23 fraktur dan dislokasi dr.dimas

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 Closed

Based on fracture anatomy

Simple

Comminutif (>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 cmModerate

Some muscle damagemoderate comminution

IIIA > 1 cmSevere damage

Comp syndrome ±Highly comminution

Soft tissue cover possible

IIIB > 10 cm Severe soft tissue loss

IIIC > 10 cm As III B + Vascular lesion

Fracture complication

Sistemic 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 mmHg

Cardinal signs : 5 P’s

Pain

Paraesthesia

Pallor

Paralysis

Pulselesness

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 examination

Radiology examination

Plain X Ray

CT-Scan

MRI

Physical Exam

Done by LOOK - FELL - MOVE system

LOOK :

Deformity, swelling, bruise, wound, bone expose

FELL :

Tenderness, DISTAL ARTERI PULSE

DON’T DO CREPITATION MOVEMENT !!

MOVE :

Function of the nerve distal to the fracture site

Radiology Exam

X-Ray is Mandatory

Remember the rule of TWO

Two views ( Most are AP / Lateral views)

Two Joints

Two limbs

Two 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 Tx

The treatment Principles are :

1. Wound debridement

2. Antibiotic Prophylaxis

3. Fracture stabilization

4. Early wound cover