Download - Dr.dimas - Fraktur Dan Dislokasi
Fracture &
DislocationAntonius Permadi, dr,m.Kes, SpOT
Definition“ Break of structural continuity of the bone “
It may :
simple Crack
Complete break
DefinitionSpecial “Term” in children (Open epiphysis)
“ Epiphysiolysis “
DefinitionDisplace Joint surface
It May :
Subluxation
Complete dislocation
Pathophysiology
Fracture and/or dislocation can occur separetly or combine in one patient
Basicly are result of :
Single traumatic incident
Repetitive stress / load
Abnormal weakening of the bone (“ Pathologic fracture” )
Fracture due to TRAUMA
Most fracture cause by sudden and excessive
force, that may be DIRECT or INDIRECT force
Fracture typeBased on Underlying skin integrity (wound)
Open or ClosedBased on fracture anatomy
SimpleComminutif (>Two fragments)
Open FractureBreak of skin integrity on fracture area
Classified by Gustillo (1990’s)
Grade Wound Soft Tissue Injury Bone injury
I < 1 cm Minimal Simple Fr
II > 1 cm ModerateSome muscle damage moderate comminution
IIIA > 1 cm Severe damageComp syndrome ±
Highly comminutionSoft tissue cover possible
IIIB > 10 cm Severe soft tissue loss
IIIC > 10 cm As III B + Vascular lesion
Fracture complicationSistemic Complication
Fat Embolism syndrome
Sepsis
Local Complication
Acute Sub acute Chronic✴Vascular injury✴Nerve injury✴Compartment syndrome✴infection✴Gas gangrene✴Haemarthrosis
✴Ligament injury✴Nerve entrapment✴tendon lesion✴joint stiffness
✴Delayed union✴Malunion✴Non-union✴Avascular necrosis✴OA✴Joint instability
Compartment syndrome
Increase intracompartment pressure > 35 mmHgCardinal signs : 5 P’s
PainParaesthesiaPallorParalysisPulselesness
ManagementHealth care provider (doctor, nurse, etc) MUST be able :
Diagnose
Determine the complication
Emergency treatment (temporary stabilization)
Definitive treatment (Orthopedic speciality)
Principles
“Do No Further Harm”
PrinciplesLife Saving procedure should be done First
Check the ABC’s Patency Stable
DiagnoseBasicly consist of several item to describe
Close or Open
Region or part of the bone (femur, antebrachii, etc)
Location of the fracture (Proximal, middle, distal)
Complication
“Close Fracture Femur 1/3 Proximal”
DiagnoseShould be done by :
Physical examinationRadiology examination
Plain X RayCT-ScanMRI
Physical Exam
Done by LOOK - FELL - MOVE systemLOOK :
Deformity, swelling, bruise, wound, bone exposeFELL :
Tenderness, DISTAL ARTERI PULSEDON’T DO CREPITATION MOVEMENT !!
MOVE :Function of the nerve distal to the fracture site
Radiology ExamX-Ray is MandatoryRemember the rule of TWO
Two views ( Most are AP / Lateral views)Two JointsTwo limbsTwo occasions
Treatment
Treatment of fracture consist of Temporary treatment in Emegency Room (ER)
Splinting, sling, wound dressing, temporary wound closure
Two Joint Imobilization
Definitive treatment
Depend on the Fracture type (Open or Closed)
Close Fracture can be treat either conservative or operative treatment
Open Fracture MUST be treat operatively with ORIF or OREF
Dislocation of the joint should be treat as emergency procedure (ASAP)
Conservative Tx
Conservative Tx
Immobilization for Clavicle fracture
Operative Tx
ORIF Prothese
Open Fracture TxThe treatment Principles are :
1. Wound debridement
2. Antibiotic Prophylaxis
3. Fracture stabilization
4. Early wound cover