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Fracture & Dislocation: Antonius Permadi, DR, M.Kes, Spot
Fracture & Dislocation: Antonius Permadi, DR, M.Kes, Spot
Fracture & Dislocation: Antonius Permadi, DR, M.Kes, Spot
&
Dislocation
Antonius Permadi, dr,m.Kes, SpOT
Definition
Break of structural continuity of the bone
It may :
simple Crack
Complete break
Definition
Special Term in children (Open epiphysis)
Epiphysiolysis
Definition
Displace 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
Fracture type
Based on Underlying skin integrity (wound)
Open or Closed
Based on fracture anatomy
Simple
Comminutif (>Two fragments)
Open Fracture
Break of skin integrity on fracture area
Classified by Gustillo (1990s)
Grade
Wound
Bone injury
< 1 cm
Minimal
Simple Fr
II
> 1 cm
Moderate
Some muscle damage
moderate comminution
Severe damage
Highly comminution
Comp syndrome
IIIA
> 1 cm
IIIB
> 10 cm
IIIC
> 10 cm
Fracture complication
Sistemic Complication
Fat Embolism syndrome
Sepsis
Local Complication
Acute
Vascular injury
Nerve injury
Compartment syndrome
infection
Gas gangrene
Haemarthrosis
Sub acute
Ligament injury
Nerve entrapment
tendon lesion
joint stiffness
Chronic
Delayed union
Malunion
Non-union
Avascular necrosis
OA
Joint instability
Compartment syndrome
Management
Health 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
Principles
Life Saving procedure should be done First
Check the ABCs Patency
Stable
Diagnose
Basicly 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
Diagnose
Should 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
DONT 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
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
Operative Tx
ORIF
Prothese
Open Fracture Tx
The treatment Principles are :
1. Wound debridement
2. Antibiotic Prophylaxis
3. Fracture stabilization
4. Early wound cover