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FRACTURES

&
DISLOCATION

Dr. Chairuddin Lubis, SpOT

DEPARTMENT OF ORTHOPAEDIC AND


TRAUMATOLOGY
ARIFIN AHMAD GENERAL HOSPITAL
PEKAN BARU
INTODUCTION
Definition :
Fracture Disruption in
the structural continuity
of
- bone
- epiphyseal plate
- cartilagoneus
Dislocation (Out of Joint)
A complete loss of contact
between the
articular surface of joint
Description fracture
1.Site:
Diaphyseal
Metaphyseal
Epiphyseal / intra
articulair
2.Extent:
Complete
Incomplete
Hairline
Buckle
greenstick
3. Configuration
Transverse
Oblique
Spiral
Comminuted
Interarticular
4. Relation of the
Fracture Fragments
to each other:
Shifted sideways
Angulated
Rotated
Distracted
Overriding
Impacted
5. Relationship of the
fracture to the
external environment
open
(compound)
><
closed fractures
From within
From without

6. Complication
Diagnosis of Fractures
1.History :
- Injury
- Pain
- Cant move/
stand
2. Assesment of the patients :
- General conditions (ATLS)
- Local physical examination
:

Look : - Swelling
- Bruising
- Deformity
- Fracture (Open)
- Distal extremity
Feel :
- Localized
tenderness
- Crepitus

Move :
- Abnormal
movement
3. Radiographic examination
Rule of twos :
Two views (AP and Lateral)
Two joints
(Proximal and Distal)
Two limbs (R and L )
Two injuries
Two occasion

4. CT Scan , MRI
COMPLICATION

1.Initial
2.Early
3.Late
Initial and Early Complication

1.Local :
1. Skin
complications
2. Vascular
complication :
a. Arterial spasm/
compression/thrombosis
b. Compartment syndrome
(pain, pallor, puffy swelling,
paresthesia)
c. Cangrene, Intermittent
claudication,Volkmanns
ischemic contracture,Gas
gangrene (clostridium
welchii)
3. Neurological complication
4. Visceral complication
5. Joint complication
2. Remote Complication :
1. Multiple injuries
2. Hemorrhagic shock
3. Fat embolism
4. Pulmonary embolism
5. Pneumonia
6. Tetanus
Late Complication
1. Local Complication :
- Joint stiffness
- Bony
complication
- Muscular
complication
2. Remote Complication :
- Renal calculi
- Accident neurosis
Special Types of Fractures:

1.Stress fractures
2.Pathological
fractures
3.Birth fractures
4.Epiphyseal
plate fractures
The General Principles of
Fracture Treatment

1. Firstly do no harm.
2. Select treatment with specific aims
3. Cooperate with the laws of nature
4. Be realistic and practical in your
treatment
5. Select treatment for patients as an
individual
Specific Methods of
Treatment
for Closed
1.Protection Fractures
alone (without
reduction / immobilization)
2.Immobilization by external
splinting (without
reduction)
3.Closed reduction by
manipulation followed by
immobilization:
Plaster of paris cast
4. Closed reduction by
continuous traction
followed by
immobilization :
- Skin traction
- Skeletal traction
5. Closed reduction
followed by functional
fracture bracing.
6. Closed reduction by
manipulation followed
by external skeletal
7.Open reduction
followed by
internal
fixation.
8.Closed
reduction by
manipulation
followed by
internal
skeletal
fixation.
9. Excision of a
fracture fragment
and replacement
by an
endoprosthesis.

Moores
prosthesis
Treatment for Open Fractures:

Gustilo and Anderson


Type 1: < 1 cm
low energy
Type 2: >2 cm,< 10 cm
moderate energy
Type 3: A, B, C: > 10 cm
high energy, high velocity
gunshot, segmental fracture,
neurovascular injury
1. Cleansing of the
wound
2. Excision of
devitalized tissue
(debridement)
3. Treatment of the
fracture
4. Closure of the
wound
5. Antibacterial
drugs
6. Prevention of
tetanus
Healing of a fracture:
1. Stage Hematoma
2. Stage
Inflammation
3. Stage Callus
4. Stage
Consolidation
5. Stage
Remodeling
Abnormal Healing of Fractures

1.Mal union
2.Delayed
union
3.Non-union =
pseudoarthr
osis
DISLOCATION

Out of Joint
Definition A complete loss
of contact between the
articular surface of joint.
Emergency case in
orthopaedic
DISLOCATION

Shoulder
Dislocations :
Anterior dislocation
> 50 %
Posterior dislocation
Hip Dislocations :
Posterior
dislocation > 80
%
Anterior
dislocation
Dislocation of
the Elbow :
Posterior >>
Anterior
Divergen
Lateral
Medial
Knee
Dislocations :
Anterior
Posterior
Lateral
Medial
Rotatory
References :

Louis Solomon, David Warwick,


Selvadurai N : Apleys System of
Orthopaedics and Fractures.
Robert B. Salter, MD : Textbook
of Disorders and Injuries of the
Musculoskeletal System.
Fraktur dan Dislokasi

Dr . Chairuddin Lubis, SpOT


Pendahuluan
Trauma adalah jejas akibat
paparan akut dari energi
Trauma Musculoskeletal : Sering,
Kadang kadang mengancam
nyawa
Trauma berat : menandakan ada
trauma tempat lain
A b c..
A Airway and cervical spine
immobilisation

B Breathing

C Circulation (treatment and diagnosis of


cause)

D Disability (head injury)

E Exposure (musculo-skeletal injury)


Trauma yang Mengancam
Nyawa
Ekstrikasi
Transportasi
Transportasi
Pertolongan Pertama
Luka Terbuka
Luka Tertutup
HIGH-ENERGY INJURY
LOW ENERGY INJURY
De-gloving Injury
Blast Injury
Pengobatan Tradisional
Konservatif
Plate Screw
Fixasi yang rigid lainnya
External Fixator

Biplane

Ex Fix
Last advance
Image Intensifier
Arthroscopy
Trauma jaringan lunak yang berat
Cedera Syaraf
Trauma Tlg Belakang
Mechanism Of Injury
Bedah Mikro
Replantasi
Trauma
Contoh Kasus
Soft Tissue Covering
Micro-reconstruction
THANK
YOU

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