Klasifikasi fraktur terbuka menurut Gustilo & Anderson

Grade Ukuran luka

kontaminasi

Jaringan lunak Bentuk patahan

I <1cm bersih Minimal Simpel/transversal/oblik

II >1cm Moderate Moderate -kominutive moderat (transverse, short oblique)

III A >10 cm Tinggi -kerusakan jaringan lunak luas, tapi masih bisa menutupi patahan tulang ketika dilakukan perbaikan

-minimal periosteal stripping-soft tissue coverage of bone is possible

III B >10 cm Masif -kerusakan jaringan lunak luas/hilang, sehingga tampak tulang (bone exposs)

-moderate to severe comminution -poor bone coverage

III C >10cm Masif -kerusakan jaringan lunak disertai kerusakan pembuluh darah /saraf yang hebat

-poor bone coverage-moderate to severe comminution

management- Prinsip penanganan fraktur terbuka:– Pembersihan luka– Debridemen/pembuangan jaringan avital

• Membuang benda asing• Membuang jaringan avital

– Reposisi dan stabilisasi tulang– Penutupan luka– Pemberian antibiotika– Pencegahan tetanus

- Konservatif dan operatif

Treatment Conservative Operative

Antibiotic Plan for ORIF

Anti tetanus Using intramedullary nailing

Debridement Using plates and screw

Stabilization with long leg back slab

Conservative A long leg cast with progressive weight bearing can be used for

isolated, closed, low-energy fractures with minimal displacement and comminution.

Cast with the knee in 0 to 5 degrees of flexion to allow for weight bearing with crutches as soon as tolerated by patient, with advancement to full weight bearing by the second to fourth week.

After 4 to 6 weeks, the long leg cast may be exchanged for a patella-bearing cast or fracture brace.

Union rates as high as 97%, although with delayed weight bearing related to delayed union or non-union.

Plates and Screws Plating is best for metaphyseal fracture that unsuitable for

nailing. The disadvantages are:

1) Increase risk of infection, wound breakdown, mal-union, non-union

2) Need to expose the fracture site

3) Stripping of the soft tissue around the fracture

4) less secure fixation and delay weight bearing (usually after 6wk)