Dr.Wahyu Eko Widiharso, Sp.

OT

RS.BINA HUSADA
2011

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
SMF Bedah FK UKI

DEFINITION

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

CAUSE BY: TRAFFIC

ACCIDENT/TRAUMA

PICTURE

ANKLE

TIBIA

I.

Berdasarkan hub dengan dunia

luar :

1.Fraktur
tertutup

2. Fraktur
terbuka

SMF Bedah FK UKI

 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
LUKA

FUNGSI

 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

3.STABILIZATION

TISSUE NECROTIC
EXC.

GRADE I
INTERNAL FIKSASI

NO VASC.TISSUE

GRADE II/III
EXTERNAL
FIXATION

SKIN, SUB CUTAN,

FAT, FASCIA AND
MUCLE
BONE FRAGMENT

TRACTION

4.WOUND
CLOSURE

5.antibitic

Prevent infection
Golden period 6-7
hours
Leave it open

Broad spectrum
Cephalosporin
Aminogcoside

Skin graft

3-5 days

Prevent Anti
Tetanus

ATS/Toxoid
Rural area accident
give Penicilin
procain

 EARLY

COMPLICATION
1.LOCAL
VASKULAR : COMPARTMENT SYND
NEUROLOGIS :

TRAUMA VARKULAR

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