BEDAH ORTOPEDI

1. Open fracture
a. Gustillo-anderson classification
Type I:
Wound less than 1 cm
Minimal soft tissue damage
Wound bed is clean
Typically low energy type injury
Fracture type is typically one of the following:simple
transverse, short oblique, and minimally comminuted.
Type II:
Wound greater than 1 cm
Moderate soft tissue damage
Minimal or no wound bed contamination
Typically low energy type injury
Fracture type is typically one of the following: simple
transverse, short oblique, or minimally comminuted
Type III:
Wound greater than 1 cm
Extensive soft tissue damage
Typically a high energy type injury
Highly unstable fractures often with multiple bone
fragments
Injury patterns resulting in fractures classified as to this
category include: Open segmental fracture regardless of wound
size, gun-shot wounds with bone involvement, open fractures with
any type of neurovascular involvement, severely contaminated
open fractures and traumatic amputations, and lastly open fractures
with delayed treatment over 8 hours
Type III is further subcategorized as:
Type IIIA
Adequate soft tissue coverage
No local or distant flap coverage required
Fracture may be open segmental or severely
comminuted and still be subclassified as Type IIIA
Type IIIB
Extensive soft tissue loss
Local or distal flap coverage required
Wound bed contamination requiring serial irrigation and
debridement to clean the open fracture site
Type IIIC
Major arterial injury
Extensive repair usually requiring the skills of a
vascular surgeon for limb salvage

b. Penatalaksanaan sesuai grade

Pembersihan luka
Luka kotor, bekuan darah dan material benda asing harsu dibuang dan dicuci
dengan air steril, dan lebih ideal dengan garam fisiologis.
Debridemen/pembuangan jaringan avital
a.
Membuang benda asing
b.
Membuang jaringan avital
Reposisi dan stabilisasi tulang
Reposisi dilakukan secara anatomis dan optimal untuk menghilangkan
terjadinya dead space dan penekanan tulang pada kulit, sehingga penutupan
luka tidak menjadi trgang.
Fiksasi/stabilisasi
Dilakukan setelah reposisi untuk mempertahankan kedudukan patahan tulang.
Penutupan luka
Penutupan luka untuk patah tulang terbuka tipe 1 dapat dilakukan
dengan penutupan secara primer
Penutupan luka untuk patah tulang teruka tipe 2 dan 3 sebaiknya
dibiarkan terbuka dan memerlukan debridemen ulang bila ada tanda-tanda
infeksi.
Pemberian antibiotika
Pemberian antibiotiotika pada patah tulang bukanlah tindakan
profilaksis, tapi merupakan tindakan terapeutik
Cephalosorin merupakan broad spectrum yang diberikan secara
parenteral, penambahan dengan aminoglikosida diindikasikan bila luka hebat
(patah tulang tipe 3)
Pencegahan tetanus