COMPLICATION ON

HEALING FRACTURE
Denny Purbawijaya (406147036)
Pembimbing: dr. Dhevariza, Sp OT
Kepaniteraan Bedah RSUD Ciawi

Biodata
Nama: Tn E
Jenis Kelamin: Laki-laki
Umur: 20 tahun

Riwayat penyakit
Keluhan utama: terasa ngilu di lokasi patah tulang paha
sebelumnya.
Riwayat penyakit: 1 minggu ini, Os merasakan ngilu
dilokasi patah tulang paha kiri sebelumnya. Sejak
september 2014, Os sudah dioperasi ORIF karena patah
tulang paha kiri akibat jatuh dari motor.

Treatment in Fracture
Cast Splintage
Traction
Bracing
Internal fixation
External fixation

Complication Cast Splintage

Tight Cast
-The cast put on too tightly
-The limb swells
Clinical finding:
1.Diffuse pain
2.Signs of vascular compression
Treatment:
1.Elevate the limb
2.Open the cast/ splint (if the pain persists)
Throughout its length
Through all the padding down the skin

Complication Cast Splintage

Pressure sores
Pressing upon the skin over a bony prominence (the
patella, heel, elbow or head of the ulna)
Clinical Finding:
1.Localized pain (Over pressure spot)
Treatment:
Make a window in the cast

Complication Cast Splintage

Skin abrasion / laceration
a complication of removing plasters, especially if an electric
saw is used.
Clinical finding:
1.Nipping/ Pinching during plaster removal
Loose cast
Once the swelling has subsided, the cast is no longer hold
the fracture.
Treatment:
Replace the cast

Complicaton of Traction
Circulation embarrassment
traction tapes and circular bandages may constrict the
Circulation (especially in children)
Nerve injury
leg traction may predispose to peroneal nerve injury and
cause a dropfoot; the limb should be checked repeatedly to
see that it does not roll into external rotation during traction

Complicaton of Traction
Circulation embarrassment
traction tapes and circular bandages may constrict the
Circulation (especially in children)
Nerve injury
leg traction may predispose to peroneal nerve injury and
cause a dropfoot; the limb should be checked repeatedly to
see that it does not roll into external rotation during traction

Internal fixation
Infection
the operation (aseptic and antiseptic) and quality of the
patients tissues
Treatment:
1. antibiotics for 2-3 days
2. Debridement
Non union
Implant failure
Refracture

Internal fixation
Implant failure
a failure of the implantation procedure to produce
satisfactory results.
Treatment:
1.patient with fracture internally xed should walk with
crutches
2.Stay away from partial weightbearing for 6 weeks or
longer

Internal fixation
Refracture
Caused by removal implant too soon.
1 year is minimum to remove the implant. (18-24 month
safer)
Non Union

Delayed Union
Failure of a fracture to consolidate within the expected time - which

varies with site and nature of the fracture and with patient factors
such as age.
Factor that prediposing delayed union:
1.Severe soft tissue damage
2.Inadequate blood supply.
3.Infection.
4.Insufficient splintage.
5.Excessive traction.
6.Older age.
7.Low vitamin D level.
8.Infection.
9.Complicated/compound fracture.
10.Osteoporosis.

Non Union
no signs of healing after 6 months (depending upon the

site of fracture). Non-union is one endpoint of delayed

union.
Factors disposing to non-union
1.Too large a space for bony remodelling to bridge.
2.Interposition of periosteum, muscle or cartilage.
3.Bony site with a limited blood supply

Mal union
the bone fragments join in an unsatisfactory position,

usually due to insufficient reduction.

External Fixation
Damage soft tissue structure

Transxing pins or wires may injure nerves or vessels, or

may tether ligaments and inhibit joint movement
Overdistraction
no contact between thefragments
Pin track infection

Managements of blister
Most blisters caused by friction or minor burns
The fluid-filled blister keeps the underlying skin clean, which prevents

infection and promotes healing

Do puncture a blister if it is large, painful, or irritated.
How to manage the blisters
1. If want to pop the blister, use a sterilized needle or razor blade (to sterilize it,

put the point or edge in a flame until it is red hot, or rinse it in alcohol).
2. If the fluid is white or yellow, the blister may be infected and needs medical
attention.
3. Do not remove the skin over a broken blister. The new skin underneath needs
this protective cover.
4. Apply an antibiotic ointment or cream.
5. Look for signs of infection to develop, including pus drainage, red or warm
skin surrounding the blister, or red streaks leading away from the blister.

Pin tract Infection

Pin-tract infection (PTI) defined as signs and symptoms of infection

around a pin or wire that required increasing the frequency of local

cleansing, protecting the pin site with dressing, using an oral or
intravenous (IV) antibiotic, removing the pin or wire, or performing
surgical dbride ment.
Sign and symptom:
1.Redness, warmth and swelling at the pin sites. A small amount of
redness is normal.
2.Extremely tender pin sites.
3.Persistent fever of 100.5 Fahrenheit or higher temperature taken
orally.
4.Thick, cloudy, white, yellow or green drainage from the pin sites.
Clear yellow or slightly bloody drainage is normal.
5.Odor at the pin sites.

Management operative
Pre operative
Aseptic and antiseptic prosedure
Peri operative
1.Irrigated with cold saline when drilling
2.Use hydroxyapatite-coated pins
3.Non touch technique
4.Dressing the pin sites with an alcoholic solution of chlorhexidine-soaked
swab
Post Operative
1.Pin tract care (twice-daily cleaning of the pin-skin interface with an
alcoholic solution of chlorhexidine and clean gauze)
2. antibiotic agents