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
- Can’t move/ stand
2. Assesment of the patient’s :
- 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,Volkmann’s
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 Fractures
1. Protection 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 fixation.
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.

Moore’s 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 : Apley’s 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

– CCirculation (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