Fracture

Ramses Indriawan
Department of Surgery
NTB Province General Hospital
Mataram

What is a fracture?
Fracture is a break
in the structural continuity of
the bone
it consist of
Closed fracture (simple fracture)
Open fracture (compound fracture)

Diskontinuitas struktur tulang

How fracture happens?

The Mechanism of
Fracture
Single traumatic incidence
Repetitive stress
Abnormal weakening of the

bone

Single Traumatic Incidence

Fractures of single
traumatic incidence,
can be due to
Direct force
Indirect force

Single Traumatic Incidence

and result in
twisting spiral
bending transverse
combination of bending and

compressing
combination of twisting,

bending and compressing

pulling

Kominutif

Spiral

Transversal

Oblik

How do fracture
heals?

1.
2.
3.
4.
5.

Steps of Fracture
Healing
Tissue destruction and
hematom formation
Inflammation and cellular
proliferation (within 6 hours)
Callus formation
Consolidation
Remodeling

PENYEMBUHAN FRAKTUR
1. Std. Destruksi / Hematom
2. Std. Inflamasi & Proliferasi sel
3. Std. Pembentukan kalus
4. Std. Konsolidasi
5. Std. Remodelling
1

Fraktur

Union

Konsolidasi

Remodelling

Some fractures never healed

(non union)

Causes of NonUnionfixation (motion

no/ unstable

between fracture segment)

infection on fracture site
too much gap between fracture
segment
lack of blood supply
Others (metabolic, age, general
condition)

NON UNION

What are the clinical signs of

fracture ?

Pain and tenderness

Loss of function
Deformity
Abnormal mobility and
crepitus
Neurovascular injury

How do we treat
fractures?

Treatment of
Fracture consists of

EMERGENCY CARE
DEFINITIVE TREATMENT
REHABILITATION

What do you do in emergency

care?

Immobilize the
extremities
How? Splinting

Why is splinting important?

Prevention of soft tissue

injury
Immobilization to relief pain
Lower the incidence of clinical

fat embolism and shock

Patient transportation and to

facilitate radiographic studies

What are the definitive

treatments of fractures?

Definitive Treatment
of Fracture
CLOSED REDUCTION
OPEN REDUCTION INTERNAL

FIXATION
OPEN REDUCTION EXTERNAL
FIXATION

Plate - screw

Fixasi External

ORIF (OPEN REDUCTION AND INTERNAL FIXATION)

Fracture and dislocation

Types of
Immobilization in
closed reduction
PLASTER OF PARIS
FIBERGLASS CAST
SKIN TRACTION in children
SKELETAL TRACTION

CARA GIP

Stockingette

Padding

PLESTER SLAB

Bryant s / Gallows
traction

Buck Extension

RUSSEL TRACTION

TRAKSI BERIMBANG
( SUSPENDED OR
FLOATING TRACTION )

When do we need to perform

surgery to immobilize a fracture?

Indication for
Operative Treatment

Failure of closed reduction

Contra - indication of closed

reduction
Fracture with displaced joint
surfaces

When do we need to perform

surgery to immobilize a fracture?
(2)

Indication for
Operative Treatment
Fracture due to metastasis of

malignancy
Fracture associated with arterial
injury
Multiple injuries
The need for early mobilization
Cost reduction

examples

in these
fractures, closed
reduction is NOT
recommended

1.
Galleazzi
fracture

2. Distal radio-ulnar
fracture in children

3. Montegia
fracture

4. Central
hipdislocation
fracture

How do we perform
rehabilitation of a fracture?

Rehabilitation
Following Fractures

Maintenance of joint motion

Muscle exercise
Gait training
Ambulation aid
Heat therapy
Massage
Orthoses prostheses