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Fracture

Perceptor:
dr. Fatah Manovito, Sp.OT

Fadel Muhammad I
Indrani Nur Winarno P
Meti Destriyana
Sayyidatun Nisa
Definition

Discontinuity of bone/cartilage or
epiphyseal plate

Related to Soft Tissue Injuries


Classification

Type of Fractures

Communication with External Environment

Fracture Location
Types of Fractures
Communication with External
Environment
Fracture Location
Open Fractures

 Open wound, relations


between bone fragments and
the environment
 Infection risk

 Gustillo ;
 Type I
 Type II
 Type III A,B and C
OPEN FRACTURES
Type I open fracture
Type II open fracture
Type III A open fracture
Type III B open fracture
Type III C open fracture
Diagnosis of Fractures
 History
 Fall, twisting injury, direct blow, MVA
 Localized pain, aggravated by movement
 Crepitus

 Physical Examination
 General condition  associated injuries
 Look : deformity, swelling, abn movement
 Feel : localized tenderness, muscle spasm,
NVD
 Move : ROM

 Diagnostic Imaging
 Exact nature & extent of fracture
 X-ray : min AP & lat (ocassional : oblique)
 CT / MRI : spine, pelvis

Salter RB. Textbook of Disorders and Injury of Musculoskeletal System


Diagnosis

 History :
 Biomechanics ~ Forces
 Time of injury
 Possibilities or serious injuries
 Decrease / lost of functions
 Previous management, transportation
Physical examination

 General condition :
 Vital signs
 ABC’s

 Local condition :
 Look
 Feel
 Move
Local Condition

 Look :
 Deformities : angulations, discrepancy, rotation
 Bone exposed
 Swelling

 Feel :
 Pain, crepitation, edema

 Move :
 Functio laesa

!
Neuro-vascular
disturbance
Supporting examinations

 Laboratory
 Imaging
Treatment

1. First do No harm
2. Base treatment on an Accurate Diagnosis and
Prognosis
3. Select Treatment with Specific Aims
4. Cooperate with the “Law of Nature”
5. Make Treatment Realistic and Practical
6. Select treatment for your patient as an individual
LIFE SAVING MEASURES

 A Airway and cervical spine immobilisation


 B Breathing and ventilation
 C Circulation (treatment and diagnosis of cause) : w/
hemorrhage control
 D Disability (head injury) : neurological status
 E Exposure (musculo-skeletal injury) : completely undress
but prevent hypothermia

Life threatening conditions are identified and simultaneous


management is instituted
SECONDARY SURVEY

Done after the patient “stable”


Head to toe
Every orificiums/every tubes
Treatment of Fracture

4 R :
 Recognition  diagnosis, soc ec, religion, etc
 Reposition  displaced /deformity to anatomic /
acceptable position
 Retaining  fixation of fragments : external, internal
 Rehabilitation  early joint ROM, muscle action, edema,
psychological consideration , previous activity
SPLINT

 Straight, strong, flat + padding


 Stable
 Safe
 Immobilization
 2 joints
 3 dimension
 Alignment / anatomic position
 Neuro-vascular conditions
Splints
Immobilization
Splinting

 Immobilize 2 joints / 2 bones


 Neuro-vascular functions

Advantages :
 Decreasing pain
 Prevent further damages
 Decrease or stop the bleeding
 Easy transportation
Extrication, stabilization & Transportation
INDICATION OF CONSULTATION

 ALL FRACTURES & DISLOCATION ARE PATOLOGIC CONDITIONS

 IMMOBILISATION/SPLINT FIRST

 STRICTLY NO DELAY OF TRANSFERING PATIENTS W/ FRACT +


NEUROVASCULAR INJURY, OPEN FRACTURES, DISLOCATION

 DO NOT DO HARM
Bone Healing

Hematoma

Granulation Tissue

Callus formation
Bone Healing

Ossification

Consolidation

Remodelling
Complications

Infection (Open Fractures)

Compartment Syndrome

Venous Thrombosis

Fat Embolism Syndrome (FES)


LATE COMPLICATION OF FRACTURES

INFECTION IN OPEN FRACTURE

 Type I less than 1%


 Type II 1-10 %
 Type III 10-50%
Fractures with vascular injuries
 Fractures with a high risk of
haemorrhagic shock :
 Fracture of pelvis
 fracture of femur

 Both are an emergency conditions


that needs an immediate
management.
 Blood vessels may injured by the bone
fragments, so it always needs a good
examination of the circulation at distal
part of the limb.
Deformity and impairment
Compartment Syndrome

A condition of increasing the closed


muscle compartmental pressure that
produce a disturbances of neuro-
vascular function of the extremity
Sign Symptoms

Pain Paresthesia Paralysis

Pulseless Pallor
Compartment Syndrome
Clinical Signs :
 Classical signs : 5 P (pain,
paresthesia, pallor, paralysis,
pulselessnes).
 Bulae
 Significant sign : strecth pain and
paresthesia,  decompresion
fasciotomy
 Measurement of the intra
compartment pressure 
fasciotomy
Management
 Remove extrinsic compression
 Elevate to at least level of heart
 Compartment pressure measurement?
 Fasciotomy
Thank you
“to cure sometimes, to relieve often, to comfort
always.”
- Edward Livingston Trudeau -