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TATALAKSANA FRAKTUR
Mohamad judha
 FRAKTUR
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Putusnya hubungan kesinambungan/ diskontinuitas

tulang dan atau tulang rawan

Fraktur tertutup :Bila kulit sekitar intak

Fraktur terbuka :Bila ada luka, sehingga
kemungkinan terjadi kontaminasi atau infeksi
 KLASIFIKASI
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I. Berdasarkan hub dengan dunia luar :

1.Fraktur 2. Fraktur
tertutup terbuka
 KLASIFIKASI
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 Gustillo – Anderson :
I. Luka < 1 cm
II. Luka 1 – 10 cm
III. Luka > 10 cm
A. Soft tissue coverage
B. Bone exposed
C. Neurovascular injury
 KLASIFIKASI
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 Gustillo – Anderson :

SMF Bedah FK UKI

 How fractures are disposed
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 Complete fractures
The bone is compeletely broken into 2 or more
fragments.
Transverse
oblique or spiral,
Impacted fracture
Comminuted fracture
 •Incomplete fracture
The bone is incompeletely divided and
the periosteum remains in continuity.
•Greenstick fracture
•Compression fracture

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8
KLASIFIKASI
II. Berdasarkan garis
patah

1.Komplet 2.Inkomplet
 KLASIFIKASI
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III. Jumlah garis patah

1. Simple 2. Komunitif 3. Segmental

 KLASIFIKASI
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IV. Arah garis patah

1. Transversal 2. Oblique 3. Spiral 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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VI. Dislokasi Fragmen

 Undisplaced
 Displaced
 Fragmen tlg searah (ad latus)
 Fragmen tlg membentuk sudut (ad axim)
 Fragmen distal memutar (ad periferum)
Learning Objectives
 Mengidentifikasi tanda-tanda fraktur
 Melakukan penatalaksanaan pada klien fraktur
Trauma Muskuloskeletal
 Sering terjadi, jarang
mengancam jiwa
 Bisa merupakan
bagian dari multi
trauma
 Ingat ABC
 Mekanisme Cedera
• Penting ditanyakan
• Petunjuk akan cedera yang mungkin diderita pasien
• Kesesuaian cerita dengan berat ringannya cedera
– Child abuse
• Terdapat gaya yang cukup untuk menyebabkan
kerusakan tulang atau jaringan lunak / fraktur atau
dislokasi
Orang tua/osteoporosis
–
– Ca metastase } Gaya yang diperlukan
lebih kecil
Mekanisme Cedera
 Jatuh
 KLL
 Trauma olahraga
 Perkelahian
 Luka tusuk
 Luka tembak
 dll
Mekanisme cedera
Mekanisme cedera
Mekanisme cedera
 Perdarahan pada trauma
muskuloskeletal
Mekanisme fisiologis tubuh :
 Mengaktifkan sistim pembekuan darah untuk

mengurangi perdarahan
 Memperbaiki integritas membran sell dan

kapiler untuk meningkatkan reabsorbsi cairan

 Meningkatkan aliran darah kolateral untuk
merangsang penyembuhan
Cedera jaringan lunak
 Terganggunya integritas kulit  tempat
masuknya mikro organisme
 Macam kerusakan jaringan lunak :
 Abrasi
 Avulsi
 Kontusi
 Laserasi
 Puncture
Cedera Pada Sendi

Occult joint
instability

Subluksasi Dislokasi
 Fraktur Femur
 Trauma mayor
 Pada orang tua : fraktur collum femur
 Fraktur femur tertutup : 1 – 1,5 liter
 Gambaran klinis :
 Nyeri,tidak dapat menahan BB
 Deformitas : pemendekan tungkai, exo/endorotasi
 Oedema
 Syok
 Long Back Board
25

December 8, 2019
 Scoop stretcher
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December 8, 2019
 INJURY ASSESSMENT
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 Initial Assessment - ABC’s

 History – SAMPLE
 Chief Complaint
 Mechanism of injury
 Onset of symptoms
 Focused Physical Assessment
 Observation
 Inspection
 Palpation
 5 P’s

Illinois EMSC
 INTERVENTIONS
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 R - Rest/immobilize
 I - Ice

 C - Compression

 E - Elevation

 S - Support

Illinois EMSC
Illinois
EMSC
SPLINTING INDICATIONS
 Prevention of further  Stabilize fracture or
injury dislocation

 Decrease pain  Relieve impaired

neurological function or
muscle spasms
 Decrease swelling

 Reduce blood and fluid

loss into tissues

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 IMMOBILIZATION/SPLINTING
Illinois
EMSC
KEY POINTS
 Immobilize joint above and  Minimize movement of
below injury extremity during splinting
 Assess neurovascular status  Secure splint to provide
distal to injury prior to splint support and compression
application and again right
after splint application  Reassess/monitor
neurovascular status
 If angulation at fracture site
every 5-10 minutes
without neurovascular
compromise, immobilize as
presented

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HIP DISLOCATION

- ORTHOPEDIC EMERGENCY!
- USUALLY CAUSED BY AUTO ACCIDENT
- POSTERIOR DISLOCATION MOST COMMON
-HIP FLEXED AND LEG ROTATED INTERNALLY
- SEVERE PAIN ON ATTEMPT TO STRAIGHTEN
HIP DISLOCTION MANAGEMENT

- SPLINT IN MOST COMFORTABLE POSITION

- DOCUMENT SENSATION AND PULSE
- PROMPT TRANSPORT
- BE ALERT FOR ASSOCIATED KNEE INJURIES
OR FRACTURES
Amputasi
 Dapat parsial atau total
 ‘Life over limb’
 Luka tajam lebih baik
prognosanya untuk
disambung kembali
dibandingkan trauma avulsi
 Pikirkan kemungkinan
replantasi
 Amputasi
Gambaran klinis :
 Hilangnya bagian tubuh

 Nyeri

 Perdarahan

 Syok
 Crush Injuries
 Kerusakan jaringan lunak
yang hebat
 Kerusakan seluler, vaskuler
dan saraf
 Hancurnya tulang dan otot
 Syok hipovolemia
Crush Injuries
Gambaran klinis :
 Pembengkakan pada pelvis atau extremitas

yang terkena
 Nyeri

 Tanda-2 syok

 Gejala-gejala sindroma kompartemen

 Ganggguan neurovaskuler distal dari daerah

cedera
Sindroma Kompartemen

 Akibat peningkatan tekanan dalam

kompartemen
 Mengakibatkan gangguan aliran darah kapiler
dan iskemia seluler
 Sering pada tungkai bawah dan lengan bawah
 Penyebab : internal (dari dalam) atau external
 Penekanan pada saraf, otot, pemb.darah
Sindroma Kompartemen

Kompartemen pada Kompartemen pada

cruris antebrachi
 Sindroma Kompartemen
Gambaran klinis :
 Nyeri pada peregangan pasif

 Gangguan sensoris (paresthesi, tebal)

 Kelemahan otot progresif

 Oedema

 Peningkatan tekanan dalam kompartemen

 Hilangnya denyut nadi

SUMMARY
 NOTE MECHANISM OF INJURY
 REMEMBER PRIORITIES
 ABCs FIRST
 TREAT FOR HEMORRHAGIC SHOCK
 VISUALIZE INJURIES AREA
 CHEK AND RECORD PULSE AND SENSATION
 How fractures heal
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 Tissue destruction and haematoma formation

 Inflamation and cellular proliferation
 Callus formation
 Consolidation
 Remodelling
 Stadium Penyembuhan
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Fraktur
 Healing by direct repair
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 Fractures of cancellous bone

 Fractures treated by rigid internal fixation
 The time factor
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Rate of repair depends upon :

 the type of bone (cancellous bone heals faster
than cortical bone.
 type of fracture (transverse fracture takes longer
than spiral fracture)
 Blood supply (poor circulation means slow
healing)
 General constitution (healthy bone heals faster

 Age (healing is almost twice as fast in children

as in adults)
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Time table

Upper limb Lower limb

Callus visible 2-3 weeks 2 - 3 weeks

on x-ray
Union (fracture 4-6 weeks 8 - 12 weeks
firm)
Consolidation 6-8 weeks 12 - 16 weeks
(bone secure)
 Fractures that fail to unite
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Causes of non union

 Distraction and separation of the fragments

 Interposition of soft tissue between the

fragments
 Excessive movement at fracture line

 Poor blood supply

 ANAMNESIS
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- Umur, jenis kelamin - Pekerjaan

- Pendidikan - Lingkungan rumah
- Riwayat trauma:
• Arah
• Jenis
- Lokalisasi nyeri - Gangguan fungsi
 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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 Crepitus and abnormal movement may be

present, but it is more important to ask if the patient
can move the joint distal to injury
 Pemeriksaan Fisik
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Move :
aktif
 Nyeri gerak
 Sensorik
pasif
 Motorik
 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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 Make sure that the airway is clear

 If there is a wound, cover it with clean material
 Stop bleeding by local compression
 Give something for pain
 If the neck or the bak is injured, prevent flexion
which may damage the spinal cord
 If there is fracture,prevent movement
 Assesment in hospital
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 Examine the airway and treat asphyxia

 Make sure the patient can breathe
 Note the obvious haemorrhage and stop it
 Assess the degree of blood loss and shock
 Check for spinal cord injury
 Look for injuries of abdominal or pelvic viscera
 Examine for the presence of fractures or dislocation
 Look for soft tissue complications, especially nerve and
vascular injury
 Arrange for an x-ray
 Definitive treatment of closed fracture
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 Manipulation to improve the position of the

fragments, followed by splintage to hold them
together until they unite; meanwhile joint
movement and function must be preserved
 Reposisi
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Mengembalikan kedudukan tulang

Cara :
• Manual
• Traksi
• Operatif
 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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 The distal part of limb is pulled in the line of the

bone
 As the fragment disengage, they are repositioned
 Alignment is adjusted in each plane
 Reposisi
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 Reposisi
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Keberhasilan dinilai dari :

 Alignment

 Contact > 50 %

 Rotation (-)

 Discrepancy (-)

 Sudut < 15 °
 Indikasi konservatif
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 Anak dalam masa pertumbuhan

 Impending infeksi
 Jenis fraktur tidak cocok untuk ORIF
 Toleransi operasi tidak baik
 Pasien menolak operasi
 Indikasi Operasi
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 Sukar reposisi tertutup

 Fraktur multipel
 Fraktur patologis
 Fraktur intra artikular
 HOLD REDUCTION
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 In order to unite, a fracture must be imobilized

 We splint most fractures, not to ensure union but
(1) to alliviate pain and (2) to ensure that union
takes place in good position
 Immobilisasi
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(mempertahankan reposisi)

 Fiksasi eksterna
 Gips
 Roger Anderson
 Fiksasi interna
 Plate + Screw
 K-nail
 ORIF ; indications
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 # that cannot be reduced except by operation

 # that inherently unstable and prone to
redisplacemaent after reduction (#mid shaft
forearm)
 # that unite poorly and take long time (# femoral
neck)
 Pathological #
 Multiple #
 # in patients who prsent nursing difficulties
(paraplegics, multiple injuries and very elderly
 ORIF; complications
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 INFECTION
 NON – UNION
 IMPLANT FAILURE
 REFRACTURE
 OREF (open reduction external fixation)
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; indications
 # associated wih severe soft tissue damage
 # associated with nerve or vessel damage
 Severely comminuted and unstable #
 # pelvis
 Infected #
80
 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
 OPEN FRACTURE; assesment
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 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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 Antibiotics : asap, combination ampicilline and

cloxacillin, given 6ho; if wound heavily
contaminated, give gentamycin or metronidazole
for 4-5 do
 Tetanus prophylaxis
 TREATMENT OF WOUND
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 To cleanse the wound of foreign material

 Remove devitalized tissue (debridement)
 4C: Colour
Consistency
Contractility
Capacity of bleeding
 Complications of fracture
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General complication
 Shock
 Crush syndrome
 Venous thrombosis and pulmonary embolism
 Tetanus
 Gas gangrene
 Fat embolism
 Complication involving # bone
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 Infection
 Delayed union and non union
 Malunion
 Growth disturbance
 Avascular necrosis
 Complication involving soft tissue
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 Vascular injury
 Compartement syndrome (Volkmann”s ischaemia)
 Nerve injury
 Visceral injury
 Myositis osificans
 Compartement syndrome
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Arterial ischaemia reduced painful

Damage blood flow pale

pulseless

paresthetic
paralysed
Direct oedema
Injury fasciotomy

incr comp pressure

 Complication involving joints
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 Joint stiffness
 Osteoarthritis
 Sudeck’s atrophy
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SMF Bedah FK UKI

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TERIMA KASIH