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OPEN FRACTURE

Dr.Wahyu Eko Widiharso, Sp.OT RS.BINA HUSADA 2011. OPEN FRACTURE. FRAKTUR. Putusnya hubungan kesinambungan/ diskontinuitas tulang dan atau tulang rawan Fraktur tertutup :Bila kulit sekitar intak

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OPEN FRACTURE

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  1. Dr.Wahyu Eko Widiharso, Sp.OT RS.BINA HUSADA 2011 OPEN FRACTURE

  2. SMF Bedah FK UKI

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

  4. OPEN FRACTURE definition picture • DEFINITION is break of bone, epifisis and cartilage adjacent with outside . CAUSE BY: TRAFFIC ACCIDENT/TRAUMA

  5. Open fracture ANKLE tibia

  6. GUSTILO CLASSIFICATION

  7. KLASIFIKASI 1.Fraktur tertutup 2. Fraktur terbuka SMF Bedah FK UKI • Berdasarkan hub dengan dunia luar :

  8. FRAKTUR • COMPLETE/ UNCOMPLETE • FRACTURE LINE FORM • FRACTURE LINE • DISPLACED /UNDISPLACED • CLOSED OR OPEN FRACTURE

  9. INCOMPLETE FRACTUR

  10. COMPLETE FRACTURE

  11. DISPLACED COMPLETE RACTURE

  12. FRACTUR DIAGNOSIS • Anamnesa • Pemeriksaan Fisik A.GENERAL EXAMINATION. B.LOCAL EXAMINATION. • Pemeriksaan X`ray

  13. HYSTORICAL EXAMINATION • TRAUMA :KLL/ non KLL • MEKANISME TRAUMA • POLYTRAUMA, MULTIPLE FRACTURE, OR LOCAL FRACTURE. • PAIN • HILANGNYA FUNGSI • LUKA

  14. Traffic accident

  15. BY CYCLE

  16. TRAFFIC ACCIDENT

  17. Traffic accident

  18. PHISYCAL EXAMINATION • ATLS • ABCD C-SPINE • EXAMINATION OF HEAD,CHEST,ABDOMEN • MULTIPLE TRAUMA/FRACTURE • SHOCK

  19. TRAUMA OPEN FRACTURE IN THE SCENE

  20. LOCAL EXAMINATION • LOOK • FEEL • MOVE

  21. LOOK • DEFORMITY abnormal MOVEMENT , angulation, rotation dan discrepency • FUNGSIOLAESA lost of function

  22. OPEN FRACTURE

  23. FEEL Pressure pain dan axial pain

  24. MOVE • Crepitation • Pain of movement • ROM and Strengt of muscle • Abnormal movement.

  25. RADIOLOGI • 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

  26. AIM OF TREATMENT • TO PROMOTE HEALING AND FUNCTION OF BONE AS SOON AS POSSIBLE.

  27. AIM OF TREATMENT • 1.RELEAVE PAIN • 2.GOOD REPOSITION • 3.PROMOTE HEALING • 4.PROMOTE FUNCTION • 5.REHABILITATION

  28. PRINCIPAL OPEN FRACTURE MANAGEMENT • 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)

  29. MANAGEMENT OPEN FRACTURE • 6.Fracture stabilisation • 7.Open wound 5-7 days • 8.Bone Graft • 9.Rehabilitation

  30. OPEN FRACTURE TREATMENT SERI • 1.WOUND CLEANING MECHANICAL IRIGATION WITH Na Cl TO REMOVED STRANGE BODY

  31. SERIAL TREATMENT OF • 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

  32. DEBRIDEMENT

  33. STABILIZATION

  34. OF MANAGEMENT • 4.WOUND CLOSURE Golden period 6-7 hours Leave it open Skin graft • 5.antibitic Prevent infection Broad spectrum Cephalosporin Aminogcoside 3-5 days

  35. antibiotic

  36. OF management • Prevent Anti Tetanus ATS/Toxoid Rural area accident give Penicilin procain

  37. Fracture Complication • EARLY COMPLICATION 1.LOCAL VASKULAR : COMPARTMENT SYND TRAUMA VARKULAR NEUROLOGIS : LESI MED.SPINAL 2.SISTEMIC : FAT EMBOLISM ,SHOCK BLEEDING, SEPSIS AND DEATH. Tetanus Ganggren.

  38. FRATURE COMPLICATION • LATE COMPLICATION JOINT STIFFNESS/CONTRACTURE DISUSE ATROFI MALUNION NONUNION DELAYED UNION GROWTH DISTURBANCE CHRONIC OSTEOMYELITIS

  39. SUMMARY • DIAGNOSA FRAKTUR : Historycal examination Physical examination Radiological examination • Open fracture Managemen • Fracture Complication

  40. THANK YOU

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