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SMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*The golden rule is Treat the patient, not
simply the part
SMF Bedah FK UKI
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Putusnya hubungan kesinambungan/ diskontinuitas tulang dan atau
tulang rawan
Fraktur tertutup :Bila kulit sekitar intakFraktur terbuka :Bila
ada luka, sehingga kemungkinan terjadi kontaminasi atau infeksi SMF
Bedah FK UKI*
SMF Bedah FK UKI
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Berdasarkan hub dengan dunia luar :
SMF Bedah FK UKI*1.Fraktur tertutup2. Fraktur terbuka
SMF Bedah FK UKI
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Gustillo Anderson :Luka < 1 cmLuka 1 10 cmLuka > 10 cmSoft
tissue coverageBone exposedNeurovascular injurySMF Bedah FK
UKI*
SMF Bedah FK UKI
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Gustillo Anderson :
SMF Bedah FK UKI*
SMF Bedah FK UKI
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Caused by sudden and exessive force, which may be tapping,
crushing, bending, twisting or pulling.
Direct violence : blow on the arm which shatters the ulna at the
point of impactIndirect violence: forcible traction by a tendon or
ligament which literally pulls the bone apartSMF Bedah FK UKI*
SMF Bedah FK UKI
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Due to repetitive stressMost often seen in the tibia or fibula
or metatarsals, especially in atheletes, dancers and army
recruits.SMF Bedah FK UKI*
SMF Bedah FK UKI
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Fractures may occur even with normal stresses if the bone has
been weakened (by a tumor) or if it is excessivelly brittle (pagets
disease)SMF Bedah FK UKI*
SMF Bedah FK UKI
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Complete fracturesThe bone is compeletely broken into 2 or more
fragments. Transverseoblique or spiral, Impacted fractureComminuted
fractureSMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*Incomplete fractureThe bone is incompeletely
divided and the periosteum remains in continuity.Greenstick
fractureCompression fracture
SMF Bedah FK UKI
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Berdasarkan garis patahSMF Bedah FK UKI*1.Komplet
2.Inkomplet
SMF Bedah FK UKI
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Jumlah garis patahSMF Bedah FK UKI*1. Simple2. Komunitif 3.
Segmental
SMF Bedah FK UKI
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Arah garis patahSMF Bedah FK UKI*1. Transversal2. Oblique 3.
Spiral 4. Kompresi
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Lokasi Tulang Panjang1/3 proksimal1/3 tengah 1/3 distalTulang
Melintang1/4 medial1/4 lateralSMF Bedah FK UKI*
SMF Bedah FK UKI
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Dislokasi FragmenUndisplacedDisplaced Fragmen tlg searah (ad
latus)Fragmen tlg membentuk sudut (ad axim)Fragmen distal memutar
(ad periferum)SMF Bedah FK UKI*
SMF Bedah FK UKI
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Tissue destruction and haematoma formationInflamation and
cellular proliferationCallus formationConsolidationRemodellingSMF
Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*
SMF Bedah FK UKI
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Fractures of cancellous boneFractures treated by rigid internal
fixationSMF Bedah FK UKI*
SMF Bedah FK UKI
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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 fasterAge (healing is almost twice as fast in children as in
adults)SMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*
Upper limbLower limbCallus visible on x-ray2-3 weeks2 - 3
weeksUnion (fracture firm)4-6 weeks8 - 12 weeksConsolidation (bone
secure)6-8 weeks12 - 16 weeks
SMF Bedah FK UKI
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Causes of non unionDistraction and separation of the
fragmentsInterposition of soft tissue between the
fragmentsExcessive movement at fracture linePoor blood supplySMF
Bedah FK UKI*
SMF Bedah FK UKI
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Placed in contact with each other andHeld more or less immobile
until new bone formation is apparentSMF Bedah FK UKI*
SMF Bedah FK UKI
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The fracture is not always at the site of the injurySMF Bedah FK
UKI*
SMF Bedah FK UKI
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Umur, jenis kelamin- PekerjaanPendidikan - Lingkungan
rumahRiwayat trauma:ArahJenis- Lokalisasi nyeri- Gangguan fungsiSMF
Bedah FK UKI*
SMF Bedah FK UKI
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General signsA 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
causeSMF Bedah FK UKI*
SMF Bedah FK UKI
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Swelling, bruising, DeformitySkin intact ?SMF Bedah FK UKI*
SMF Bedah FK UKI
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Local tendernessExamine distal to the fracture in order to feel
the pulse and test the sensationCompartement syndrome ?
SMF Bedah FK UKI*
SMF Bedah FK UKI
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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
injurySMF Bedah FK UKI*
SMF Bedah FK UKI
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Move :Nyeri gerakSensorikMotorik SMF Bedah FK UKI*aktifpasif
SMF Bedah FK UKI
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TomographyCT- scanMRIRadioisotope scanningSMF Bedah FK UKI*
SMF Bedah FK UKI
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Rule of 2 :2 proyeksi2 sendi2 ekstremitas2 waktu
SMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*PRINCIPLES OF FRACTURE TREATMENT
SMF Bedah FK UKI
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Make sure that the airway is clearIf there is a wound, cover it
with clean materialStop bleeding by local compressionGive something
for painIf the neck or the bak is injured, prevent flexion which
may damage the spinal cordIf there is fracture,prevent movementSMF
Bedah FK UKI*
SMF Bedah FK UKI
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Examine the airway and treat asphyxiaMake sure the patient can
breatheNote the obvious haemorrhage and stop itAssess the degree of
blood loss and shockCheck for spinal cord injuryLook for injuries
of abdominal or pelvic visceraExamine for the presence of fractures
or dislocationLook for soft tissue complications, especially nerve
and vascular injuryArrange for an x-raySMF Bedah FK UKI*
SMF Bedah FK UKI
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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 preservedSMF Bedah FK UKI*
SMF Bedah FK UKI
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Mengembalikan kedudukan tulang
SMF Bedah FK UKI*Cara : Manual Traksi Operatif
SMF Bedah FK UKI
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SMF Bedah FK UKI*Fracture involving an articular surface; this
should be reduced as near to perfection as possible because any
irregularity will predispose to degenerative arthritis
SMF Bedah FK UKI
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The distal part of limb is pulled in the line of the boneAs the
fragment disengage, they are repositionedAlignment is adjusted in
each planeSMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*
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Keberhasilan dinilai dari :AlignmentContact > 50 %Rotation
(-)Discrepancy (-)Sudut < 15 SMF Bedah FK UKI*
SMF Bedah FK UKI
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Anak dalam masa pertumbuhanImpending infeksiJenis fraktur tidak
cocok untuk ORIFToleransi operasi tidak baikPasien menolak
operasiSMF Bedah FK UKI*
SMF Bedah FK UKI
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Sukar reposisi tertutupFraktur multipelFraktur patologisFraktur
intra artikularSMF Bedah FK UKI*
SMF Bedah FK UKI
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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 positionSMF Bedah FK UKI*
SMF Bedah FK UKI
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Fiksasi eksternaGipsRoger AndersonFiksasi internaPlate +
ScrewK-nailSMF Bedah FK UKI*
SMF Bedah FK UKI
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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 SMF
Bedah FK UKI*
SMF Bedah FK UKI
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INFECTIONNON UNIONIMPLANT FAILUREREFRACTURESMF Bedah FK UKI*
SMF Bedah FK UKI
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# associated wih severe soft tissue damage# associated with
nerve or vessel damageSeverely comminuted and unstable # #
pelvisInfected #SMF Bedah FK UKI*
SMF Bedah FK UKI
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OverdistractionReduced load transmission trough bone, which
delays fracture healing causes osteoporosis (EF shoul be removed
after 6-8 wo,and replace)Pin tract infection
SMF Bedah FK UKI*
SMF Bedah FK UKI
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EMERGENCYGOLDEN PERIOD 6 8 HO
SMF Bedah FK UKI*
SMF Bedah FK UKI
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Is circulation intact ?Peripheral nerve intact ?State of skin
arround the woundDoes the wound communicate with # ?SMF Bedah FK
UKI*
SMF Bedah FK UKI
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Perbaiki KU Debridement, kultur/resistensiATS-Toxoid,
AntibiotikTutup luka dengan kasa bersihReposisiImobilisasi SMF
Bedah FK UKI*
SMF Bedah FK UKI
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Antibiotics : asap, combination ampicilline and cloxacillin,
given 6ho; if wound heavily contaminated, give gentamycin or
metronidazole for 4-5 doTetanus prophylaxis SMF Bedah FK UKI*
SMF Bedah FK UKI
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To cleanse the wound of foreign materialRemove devitalized
tissue (debridement)4 C :ColourConsistencyContractilityCapacity of
bleedingSMF Bedah FK UKI*
SMF Bedah FK UKI
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ShockCrush syndromeVenous thrombosis and pulmonary
embolismTetanusGas gangreneFat embolismSMF Bedah FK UKI*
SMF Bedah FK UKI
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InfectionDelayed union and non unionMalunionGrowth
disturbanceAvascular necrosisSMF Bedah FK UKI*
SMF Bedah FK UKI
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Vascular injuryCompartement syndrome (Volkmanns ischaemia)Nerve
injuryVisceral injuryMyositis osificansSMF Bedah FK UKI*
SMF Bedah FK UKI
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Arterial ischaemia reduced painfulDamage blood flow pale
pulseless paresthetic paralysedDirect oedemaInjury fasciotomy
incr comp pressureSMF Bedah FK UKI*
SMF Bedah FK UKI
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Joint stiffnessOsteoarthritisSudecks atrophySMF Bedah FK
UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*
SMF Bedah FK UKI
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SMF Bedah FK UKI*Created by : Tepeng
SMF Bedah FK UKI
