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Open and Closed Fractures

Definition
 A fracture is the loss of bone continuity and is
determined according to the type and extent.
Fractures can occur if bones are subjected to
greater stress than can be absorbed.
Clasification
 Based on the place (humerus fracture, tibia,
clavicle, and cruris etc.).

 Based on the area and fracture line consists of:


 Complete fracture
 Incomplete fracture

 Based on the shape and number of broken lines:


 Comminite fracture
 Segmental fracture
 Multiple Fractures
 Based on fragment position:
 Undisplaced (not shifted)
 Displaced (shifted)

 Based on fracture relations with the outside world:


 Closed
 Open
• Closed fracture: bone fracture that is not
related to the outside world
• Open fractures: bone fractures that have a
relationship with the outside world
Etiologi
 Fracture due to trauma
 Direct trauma: impact, blow
 Indirect trauma: the condition of falling
that rests on the bone
 Fracture due to fatigue (stress)
 Pathologic fractures due to weakness in
bone
Epidemiology
• The occurrence of fractures is more common in
men than women under the age of 45 years

• Often associated with sports, work or accidents


• whereas in the elderly (elderly) the prevalence
tends to be more common in women related to
the occurrence of osteoporosis associated with
hormonal changes in the menapouse phase

• Location of the frequent fracture: limb fracture


Open fracture
Closed fracture
Clinical Manifestations
 Continual pain and weight gain until bone
fragments are immobilized
 Hematoma
 Edema
 Deformity due to shifting broken bone fragments.
 Actual bone shortening occurs due to contraction
of the muscles attached above and below the
fracture site.
 Crepitation due to friction between fragments with
one another.
 Swelling and local discoloration of the skin as a
result of trauma and bleeding following the
fracture.
Diagnosis
• Anamnesis
• Physical examination : look, feel, move
• Radiologist exmination : rule of two
Treatment
The main objectives in the initial treatment of
fractures are:
• To maintain the lives of patients
• To maintain both anatomy and extremity
functions as before.
As for some things that must be considered in
handling the right fracture is :
(1) Primary survey which includes Airway,
Breathing, Circulation, Disability, Exposure
(2) Minimizing pain
(3) Preventing ischemia-reperfusion injury,
(4) Remove and prevent potential sources of
contamination.
Gambar 4. Alat Imobilisasi ekstrimitas bagian bawah. (1) Traction Splint.

(2)Long Leg Splint


The purpose of subsequent fracture management is to prevent potential
sources of contamination in the fracture wound. As for some ways that can be
done is to irrigate the wound with saline and wrap the wound fracture with a
moist sterile ghas or can also be given betadine to ghas. Give tetanus
vaccination and antibiotics as infection prophylaxis. Antibiotics that can be
given are:

1. The first generation cephalosporin (cephalotin 1-2 g divided by dose 3-4


times a day) can be used for Gustilo type I fractures

2. Aminoglycosides (antibiotics for gram negative) such as gentamicin (120 mg


dose 2x / day) can be added for type II and type III Gustilo classifications.

3. Metronidazole (500 mg 2x dose / day) can be added to treat anaerobic


bacteria.
Antibiotics can be continued for up to 72 hours after the
wound is closed. Debridement of the wound in the
operating room should also be done before 6 hours post-
trauma to avoid post-traumatic sepsis.

Reduction, repositioning and immobilization according to


the anatomical position can wait until the patient is ready
for surgery unless a neurovascular deficit is found on
examination. If there are indications for repositioning due
to neurovascular deficits, then repositioning should be
done in the ED using adequate analgesia techniques.
Komplikasi
 Komplikasi awal
 Kerusakan Arteri
 Compartement Syndrom
 Fat Embolism Syndrom
 Infeksi
 Avaskuler Nekrosis
 Shock
 Komplikasi dalam waktu lama
 Delayed Union
 Non Union
 Mal Union