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PATAH TULANG DAN
SENDI
Dr. Ketut Martiana
DEPT. OF ORTHOPAEDICS SURGERYAIRLANGGA UNIVERSITY/
DR. SOETOMO HOSPITALSURABAYA
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DEFINISI PATAHTULANG
Adalah hilangnyakontinyuitas tulang
Dapat diakibatkanoleh trauma maupun
keadaan patologis
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Macam-macam fraktur
Fraktur akibat trauma
yang adekwatAkibat kecelakaan lalu
lintas
Kecelakaan kerja
Jatuh dari ketinggian
Fraktur patologis Trauma minimal pada
tulang yang sudahpatologis: tumor,infeksi,
osteoporosis
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Macam-macam fraktur
Fraktur terbuka Fraktu yang disertai dengan luka,
dimana tulang pernah atau sedangberhubungan dengan lingkungan luar
Syarat: luka berjarak < 5 cm dari
patahan tulang Fraktur tertutup
Fraktur yang tidak disertai luka
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Transverse / sederhana
Oblique
Spiral Akibat trauma yang
memuntir
Comminutive
fragmen lebih dari 2 buah Greenstick
Khusus pada anak-anak
Macam bentuk fraktur
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Penyembuhan Tulang
Fase hematom
Fase proliferasi sel Fase kalus
Fase konsolidasi
Fase remodelling
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ABC Reposisi
Immobilisasi
Fiksasi /stabilisasi
Rehabilitasi
Prinsip Perawatan Fraktur
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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
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Macam Traksi
Traksi kulit / skin traction Dari bahan plester
Tulang di tarik melalui kulit
Maksimum 2 minggu dan beban 5kg
Traksi tulang / skeletal traction K- wire atau steinmann pin
Langsung menarik tulang
Beban sampai 20 kg
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JENIS INSTRUMENTASI
INTERNALFIKSASI
EKSTERNAL
FIKSASI
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DI NEGARA MAJU
In North America, and I suspect in most other technicallyadvanced countries, closed methods of fracturemanagement are in a marked decline. The ability toproduce anatomical alignment and maintain it byinternal fixation, particularly by interlocking nails, isapparently making such methods pass. It has been ourobservation during the past 5 years that orthopaedicresidents are incapable of applying casts with any
degree of dexterity, although they are very expert ininserting a variety of nails. Similarly, the application oftraction is an arcane, antique procedure of historicalinterest 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 TendonEntrapment andAdherence
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KOMPLIKASI FRAKTURsistemik
Shock1. Hematogenic (oligemia)
2. Neurogenic (caused primarily bynervous influences)
3. Vasogenic (initially decreasedvascular resistance and increasedvascular capacity)
4. Cardiogenic (caused by eitherfailure of the heart as a pump ordiminished cardiac output fromvarious causes)
TABLE 8 1
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TABLE 8-1
Classes of Acute Hemorrhage
Class I Class II Class III Class IV
Blood loss (mL) 750 1000-1250 1500-1800 2000-2500
Blood loss (units) 1-2 2-3 3-4 5
Blood loss* (%) 15 20-25 30-35 40-50
Pulse rater (bpm) 72-84 >100 >120 >140
Blood pressure (mm Hg) 118/82 110/80 70-90/50-60 35
Urine output (mL/h) 30-35 25-30 5-15 Negligible
Central nervous systemmental status Slightly anxious Mildly anxious Anxious andconfused Confused-lethargic
Fluid replacement Crystalloid Crystalloid Crystalloid + Blood 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): AdvancedTrauma life Support ManualProgram for Physicians, p. 86. Chicago, American College of Surgeons,1993.)
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KOMPLIKASI FRAKTUR
sistemik Fat Embolism Syndrome/AcuteRespiratory Distress Syndrome
high-energy long-bone fracture
2 or 3 days after trauma
respiratory distress
pulmonary edema
temperature 39 to 40C
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