FRAKTUR UMUM

DR. WAHYU EKO W, SPOT

ORTHOPAEDI DAN TULANG BELAKANG

RS BINA HUSADA
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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
tertutup
2. Fraktur
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 :

Fractures due to a traumatic incident
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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 impact
Indirect violence: forcible traction by a tendon
or ligament which literally pulls the bone
apart
Fatigue or stress fractures
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Due to repetitive stress
Most often seen in the tibia or fibula or
metatarsals, especially in atheletes, dancers
and army recruits.
Pathological fractures
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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)
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
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Incomplete fracture
The bone is incompeletely divided and
the periosteum remains in continuity.
Greenstick fracture
Compression fracture

KLASIFIKASI
II. Berdasarkan garis
patah
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1.Komplet 2.Inkomplet
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III. Jumlah garis patah
1. Simple
2. Komunitif
3. Segmental
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IV. Arah garis patah
1. Transversal
2. Oblique
3. Spiral
4. Kompresi
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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
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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)
How fractures heal
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Tissue destruction and haematoma
formation
Inflamation and cellular proliferation
Callus formation
Consolidation
Remodelling
Stadium Penyembuhan
Fraktur
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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)
Time table
Upper limb Lower limb
Callus visible
on x-ray
2-3 weeks 2 - 3 weeks
Union (fracture
firm)
4-6 weeks 8 - 12 weeks
Consolidation
(bone secure)
6-8 weeks 12 - 16 weeks
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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
Most fracture will unite provide
the bone fragments are
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Placed in contact with each other and
Held more or less immobile until new bone
formation is apparent
Anamnesa
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The fracture is not always at the site of
the injury
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 :
Nyeri gerak
Sensorik
Motorik
aktif
pasif
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

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PRINCIPLES OF FRACTURE
TREATMENT
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
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Fracture involving an articular
surface; this should be reduced
as near to perfection as
possible because any
irregularity will
predispose to degenerative
arthritis
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
(mempertahankan reposisi)
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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) ; indications
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# associated wih severe soft tissue damage
# associated with nerve or vessel damage
Severely comminuted and unstable #
# pelvis
Infected #
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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)
4 C : Colour
Consistency
Contractility
Capacity of bleeding
Complications of fracture
General complication
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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 (Volkmanns
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
Sudecks atrophy
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TERIMA KASIH
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Created by : Tepeng
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