Dr.Wahyu Eko Widiharso, Sp.OT

RS.BINA HUSADA 2011

SMF Bedah FK UKI 3

Putusnya hubungan kesinambungan/ diskontinuitas tulang dan atau tulang rawan Fraktur tertutup :Bila kulit sekitar intak Fraktur terbuka kemungkinan terjadi kontaminasi atau infeksi :Bila ada luka, sehingga SMF Bedah FK UKI 4

DEFINITION

 DEFINITION is break of bone, epifisis and cartilage adjacent with outside .

CAUSE BY: TRAFFIC ACCIDENT/TRAUMA

PICTURE

ANKLE TIBIA

I

Gustilo Classification Low energy, wound less than 1 cm

II

Wound greater than 1 cm with moderate soft tissue damage High energy wound greater than 1 cm with extensive soft tissue damage

III IIIA IIIB IIIC

Adequate soft tissue cover Inadequate soft tissue cover Associated with arterial injury

I.

Berdasarkan hub dengan dunia luar : 1.

Fraktur tertutup 2 . Fraktur terbuka SMF Bedah FK UKI 8

     COMPLETE/ UNCOMPLETE FRACTURE LINE FORM FRACTURE LINE DISPLACED /UNDISPLACED CLOSED OR OPEN FRACTURE

 Anamnesa  Pemeriksaan Fisik A.GENERAL EXAMINATION.

B.LOCAL EXAMINATION.

 Pemeriksaan X`ray

 TRAUMA :KLL/ non KLL  MEKANISME TRAUMA   POLYTRAUMA, MULTIPLE FRACTURE, OR LOCAL FRACTURE.

PAIN   HILANGNYA FUNGSI LUKA

  ATLS ABCD C-SPINE   EXAMINATION OF HEAD,CHEST,ABDOMEN MULTIPLE TRAUMA/FRACTURE  SHOCK

OPEN FRACTURE IN THE SCENE

 LOOK  FEEL  MOVE

 DEFORMITY  abnormal MOVEMENT , angulation, rotation dan discrepency FUNGSIOLAESA lost of function

Pressure pain dan axial pain

 Crepitation  Pain of movement  ROM and Strengt of muscle  Abnormal movement.

  Classical fracture easy to diagnose Non Classical Fractur need radiological examination  Minimal 2 AP/Lateral projection Axial, alar and obturator.

Chidren : need opposite side Include 2 joint

 TO PROMOTE HEALING AND FUNCTION OF BONE AS SOON AS POSSIBLE.

     1.RELEAVE PAIN 2.GOOD REPOSITION 3.PROMOTE HEALING 4.PROMOTE FUNCTION 5.REHABILITATION

     1.OPEN FRACTURE IS EMERGENCY CASE 2.INITIAL EVALUATION (ATLS) 3.ANTIBIOTIC FROM EMERGENCY ROOM, OPERATING THEATER AND POST OPERATION 4.ADEQUATE DEBRIDEMENT DAN IRIGATION 5.REPEAT DEBRIDEMEN (24-72 HOURS)

 6.Fracture stabilisation  7.Open wound 5-7 days  8.Bone Graft  9.Rehabilitation

 1.WOUND CLEANING MECHANICAL IRIGATION WITH Na Cl TO REMOVED STRANGE BODY

 2.DEBRIDEMENT

TISSUE NECROTIC EXC.

NO VASC.TISSUE

SKIN, SUB CUTAN, FAT, FASCIA AND MUCLE BONE FRAGMENT  3.STABILIZATION

GRADE I INTERNAL FIKSASI GRADE II/III EXTERNAL FIXATION TRACTION

 4.WOUND CLOSURE Golden period 6-7 hours Leave it open Skin graft  5.antibitic

Prevent infection Broad spectrum Cephalosporin Aminogcoside 3-5 days

 Prevent Anti Tetanus ATS/Toxoid Rural area accident give Penicilin procain

 EARLY COMPLICATION 1.LOCAL

VASKULAR : COMPARTMENT SYND TRAUMA VARKULAR NEUROLOGIS : LESI MED.SPINAL

2.SISTEMIC : FAT EMBOLISM ,SHOCK BLEEDING, SEPSIS AND DEATH. Tetanus Ganggren.

 LATE COMPLICATION JOINT STIFFNESS/CONTRACTURE DISUSE ATROFI MALUNION NONUNION DELAYED UNION GROWTH DISTURBANCE CHRONIC OSTEOMYELITIS

 DIAGNOSA FRAKTUR : Historycal examination Physical examination Radiological examination  Open fracture Managemen  Fracture Complication