Fracture

Dr.dr. Izaak Zoelkarnain Akbar, SpOT

 Definition of Fracture

Fracture: A fracture is a break in

the continuity of the bone.
 Etiology
 Motor Vehicle Accident
 Fall
 Direct blow to the bone or an indirect
force from muscle contraction
 Sports
 Vigorous Exercise
 Malnutrition
 Bone Diseases like Osteoporosis
 Types of Fracture
Oblique
Oblique Butterfly
Butterfly

Multiple
Multiple Unstable
Unstable

Incomplete
Incomplete Spiral
Spiral
Fracture

Greenstick
Greenstick Closed
Closed

Compression
Compression Compound
Compound
Hairline
Hairline
 Butterfly Fracture
This type of
fracture has
slight
comminution at
the fracture site
 Closed Fracture
There is no broken
skin. The bones
which are broken
do not penetrate
the skin.
 Compound Bone Fracture
The skin is broken, leading
directly into fracture
 Grade I : Minimal soft
tissue injury
 Grade II : Laceration
greater then 1cm without
extensive soft tissue flaps.
 Grade III : Extensive soft
tissue injury, including
skin, muscles, neuro
vascular structures, with
crushing.
 Compression Fracture
A fracture in
which bone
has been
compressed.
 Greenstick Fracture
The fracture in
which one side of
the bone is broken
and the other side
is bent.
 Hairline Fracture
In this type of the
fracture the crack
only extends into
the outer layer of
the bone but not
completely
through the entire
bone. It is also
known as a Fissure
Fracture.
 Incomplete Fracture
A fracture in
which the end
of the bone do
not completely
separate leaving
the bone with a
crack
 Multiple Fractures
A bone with
several fracture.
It can also mean
several fractures
in one patient
but on separate
bones but
generally due to
the same injury.
 Oblique Fractures

A fracture
occurring at an
angle across the
bone. It is an
unstable fracture,
it can be easily
diagnosed as
spiral fracture.
 Spiral Fractures
A fracture
twisting around
the shaft of the
bone. It is highly
unstable. It can be
diagnosed as
oblique fracture
unless a proper
X-ray has been
taken.
 Unstable Fracture
An unstable
fracture is
generally a broken
bone which is
comminuted,
oblique or a spiral
fracture requiring
external or
internal fixation.
 Sign and Symptoms of Fracture
Arm and leg fractures
 5 P’s : Pain and point tenderness.
Pallor
Pulse loss
Paresthesia
Paralysis
 Deformity
 Swelling
 Discoloration
 Crepitus (grating, crackling or popping sounds )
 Loss of limb function
 Numbness
 Cool skin at the end of
extremity
 Loss of pulse
 Diagnostic Evaluation
 X-ray
 MRI, CT-scan
 Blood studies
 Arthroscopy
 Angiography
 Nerve conduction /
electromyogram
studies
 Management of Fracture
 Assessment
a. Type, location and
severity of fracture
b. Soft tissue damage
c. Age and health
status of patient
d. Extend of other
parts of organs
 Approaches to Management

Management

Closed Open

Bandages Splints Casts Traction Internal F External F

 Closed reduction
Is the most common non
surgical method for
managing a simple
fracture.
 Bandages : are elastic or
muslin bandage used to
immobilize the bone
during healing.
 Splints : as upper
extremity bones do not
bear weight, splints may be
sufficient to keep bone
fragments in place.
 Casts : A cast is an
immobilizing device
made up of layers of
plaster or fiber
glass. A cast also
allows early mobility
and reduces pain.
 Types of cast :
Arm cast
Leg cast
Cast braces
Body or spica cast
 Traction : it’s the
application of a
pulling force to a
part of the body. It
uses a system of
ropes, pulleys, and
weights to provide
reduction,
alignment and
rest.
 Open reduction
 Internal fixation : Open
reduction with internal
fixation permits early
mobilization. It is often the
preferred surgical method
for an elderly client who is
susceptible to the
complications of immobility.
Internal fixation uses pins,
screws, rods, plates and / or
protheses to immobilize a
fracture during healing. After
the bone achives union, the
hardware may be removed,
depending on the location
and type of fracture.
 External fixation :
Open reduction with
external fixation. The
physican makes small
percutaneous incisions so
that pins may be
implanted into the bone.
The pins are held in place
by a large external metal
frame to help in bone
healing.
 Goals of management
 To regain and maintain correct
position and alignment.
 To regain the function of involved
part.
 To return the patient to usual
activities in the shortest time and at
the least expenses.
Complications of Fracture
 Acute compartment syndrome.
 Shock.
 Fat embolism syndrome.
 Thrombo embolic complication.
 Infection.
 Avascular necrosis.
 Delayed union, non union and
mal union.
QUESTIONS
?
Fractures of
upper extremity

dr. Izaak Zoelkarnain Akbar

Fracture of the clavicle
The clavicle
serves as protector of
brachial plexus
acts as a strut which provides
the only bony connection
between upper limb and the
thorax.
mechanism of injury

indirect injury: a fall on
the outstretched hand, the
most common cause
a direct blow
 diagnosis
 history of injury
 clinical features
symptoms:pain with the motion of
shoulder joint , swelling, ecchymosis,
sign: deformity,tenderness,bony
crepitus
 x-ray
Treatment
Non Operative Treatment
 figure-of-eight bandage fixation
 it is difficult to reduce and maintain the
reduction of clavicle fractures
 despite deformity, healing usually proceeds
rapidly;
 Even when heal in overlapped or bayonet
position with a substantial bony
prominence, this will largely be resorbed
with time and the mass will decrease in size.
Indications of open reduction
and internal fixation
 Nonunion: the most frequent
indication
 Neurovascular involvement
 A persistent wide separation of the
fragments with interposition of soft
tissue
 Fracture of the distal end with torn
of coracoclavicular ligaments in an
adult
 Floating shoulder: Fractures of both
the clavicle and the surgical neck of
the scapula
 A patient that cannot endure the
suffer of figure-of-eight bandage
fixation
 Redisplacement after reduction that
cannot be accepted by the patient
FRACTURE OF
THE HUMERAL
SHAFT
Anatomy
 The radial nerve is the nerve most
frequently injured with fractures of the
humerus
 spiral course across the back of the
midshaft (spiral groove) of the bone
 It is relatively fixed in the distal arm as
it penetrates the lateral intermuscular
septum anteriorly to enter the forearm.
mechanism
 bending force produces transverse
fracture
 torsion force will result in a spiral
fracture
 combination of bending and torsion
produce oblique fracture or a butterfly
fragment
 compression forces will lead to either
proximal or distal ends of humerus
fracture
diagnosis
 history of injury
 clinical features: swelling, subcutaneous
ecchymosis, pain , limitation of upper extremity
motion,deformity,tenderness,
bony crepitus, abnormal motion
 x-ray
 rule out radial nerve palsy
Treatment
Most humeral shaft
fractures can be treated
nonoperatively
Method: the hanging arm
cast method or coaptation
splint
Notes
 these injuries are often very
painful and that good initial
immobilization is required
 long arm splint needs to be
applied from shoulder to wrist
to fully immobilize the extremity
Indications for Operative
Treatment
 satisfactory position and
alignment cannot be achieved
by conservative measures
 associated injuries in the
extremity require early
mobilization
 open humeral fractures
within 8-12 hours after injury
 pathological fracture
 fractures that associated
with major vascular injuries
 a fracture is segmental
 Malunion that influence the
function
 Nounion of a delayed fracture
 a spiral fracture of the distal
humerus, radial nerve palsy
develops after manipulation
or application of a cast or
splint
 when treatment of associated
injuries makes bed rest
necessary
fractures associated with vascular injuries
a spiral fracture with radial nerve injury
exploration of the nerve
 function has not returned in 3to 4 months
and the fracture has healed.
 radial nerve palsy occurs with open
fractures of the humeral shaft
 Early exploration when evidence suggests
that the radial nerve is impaled on a bone
fragment or is caught between the fragments
 Early exploration if the humeral fracture is
to be repaired early by open reduction and
internal fixation
Operative method
Fractures of the humeral shaft
can be fixed internally by plates
and screws, intramedullary
nails, or external fixation
devices.
Humeral shaft fracture treated by closed
intramedullary nailing
Humeral shaft fracture fixed with
compression plate
SUPRACONDYLAR humerus FRACTURES
classification
extension type
2 types: (95%)
flexion type
diagnosis
 history of injury
 clinical features: swelling,
subcutaneous ecchymosis,pain ,
deformity,tenderness,bony crepitus,
limitation of upper extremity motion
 x-ray
 rule out nerve and vascular injury
 Careful neurovascular examination of the
arm is essential, especially in extension-
type supracondylar fractures .
 The brachial artery may be lacerated by
the proximal fracture fragment and a
compartment syndrome may develop.
 All three major nerves that cross the
elbow can be injured, but the radial and
median nerves are those most commonly
affected.
treatment
 similarlyto humeral shaft
fractures with a hanging arm
cast or coaptation splint

NORMAL
treatment
 Open reduction and internal fixation are
used only in the presence of
neurovascular damage or when a
satisfactory position of the fracture is not
obtained by closed methods
FRACTURES OF
SHAFT OF RADIUS
AND ULNA
Anatomy
 radius & ulna lie parallel to each
other when forearm is supinated
 interosseous membrane: join
radius and ulna, which is directed
obliquely downward from radius
to ulna and is relaxant at the
neutral position of forearm
special type
 Monteggia fracture-dislocation
fractures of proximal third of ulna
with dislocation of radial head
 Galeazzi fracture-dislocation

fracture of distal third of radius with

dislocation of distal radioulnar joint
Monteggia fracture-dislocation
Galeazzi fracture-dislocation
diagnosis
 history of injury
 clinical features: swelling, pain ,
subcutaneous ecchymosis, limitation
of upper extremity motion,
deformity, tenderness, bony crepitus
,
normal postelbow triangle
 x-ray
Treatment
 Fractures of the forearm bones may
result in severe loss of function
unless adequately treated
 Open reduction and internal
fixation for displaced diaphyseal
fractures in the adult are generally
accepted as the best method of
treatment.
Internal fixation
 A satisfactory device for internal
fixation must hold the fracture
rigidly, eliminating as completely
as possible angular as well as
rotary motions
 method: intramedullary nail or
the AO compression plate
FRACTURES
OF DISTAL
RADIUS
Classification
 extension type
Colles fracture
 flexion type

Smith fracture
Colles fracture
Smith fracture
Mechanism of Colles
fracture
 fractureis caused
by a forced dorsiextention
of the wrist
 occurs in > 50 years
of age who fall on
out stretched hand
Diagnosis of Colles
fracture
 history of injury:fall on out
stretched hand
 clinical features: swelling,
subcutaneous ecchymosis,pain ,
limitation of wrist joint,
tenderness, fork deformity
 x-ray
Treatment
Most distal radial fractures can
be successfully treated
nonoperatively （ Manual
reduction ）
Barton fracture
A special type of fractures of
distal radius which is
intraarticular and is produced
by shearing.  
 HAND INJURY
Y
The posture of the
hand
 rest posture
 function posture
skin activility
 color and temperature of skin   
  capillary reflux test
  shape and size of flap
 ratio between length and width of
flap
 direction of flap
 bleeding state of skin edge
Tendons injury
 the posture of the hand often provides
clues as to which flexor tendons are
severed
 When both flexor tendons of a finger are
severed, the finger lies in an unnatural
position of hyperextension, especially
when compared with uninjured fingers.
 If middle finger remains extended when hand is at
rest, its flexor tendons have been severed
 This finger becomes normally flexed after its
profundus tendon or both this tendon and sublimis
have been repaired
Distribution of major nerves
innervating hand for sensory function.
Fractures of
Lower extremity
FRACTURES
OF FEMORAL
NECK
 Anatomy
Neck-Shaft Angle:
In the anteroposterior roentgenogram,
it is the angle between the long axis of
the femoral neck and the axis of femoral
shaft.
normal: 110-140 degree
mean: 127 degree
Anteversion angle:
On the sagittal plane, the
femoral head is anterior to
the shaft of the femur with the
angle of 12-15 degree.
blood supply to the proximal
end of the femur
 extracapsular arterial ring located
at the base of the femoral neck
 ascending cervical branches of the
arterial ring on the surface of the
femoral neck
 arteries of the ligamentum teres
blood supply to the proximal end
of the femur
Classification
In the AO classification system,
fractures of the femoral neck are
classified as subcapital with no or
minimal displacement (type B1),
transcervical (type B2), or
displaced subcapital fractures (type
B3)
Subcapital with no or minimal
displacement (Type B1) fractures may
be

 impacted in valgus of 15 degrees or

more (type B1.1),
 impacted in valgus of less than 15
degrees (type B1.2),
 or nonimpacted (type B1.3).
Transcervical (type B2)
fractures may be

 basicervical (type B2.1),

 midcervical with adduction (type B2.2),
 or midcervical with shear (type B2.3).
subcapital fractures (type B3)
may be
 moderately displaced in varus and
external rotation (type B3.1),
 moderately displaced with vertical
translation and external rotation (type
B3.2),
 or markedly displaced (type B3.3).

Type B3 fractures have the worst

prognosis.
AO
classification
system
Diagnosis
 history of falling
 clinical features
pain, limitation of hip joint ,
external rotation deformity:45-60degree,
tenderness, shorting of involved
limb:change of Bryant triangle and
Nelaton line
 x-ray
Treatment
We prefer manipulation and closed
reduction of femoral neck fractures
and perform open reduction only
when anatomical, closed reduction is
not attainable and the patient is not
a good candidate for a
hemiarthroplasty with a femoral
head prosthesis.
WHY HEALING DIFFICULT

 Femoral neck fractures usually are

entirely intracapsular, and, common to
all intracapsular fractures, the synovial
fluid bathing the fracture may interfere
with the healing process.
 Because the femoral neck has
essentially no periosteal layer, all
healing must be endosteal.
 Angiogenic-inhibiting factors in synovial
fluid also can inhibit fracture repair.
 These factors, along with the precarious
blood supply to the femoral head, make
healing unpredictable and nonunions
fairly frequent.
 With anatomical reduction and stable
fixation, the incidence of nonunion
should be acceptably low.
Non operative treatment
 1.fractures has no obvious displacement
 2.stable fracture, such as adduction or impacted
type
 3.the patient is too old
 4.general situation is too poor or combined with
cardiac, pulmonary, renal or hepatic malfunction

Method: skin traction for 6-8 weeks—sitting on bed

—standing on crutches after 3 months without
weight-bearing on foot—giving up crutches after
6 months
INDICATION OF SURGERY
 1.adduction type with obvious displacement
 2.age over 65 and the type of fracture is
subcapital
 3.adulesence femoral neck fracture
 4.delayed fracture and nonunion, malunion
that interfere with function, avascular
necrosis of femoral head or combined with
arthritis of hip
Internal fixation
currently two are commonly used
 multiple cannulated screws
 collapsible compression screw and
side plate combinations typically
used with an additional antirotation
screw
Internal fixation with cannulated
screws (AO technique)
Arthroplasty
Rehabilitation after
operation
 For internal fixation: bed rest for 2-3
weeks, then can sit on the bed. Can walk
with crutches without weight-bearing after
6 weeks. After fracture healing, can give
up the crutches.
 For arthroplasty: can stand on the ground
after 1 week of operation
INTERTROCHANTERIC FEMORAL FRACTURE
Anatommy
The calcar is a dense, vertical plate of
bone extending from the posteromedial
portion of the femoral shaft under the
lesser trochanter and radiating laterally
to the greater trochanter, reinforcing
the femoral neck posteroinferiorly. The
calcar is thickest medially and
gradually thins as it passes laterally.
The calcar
Orientation of the trabeculae

 It is along the lines of stress, with thicker

trabeculae coming from the calcar and
passing superiorly into the weight-bearing
dome of the femoral head.
 Smaller trabeculae extend from the inferior
region of the foveal area across the head
and the superior portion of the femoral neck
and into the trochanter, and hence to the
lateral cortex.
 Classification
Evans classification of intertrochanteric
fractures based on direction of fracture.

He further divided the unstable fractures

into those in which stability could be
restored by anatomical or near anatomical
reduction and those in which anatomical
reduction would not create stability.
 In an Evans type I fracture, the fracture
line extends upward and outward from
the lesser trochanter.
 In type II, the reversed obliquity fracture,
the major fracture line extends outward
and downward from the lesser
trochanter.
 Type II fractures have a tendency
toward medial displacement of the
femoral shaft because of the pull of the
adductor muscles.
Evans
classification
Diagnosis
 history of falling
 clinical features : swelling, pain,
subcutaneous ecchymosis,
limitation of hip joint , tenderness,
External rotation deformity: 90
degree, shorting of involved limb
 x-ray
Treatment
Nonoperative treatment

Closed methods of treatment of

intertrochanteric fractures
have largely been abandoned.
Operative treatment
Two broad categories of internal
fixation devices are commonly used
 Sliding compression hip screws
with side plate assemblies
 Intramedullary fixation devices
sliding compression hip
screws with side plate
intramedullary fixation devices
Aftertreatment
 The patient is allowed to sit in a chair
the day after surgery, and active
exercises of the upper and lower
extremities are begun
 Depending on the patient’s condition
and the stability of the internal
fixation, partial weight-bearing is
begun using a walker.
 Most patients can bear weight to
tolerance, although some with more
unstable fractures require approximately 6
weeks of protection with touch-down
weight-bearing.
FRACTURE OF THE
SHAFT OF FEMUR
Introduction
 Fractures of the shaft of the femur are the most
common fractures encountered in orthopaedic
practice.
 The femur is the largest bone of the body and
one of the principal load-bearing bones in the
lower extremity, fractures may result in
prolonged morbidity and extensive disability
unless treatment is appropriate.
 Fractures of the femoral shaft often are the
result of high-energy trauma and may be
associated with multiple system injuries
Diagnosis
 history of trauma
 clinical features: swelling, pain,
ecchymosis, deformity, tenderness, bony
crepitus, pseudoarthrosis, limitation of hip
and knee joints ,even shock
 x-ray
 rule out the injury of popliteal artery and
vein, tibial and common peroneal nerve
Treatment
 Several techniques are now available for
the treatment and the orthopaedic
surgeon must select the proper treatment
for each patient
 The type and location of the fracture, the
degree of comminution, the age of the
patient, the patient’s social and economic
demands and other factors may influence
the method of treatment.
Treatment methods
 Closed reduction and spica cast
immobilization
 Skeletal traction
 Femoral cast brace
 External fixation
 Internal fixation
Internal fixation
 Intramedullary nail
1.Open technique
2.Closed technique
 Interlocking intramedullary nail
1.Reamed
2.Unreamed
 Plate fixation
principles of treatment
Regardless of the method of treatment chosen,
the following principles are agreed upon:

 restoration of alignment, rotation and length

 preservation of the blood supply to aid union
and prevent infection
 rehabilitation of the extremity and thereby the
patient.
 Interlocking intramedullary nailing is
currently considered to be choice for
most femoral shaft fractures

Open femoral shaft

fracture stabilized
with small diameter
(10-mm) interlocking
nail using unreamed
technique.
FRACTURES OF
THE PATELLA
 Introduction
     Fractures of the patella
constitute almost 1% of all
skeletal injuries, resulting from
either direct or indirect trauma
Classification
Fractures of the patella can be
classified as undisplaced or
displaced and further
subclassified according to
fracture configuration
Diagnosis
 history of trauma
 clinical features:
swelling, pain, subcutaneous
ecchymosis, localized tenderness,
a palpable defect, limitation of
knee joint, Hemarthrosis:floating
patella test(+)
 X-ray
limitation of knee joint:
 Inability of the patient to actively extend
the affected knee usually indicates a
disruption of the extensor mechanism and
a torn retinaculum, which require surgical
treatment.
Treatment
The initial treatment of acute patellar
fractures
splinting the extremity in extension
or slight flexion
applying ice to the knee.To prevent
soft tissue damage, the ice should not
be applied directly to the skin.
Nonoperative treatment
 Closed fractures with minimal
displacement(3-4mm), minimal articular
incongruity(2-3mm) and an intact extensor
retinaculum can be treated nonoperatively
 immobilizing the knee in extension in a
cylinder cast from ankle to groin for 4 to 6
weeks, with weight-bearing allowed as
tolerated
Operative treatment
Fractures associated with
retinacular tears, open fractures,
and fractures with more than 2 to
3 mm of displacement or
incongruity are best treated
operatively.
Types of patellar
fixation
FRACTURES OF
THE TIBIAL
SHAFT
Introduction
 By its very location the tibia is exposed to
frequent injury.
 Because one third of its surface is
subcutaneous throughout most of its length,
open fractures are more common in the
tibia
 blood supply to the tibia is more precarious
than that of bones enclosed by heavy
muscles.
 High-energy tibial fractures
may be associated with
compartment syndrome or
neural or vascular injury
 Delayed union, nonunion, and
infection are relatively
common complications of
tibial shaft fractures
Diagnosis
 history of trauma
 clinical features
swelling,pain,subcutaneous ecchymosis,
eformity, tenderness, bony crepitus,etc
 x-ray
Prognosis
 The amount of initial displacement:
more than 50% of the width of the tibia
at the fracture site was a significant
cause of delayed union or nonunion
 the degree of comminution
 whether infection has developed
 the severity of the soft tissue injury
excluding infection
Treatment
Closed reduction and casting
for stable, low-energy tibial
fractures
 Operative treatment
 unstable, comminuted, segmental or bilateral
fractures
 floating knee injuries
 intraarticular extension of the fractures
 fractures in which the initial reduction is not
achieved or is lost
 open fractures
 fractures associated with compartment syndrome
and involving vascular injury
Locked intramedullary nailing
currently is the preferred
treatment for most tibial shaft
fractures requiring operative
fixation.
Open tibial fracture stabilized with
Russell-Taylor intramedullary nail.
Open tibial fracture stabilized with
monolateral external fixator
Fracture of tibia fixed by
compression plate and screws
TIBIAL
PLATEAU
FRACTURE
Classification
Treatment
Goals
restoration of articular congruity, axial
alignment, joint stability, and functional
motion.
 Nonoperative treatment
undisplaced fractures: a few days of splinting
followed by early active knee motion. Weight-
bearing should be delayed until fracture
healing is evident, generally at 8 to 10 weeks.
 Surgical treatment
 fractures associated with instability,
ligamentous injury, and significant
articular displacement
 open fractures
 fractures associated with
compartment syndrome
Plate and screw fixation of fracture of
medial tibial plateau
Ligament repair
 Ligamentous injuries have been
reported in 4% to 33% of tibial
plateau fractures
 Collateral and cruciate ligament
injuries occurring with tibial condylar
fractures are much more common
 The medial collateral ligament is most
commonly injured
FRACTURE OF
ANKLE
 Introduction
 The ankle joint is easily injuried at
plantar flexion posture.
 Injuries about the ankle joint cause
destruction of not only the bony
architecture but also often of the
ligamentous and soft tissue
components.
Classification
Ankle fractures can be classified
purely along anatomical lines as
 monomalleolar
 bimalleolar
 trimalleolar
Treatment
 Nondisplaced fractures usually can be
treated with cast immobilization
 In individuals with high functional
demands, internal fixation may be
appropriate to hasten healing and
rehabilitation.
 Displaced fractures should be treated
surgically.
X-ray after reduction
 the normal relationships of the ankle
mortise must be restored
 the weight-bearing alignment of the
ankle must be at a right angle to the
longitudinal axis of the leg
 the contours of the articular surface
must be as smooth as possible. The
best results are obtained by
anatomical joint restoration 
FRACTURES OF
CALCANEUS
Bohler angle
Diagnosis
 history of falling from high
 clinical features

swelling, subcutaneous ecchymosis,

pain, limitation of walking sign:
tenderness,deformity
 x-ray
X-ray should include five views
A lateral roentgenogram :to assess height
loss (loss of the Bohler angle) and rotation
of the posterior facet.
 The axial (or Harris) view :to assess varus
position of the tuberosity and width of the
heel.
 Anteroposterior and oblique views of the
foot to assess the anterior process and
calcaneocuboid involvement.
A single Brodén view, obtained by
internally rotating the leg 40
degrees with the ankle in neutral,
then angling the beam 10 to 15
degrees cephalad, to evaluate
congruency of the posterior facet
 External rotation view is taken at
45 degrees of external rotation and
30 degrees of roentgenographic
tube angulation.
single Brodén view
Treatment
 conservative treatment for
nondisplaced or minimally displaced
fractures with early range of motion
 axial fixation with a metallic pin for
tongue-type fractures
 open reduction and internal fixation
for joint depression fractures
INJURY OF
MENISCI
Function of menisci
 The menisci act as a joint filler,
compensating for gross
incongruity between femoral and
tibial articulating surfaces
 the menisci prevent capsular and
synovial impingement during
flexion-extension movements.
 The menisci have a joint lubrication
function, helping to distribute synovial
fluid throughout the joint and aiding
the nutrition of the articular cartilage
 They contribute to stability in all
planes but are especially important
rotary stabilizers and are probably
essential for the smooth transmission
from a pure hinge to a gliding or
rotary motion as the knee moves from
flexion to extension
Mechenism
 Traumatic lesions of the menisci are
most commonly produced by rotation
as the flexed knee moves toward an
extended position.
 The most common location for injury
is the posterior horn of the meniscus,
and longitudinal tears are the most
common type of injury.
Diagnosis
 The diagnosis of internal
derangement of the knee caused by a
meniscal tear is difficult
 Using a careful history and physical
examination and supplementing
standard roentgenograms in specific
instances with special imaging
techniques and arthroscopy
Diagnostic tests
 Clicks, snaps, or catches, either audible
or detected by palpation during flexion,
extension, and rotary motions of the joint
 McMurray test
 Apley grinding test
 magnetic resonance imaging (MRI)
 Arthroscopy acts as the method of
diagnosis and therapy
Dr. Izaak Zoelkarnain Akbar SpOT
Terputusnya kontinuitas tulang,
tulang rawan dan lempeng
pertumbuhan.
 Trauma langsung atau tidak langsung
 Kecelakaan lalulintas
 Kecelakaan kerja
 Jatuh dari pohon/gedung
 Kecelakaan olah raga
 Berkelahi
 Dll
Fraktur terbuka
 Perforasi kulit dan jaringan lunak dengan disertai
patah tulang.
 Akibat tusukan tulang dari dalam atau terkena
benda tajam / tumpul.
 Hampir pasti terjadi kontaminasi.

GAWAT DARURAT
 1. Fraktur terbuka
 2. Fraktur dengan lesi
vaskuler
 3. Dislokasi
Klasifikasi fraktur terbuka :
Gustillo (1987)
 Tipe I =Energi trauma rendah
=Luka kurang 1 cm, biasanya
karena tusukan tulang.
=Luka bersih
=Kerusakan jaringan lunak sedikit
Klasifikasi fraktur terbuka :
Gustillo (1987)
 Tipe II = Luka lebih 1 cm
= Kerusakan jar lunak tidak luas
= Luka kotor
Klasifikasi fraktur terbuka :
Gustillo (1987)
 Tipe III = Energi trauma besar.
= Kerusakan jaringan luas.
= Luka sangat kotor.
Klasifikasi fraktur terbuka :
Gustillo (1987)

 Tipe IIIa = Tulang masih dapat ditutup

dengan jar lunak.
 Tipe IIIb = Tulang tidak bisa ditutup jar
lunak.
Periosteum terkelupas.
 Tipe IIIc = Fraktur dengan kerusakan
vaskuler utama yang masih
bisa di repair
1. Anamnesa
2. Pemeriksaan umum
3. Pemeriksaan lokal.
Look : kulit? Bentuk? Posisi?
Feel : Hangat? Nyeri?
Move : Krepitasi? False movement? Nyeri? ROM?
4. Pemeriksaan radiologi
 Tanda TIDAK pasti fraktur
 Nyeri

 Bengkak

 Deformitas

 Perdarahan

 Tanda PASTI fraktur.

 Krepitasi

 False movement
I. UMUM :
- Primary survey :
Airway : bersih? Tersumbat?
Breathing: Pneumo/ hemato thorax?
Circulation:hemoragi shock

- Secondary survey : head to toe

ADAKAH MULTI TRAUMA

II. LOKAL.
1. Pasang bidai dengan benar, jangan masukkan
tulang sebelum debridement
2. Hentikan perdarahan dengan bebat tekan
3. Hentikan perdarahan besar dengan klem
4. ATS/ tetanus toxoid
5. Antibiotik : Cephalosporin, aminoglikosida,
penisillin
6. Pemeriksaan radiologi dan laboratorium
7. Debridement
8. Fiksasi fraktur
9. Tutup jaringan lunak
10. Rehabilitasi
SEGERA AWAL LANJUT
.Shock hemoragic .Kompartment sindrom .Kaku sendi
.Lesi vaskuler utama .Osteomyelitis .Degeneratif artritis
.Lokal hemoragik .Septik artritis .Malunion, non union
.Lesi saraf perifer .Gas gangren .Ggn pertumbuhan
.Hematoma .Avaskuler nekrosis .Osteomyelitis kronis
.Emboli lemak .Osteoporosis
.Pneumonia .Myositis ossificans
.Sudeck dystrophy
.Refraktur