASIC CONSIDERATION
1. Do not worsen the patients condition
2. Treatment is based on correct diagnosis and prognosis
3. Treatment with spesific aim
-
Relief pain
Reposition of fragments
FRACTURE
FRACTURE TREATMENT
TREATMENT
BASIC PRINCIPLES
Recognition
Reduction
Retention
Rehabilitation
FRACTURE
FRACTURE TREATMENT
TREATMENT
Recognition
o Diagnosis and evaluation
o Anamnesis, clinical exam, radiograph exam
o Consider :
- fracture localization
- types of fracture
- complication prediction
- treatment technique
FRACTURE
FRACTURE TREATMENT
TREATMENT
Reduction
o if necessary
o place bone fragments in proper relationship to each other
o Alignment and Apposition
Retention
o immobilize fracture free of motion
Rehabilitation
o restore function of invovled part
FRACTURE
FRACTURE TREATMENT
TREATMENT
CLOSED FRACTURE
Tscherne ( 1984 ) classification of closed fracture
Level 1 : fracture with shallow abrasion or oedema on skin and
subcutaneous tissue
Level 2 : higher fracture with contusion of soft tissue and oedema
Level 3 : severe injury with obviously soft tissue damage and
compartement syndrome threats
FRACTURE
FRACTURE TREATMENT
TREATMENT
1. Reduction
-
Close reduction
Open reduction
2. Immobilization
-
Traction
Dressing ( Gips )
Internal Fixation
External Fixation
3. Excersise
FRACTURE
FRACTURE TREATMENT
TREATMENT
Traction
Open reduction
FRACTURE
FRACTURE TREATMENT
TREATMENT
FRACTURE
FRACTURE TREATMENT
TREATMENT
Figure-of-eight dressing
Long-leg plaster
10
FRACTURE
FRACTURE TREATMENT
TREATMENT
11
OPEN FRACTURE
Gustillo - Anderson classification of open fracture
Type I
Type II
Type IIIA
Type IIIB
Type IIIC
FRACTURE
FRACTURE TREATMENT
TREATMENT
o Treated with emergency surgery to minimize the risk of infection
and non-union
o Debridement
o Wound closing
o Fracture stabilization ( fixation )
o Post-operative care
12
FRACTURE
FRACTURE TREATMENT
TREATMENT
FIGURE 1
Grade IIIC distal tibia injury of 57-year-old involved in high velocity
motorcycle accident.
13
FRACTURE
FRACTURE TREATMENT
TREATMENT
FIGURE 2
Grade IIIB foot injury of 9-year-old run over by an ice cream truck.
14
FRACTURE
FRACTURE TREATMENT
TREATMENT
15
FIGURE 6
Versajet debridement and
gravity irrigation.
FRACTURE
FRACTURE TREATMENT
TREATMENT
FIGURE 7
Final appearance after
debridement and irrigation.
16
FRACTURE
FRACTURE TREATMENT
TREATMENT
FIGURE 13
6 month post-operative anteroposterior
radiograph after
debridement, treatment of infection, bone
grafting and
open reduction internal fixation.
17
FRACTURE
FRACTURE TREATMENT
TREATMENT
18
FRACTURE
FRACTURE TREATMENT
TREATMENT
AMPUTATION
o Patient with severely injured extremity
o early amputation indicated under following circumstances :
- The limb is nonviable
- the patient has shock and severe multisystem injuries,
couldnt tolerate a prolonged salvage procedure
- the patient has severe chronic medical illness ( DM /
vascular disease )
19