Fraktur

dr. Eko Perdana Putra, Sp.OT, M.Kes

 Introduction
A fracture is a break in the structural continuity
of bone.

Complete >< incomplete

Closed >< open

 HOW FRACTURES HAPPEN

Fractures result from: Injury; Repetitive stress; Abnormal

weakening of the bone (a ‘pathological’fracture).
 FRACTURES DUE TO INJURY

Most fractures are caused by sudden and excessive force, which

may be direct or indirect.
• Direct force  A direct blow usually splits the bone
transversely or may bend it over a fulcrum so as to create a
break with a ‘butterfly’ fragment.
• Indirect force  most fractures are due to a combination of
forces (twisting, bending, compressing or tension)
 TYPES OF FRACTURE
• Complete Fracture
– Simple
– Wedge
– Complex

• Incomplete Fracture
– Plastic Deformity
– Green stick
– Buckle
• Simple Fracture

• Wedge Fracture

• Complex Fracture
Plastic Deformity Green stick Buckle
 TYPES OF FRACTURE
• Open >< Closed Fracture

VS

• Displaced >< non displaced Fracture

 HOW FRACTURES ARE DISPLACED
• Translation (shift) – The fragments may be shifted
Sideways
• Angulation (tilt) – The fragments may be tilted or
angulated in relation to each other. • Rotation (twist)
– One of the fragments may be
• twisted on its longitudinal axis; the bone looks
straight but the limb ends up with a rotational
deformity.
• Length – The fragments may be distracted and
separated, or they may overlap, due to muscle
spasm, causing shortening of the bone.
Fracture Classification
 How to Diagnose a fracture?
• History taking
– Chief complaint
– MOI

• Past History
• Family History
 Physical Examination
Systemic approach:
• Examine the most obviously injured part.
• Test for artery and nerve damage.
• Look for associated injuries in the region.
• Look for associated injuries in distant parts.
 Physical Examination
• LOOK : skin, shape, size, posture
• FEEL : point of tenderness, NVD
• MOVE Range of motion

• Signs of fracture:
– Crepitation
– False Movement
– Discontinuity
 Imaging
X-Ray
Rule of 2:
• Two views
• Two joints
• Two limbs
• Two injuries
• Two occasions
 Special Imaging
• CT Scan
• MRI
 Diagnosis Fraktur
1. open/closed?
2. Which Bone?
3. Which part of the bone?
4. Left or Right?
5. Configuration/Classification
6. Complication
 TREATMENT OF CLOSED FRACTURES

• Reduction  Closed / open

• Hold reduction:
– Continuous traction.
– Cast splintage.
– Functional bracing.
– Internal fixation.
– External fixation.
• Excercise

Operative vs Conservative
Closed Reduction
Open Reduction
 Hold Reduction
• Continuous Traction
 Hold Reduction
• Cast Splintage
 Hold Reduction
• Functional Bracing
 Hold Reduction
• Internal Fixation
 Hold Reduction
• External Fixation
 Name of the Procedure
• Closed Reduction and Casting
• Closed Reduction and Internal Fixation (CRIF)
• Open Reduction and Internal Fixation (ORIF)
• Open Reduction and External Fixation (OREF)
 Indications for Operative Treatment
• Failed conserfative treatment
• Fracture with nerve and vascular injury
• Displaced Extra articular fractureFracture
• Intra articular fracture displaced more than 2
mm
• Impending open fracture
• Fracture dislocation
• Multiple fracture
Open fracture Treatment
 Open Fracture
• General Supportive
• IV antibiotics
• Surgical Debridement
• Open Reduction
• Internal / External Fixation
• Wound closure
• Rehabilitation
Thank You