FRAKTUR UMUM dr. Wahyu Eko W, SpOT ORTHOPAEDI DAN TULANG BELAKANG RS BINA HUSADA - PowerPoint PPT Presentation

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FRAKTUR UMUM dr. Wahyu Eko W, SpOT ORTHOPAEDI DAN TULANG BELAKANG RS BINA HUSADA

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  1. FRAKTUR UMUMdr. WahyuEko W, SpOTORTHOPAEDI DAN TULANG BELAKANGRS BINA HUSADA

  2. SMF Bedah FK UKI

  3. FRAKTUR 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 SMF Bedah FK UKI

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

  5. KLASIFIKASI • Gustillo – Anderson : • Luka < 1 cm • Luka 1 – 10 cm • Luka > 10 cm • Soft tissue coverage • Bone exposed • Neurovascular injury SMF Bedah FK UKI

  6. KLASIFIKASI • Gustillo – Anderson : SMF Bedah FK UKI

  7. Fractures due to a traumatic incident Caused by sudden and exessive force, which may be tapping, crushing, bending, twisting or pulling. • Direct violence : blow on the arm which shatters the ulna at the point of impact • Indirect violence: forcible traction by a tendon or ligament which literally pulls the bone apart SMF Bedah FK UKI

  8. Fatigue or stress fractures • Due to repetitive stress • Most often seen in the tibia or fibula or metatarsals, especially in atheletes, dancers and army recruits. SMF Bedah FK UKI

  9. Pathological fractures • Fractures may occur even with normal stresses if the bone has been weakened (by a tumor) or if it is excessivelly brittle (paget’s disease) SMF Bedah FK UKI

  10. How fractures are disposed • Complete fractures The bone is compeletely broken into 2 or more fragments. Transverse oblique or spiral, Impacted fracture Comminuted fracture SMF Bedah FK UKI

  11. Incomplete fracture • The bone is incompeletely divided and the periosteum remains in continuity. • Greenstick fracture • Compression fracture SMF Bedah FK UKI

  12. KLASIFIKASI • Berdasarkan garis patah 1.Komplet 2.Inkomplet SMF Bedah FK UKI

  13. KLASIFIKASI • Jumlah garis patah 3. Segmental 2. Komunitif 1. Simple SMF Bedah FK UKI

  14. KLASIFIKASI • Arah garis patah 4. Kompresi 2. Oblique 1. Transversal 3. Spiral SMF Bedah FK UKI

  15. KLASIFIKASI • Lokasi • Tulang Panjang • 1/3 proksimal • 1/3 tengah • 1/3 distal • Tulang Melintang • 1/4 medial • 1/4 lateral SMF Bedah FK UKI

  16. KLASIFIKASI • Dislokasi Fragmen • Undisplaced • Displaced • Fragmen tlg searah (ad latus) • Fragmen tlg membentuk sudut (ad axim) • Fragmen distal memutar (ad periferum) SMF Bedah FK UKI

  17. How fractures heal • Tissue destruction and haematoma formation • Inflamation and cellular proliferation • Callus formation • Consolidation • Remodelling SMF Bedah FK UKI

  18. Stadium Penyembuhan Fraktur SMF Bedah FK UKI

  19. Healing by direct repair • Fractures of cancellous bone • Fractures treated by rigid internal fixation SMF Bedah FK UKI

  20. The time factor Rate of repair depends upon : • the type of bone (cancellous bone heals faster than cortical bone. • type of fracture (transverse fracture takes longer than spiral fracture) • Blood supply (poor circulation means slow healing) • General constitution (healthy bone heals faster • Age (healing is almost twice as fast in children as in adults) SMF Bedah FK UKI

  21. Time table SMF Bedah FK UKI

  22. Fractures that fail to unite Causes of non union • Distraction and separation of the fragments • Interposition of soft tissue between the fragments • Excessive movement at fracture line • Poor blood supply SMF Bedah FK UKI

  23. Most fracture will unite provide the bone fragments are • Placed in contact with each other and • Held more or less immobile until new bone formation is apparent SMF Bedah FK UKI

  24. Anamnesa • The fracture is not always at the site of the injury SMF Bedah FK UKI

  25. ANAMNESIS • Umur, jenis kelamin - Pekerjaan • Pendidikan - Lingkungan rumah • Riwayat trauma: • Arah • Jenis - Lokalisasi nyeri - Gangguan fungsi SMF Bedah FK UKI

  26. Examination • General signs A broken bone is part of a patient. It is important to look for evidence of : (1) shock or haemorrhage; (2) associted damage to brain, spinal cord or viscera; and (3) a prediposing cause SMF Bedah FK UKI

  27. Look • Swelling, • bruising, • Deformity • Skin intact ? SMF Bedah FK UKI

  28. Feel • Local tenderness • Examine distal to the fracture in order to feel the pulse and test the sensation • Compartement syndrome ? SMF Bedah FK UKI

  29. Move • Crepitus and abnormal movement may be present, but it is more important to ask if the patient can move the joint distal to injury SMF Bedah FK UKI

  30. Pemeriksaan Fisik Move : • Nyeri gerak • Sensorik • Motorik aktif pasif SMF Bedah FK UKI

  31. Bekas dukun SMF Bedah FK UKI

  32. Bekas dukun SMF Bedah FK UKI

  33. Xray SMF Bedah FK UKI

  34. Special imaging • Tomography • CT- scan • MRI • Radioisotope scanning SMF Bedah FK UKI

  35. RADIOLOGI Rule of 2 : • 2 proyeksi • 2 sendi • 2 ekstremitas • 2 waktu SMF Bedah FK UKI

  36. PRINCIPLES OF FRACTURE TREATMENT SMF Bedah FK UKI

  37. First aid • Make sure that the airway is clear • If there is a wound, cover it with clean material • Stop bleeding by local compression • Give something for pain • If the neck or the bak is injured, prevent flexion which may damage the spinal cord • If there is fracture,prevent movement SMF Bedah FK UKI

  38. Assesment in hospital • Examine the airway and treat asphyxia • Make sure the patient can breathe • Note the obvious haemorrhage and stop it • Assess the degree of blood loss and shock • Check for spinal cord injury • Look for injuries of abdominal or pelvic viscera • Examine for the presence of fractures or dislocation • Look for soft tissue complications, especially nerve and vascular injury • Arrange for an x-ray SMF Bedah FK UKI

  39. Definitive treatment of closed fracture • Manipulation to improve the position of the fragments, followed by splintage to hold them together until they unite; meanwhile joint movement and function must be preserved SMF Bedah FK UKI

  40. Reposisi Mengembalikan kedudukan tulang • Cara : • Manual • Traksi • Operatif SMF Bedah FK UKI

  41. Fracture involving an articular surface; this should be reduced as near to perfection as possible because any irregularity will predispose to degenerative arthritis SMF Bedah FK UKI

  42. Closed reduction • The distal part of limb is pulled in the line of the bone • As the fragment disengage, they are repositioned • Alignment is adjusted in each plane SMF Bedah FK UKI

  43. Reposisi SMF Bedah FK UKI

  44. Reposisi Keberhasilan dinilai dari : • Alignment • Contact > 50 % • Rotation (-) • Discrepancy (-) • Sudut < 15 ° SMF Bedah FK UKI

  45. Indikasi konservatif • Anak dalam masa pertumbuhan • Impending infeksi • Jenis fraktur tidak cocok untuk ORIF • Toleransi operasi tidak baik • Pasien menolak operasi SMF Bedah FK UKI

  46. Indikasi Operasi • Sukar reposisi tertutup • Fraktur multipel • Fraktur patologis • Fraktur intra artikular SMF Bedah FK UKI

  47. HOLD REDUCTION • In order to unite, a fracture must be imobilized • We splint most fractures, not to ensure union but (1) to alliviate pain and (2) to ensure that union takes place in good position SMF Bedah FK UKI

  48. Immobilisasi (mempertahankan reposisi) • Fiksasi eksterna • Gips • Roger Anderson • Fiksasi interna • Plate + Screw • K-nail SMF Bedah FK UKI

  49. ORIF ; indications • # that cannot be reduced except by operation • # that inherently unstable and prone to redisplacemaent after reduction (#mid shaft forearm) • # that unite poorly and take long time (# femoral neck) • Pathological # • Multiple # • # in patients who prsent nursing difficulties (paraplegics, multiple injuries and very elderly SMF Bedah FK UKI

  50. ORIF; complications • INFECTION • NON – UNION • IMPLANT FAILURE • REFRACTURE SMF Bedah FK UKI