Diagnosis Dan Penanganan Fraktur - Andri R. Winoto, SpOT

8/18/2019 Diagnosis Dan Penanganan Fraktur - Andri R. Winoto, SpOT

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F R A C T U R E SDiagnosis and Treatment

ORTHOPEDIC AND TRAUMATOLOGYMEDICAL FACULTY of DIPONEGORO UNIERSITY

!"#"


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MIND MAPPING

F R A C T UR E S

DEFINITION

TYPES $CLASSIFICATIONDEFORMITY

FRACTURE HEALING

DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE


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D E F I N I T I O N

Break in continuityof bone and its

structures

tra%ma& dire't ( indire't

for'e ) stress

*at+o,ogi'fra't%res


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MIND MAPPING

F R A C T UR E S


DEFINITION

FRACTURE HEALING

DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE


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TYPES of FRACTURES

•COMPLETE FRACTURE-one di.ided into ! fragments

fra't%res 'an -e o-,i/%e0 s*ira,0 im*a't0 or'ommin%ted in its 'on1g%ration

•INCOMPLETE FRACTURE-one in'om*,ete,2 di.ided0 3it+ *erioste%m sti,,remainE4 5 greensti'6 fra't%res

TYPES and CLASSIFICATION#


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TYPES and CLASSIFICATION!


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TYPES and CLASSIFICATION7


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S*e'ia, C,assi1'ation

fra't%res +a.e some .ariet20 t+ro%g+ t+eir s*e'i1'di.ision

#:Et+io,og2

Tra%mati' fra't%res'a%sed -2 s%dden for'e

Pat+o,ogi' fra't%res'a%sed -2 3ea6ness of -one in a''ording to its *at+o,ogi' 'ond

Stress fra't%res'a%sed -2 ,ong;time for'e < stress on 'ertain ,o'ationm%,ti*,e re*etiti.e strain '2',e0 res%,t in mi'ro'ra'6s of -one


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TYPES and CLASSIFICATION=

Tra%mati'fra't%res Pat+o,ogi' fra't%res


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TYPES and CLASSIFICATION>


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TYPES and CLASSIFICATION?

!: C,ini'a, C,assi1'ation

Sim*,e fra't%res ',osed fra't%res no 'omm%ni'ation -et3een -one and e4terna, s%rfa'e of -od2

Com*o%nd fra't%res @o*en fra't%res +a.e 'omm%ni'ation -et3een -one and e4terna, s%rfa'e of -od2

Com*,i'ated fra't%res fo,,o3ed -2 'om*,i'ation0 e:g 5 %nion0 de,a2ed %nion0 non%nion0-one infe'tion


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TYPES and CLASSIFICATIONB


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TYPES and CLASSIFICATION#"

7: Radio,ogi' C,assi1'ation

• Lo'a,iation

( Dia1sia,( Meta1sia,

( Intra;arti6%,er( Fra't%re 3<dis,o'ation

• Con1g%ration

Trans.ersa,Fra't%re

O-,i6 Fra't%reS*ira, Fra't%re Fra't%reSegmenta,Fra't%reedge Fra't%reA.%,sion Fra't%reDe*resion Fra't%reIm*a'tion Fra't%re%rst Fra't%reE*i1sea, Fra't%re

• one e4isten'e

Tota, Fra't%reCra'6 Fra't%re

%'6,e < tor%sFra't%reHair ,ine Fra't%reGreensti'6Fra't%re


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8: fragmen;to;fragmen 'onne'tion

Undis*,a'ed

Dis*,a'ed dis*,e'e of -one 'an -e r%n in = 3a2s 5

; A**osition; Rotation; O.erriding; Ang%,ation 5 .a,g%s0 .ar%s0 ant0 *ost; Im*a'tion

TYPES and CLASSIFICATION##


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TYPES and CLASSIFICATION#!


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FRACTURE HEALING

Fracture healing depends onFracture healing depends on

types of bonetypes of bone

andand

amount of movementamount of movement

Divided into 5 stage :

oTissue injury and haematoma

oInflammation and cellular proliferation

oCallus forming

o

Consolidation

oRemodelling

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FRACTURE HEALING

Fracture healing is influenced by many factors :Fracture healing is influenced by many factors :

Age

ocali!ation and Configuration

"arly dislocation of fracture

#ascular supply in $oth fragments

Reduction and Immo$ilitation

Immo$ilitation period

%pace $et&een $oth fragments and soft

tissue interposition

'resence of infection

%ynnovial fluid

'assive and active movement of

e(tremity

!


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FRACTURE HEALING

Fracture healing abnormalities :Fracture healing abnormalities :

o)alunion

oDelayed union

o*onunion

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FRACTURE HEALING

Metacarpal shaft malunion with dorsal angulationMetacarpal shaft malunion with dorsal angulation

*ote : red circle sho&s the location of malunion in the same patients

8

http://www.emedicine.com/orthoped/images/1230552-1243899-2655.jpghttp://www.emedicine.com/orthoped/images/1230552-1243899-2654.jpghttp://www.emedicine.com/orthoped/images/1230552-1243899-2658.jpg


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MIND MAPPING


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MIND MAPPING

F R A C T UR E S

DEFINITION


FRACTURE HEALING

DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE


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o +istory

o ,eneral Features

o ocal Features

D I A G N O S I S #


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D I A G N O S I S !

+istory+istory Anamnesa

Age - pathological fracture .. /

%ymptomps

pain

sensory loss

motor loss

pale

haematuri

a$dominal pain

unconsciousness

neurovascular status of e(tremity distal to the fractures


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D I A G N O S I S 7

,eneral Features,eneral Features

"arly 'hysical "(amination

%hoc0 1 anemia 1 $leeding ..

injury of organs &ithin $ody2s cavity

predispose factors - e3g : pathological factors /

ocal Featuresocal Features

ocal "(amination

Inspection - oo0 /

'alpation - Feel /

)ovement e(am3

*eurological e(am3

G O S S


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D I A G N O S I S 8

InspectionInspection

Com*are 3it+ norma, site

E4tremit2 *osition

Fa'e e4*ression & *ain )

Anemi' signs &

-,eeding )

S6in < soft tiss%e 3o%nd

S%-'%tan e4tra.asasion

Deformit2 of -one

fragments

Tra%ma of ot+er organs

PalpationPalpation

,o'a, tem*erat%re

*ain

're*it%s & one -one fragments

grants on t+e ot+er )

ne%ro.as'%,ar stat%s on t+e dista,

site

Lim- ,engt+ & 'om*ared 3 <

norma, ,eng+t on t+e ot+er side )

D I A G N O S I S


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D I A G N O S I S 9

MovementMovement

a,,o3 *atient to mo.e at

t+e site of in%r2

m%st -e done 'aref%,,20 to

a.oid f%rt+er in%ries of soft

tiss%es0 .as'%,ar0 and ner.es

Neurologic ExaminationNeurologic Examination sensori' and motori'

e4amination

ot+er ne%ro,igi'

'onsideration 5

ne%ro*ra6sia

a6sonotmesis

ne%rotmesis

D I A G N O S I S


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D I A G N O S I S =

D I A G N O S I S


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D I A G N O S I S >

Radiograph e(aminationRadiograph e(aminationDefine :

o *ormal structure of $one and joints

o Confirm of fracture

o Fragments structure and movements

o )edical treatments

o Fractures types

o 'athological conditions of $one

o 'resence of alienete $ody - projectile4 etc /

'rinciples :

T&o sides projection

T&o joints affected

T&o e(tremities

T&o times of radiograph imaging

D I A G N O S I S


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D I A G N O S I S ?

D I A G N O S I S


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%uperior vie&

ateral vie&

Radiograph sho&s fracture line at the junction of

the middle and distal onethird diaphysis appears

transverse &ith no angulation nor displacement3

+o&ever4 in the lateral vie&4 the fracture line is

o$li6ue and the distal segment is displaced

superiorly

D I A G N O S I S B

D I A G N O S I S


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D I A G N O S I S =

Tomogr Tomogr aphaph44 e3g3 : one3g3 : on verte$raverte$rall

fracture or condylus ti$iafracture or condylus ti$ia

CTscanCTscan )RI)RI Radioisotop scanningRadioisotop scanning

MIND MAPPING


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MIND MAPPING

F R A C T UR E S

DEFINITION


FRACTURE HEALING

DIAGNOSIS

FRACTURE TREATMENT

SPECIFIC FRACTURE

FRACTURE TREATMENT


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FRACTURE TREATMENT #

Early stage treatment :Early stage treatment :

73 First Aid 8 A9C 8 Assesment

&ound closing

immo$ili!e to relief pain

3 Clinical evaluation $one injury .

neurovascular injuries .

find other condition : D) . ; Cardiovascular

disease . ; Allergic .


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FRACTURE TREATMENT !

BASIC C!SI"E#A$I!BASIC C!SI"E#A$I!

73 Do not &orsen the patient2s condition

3 Treatment is $ased on correct diagnosis and prognosis

3 According to individual condition of patient


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FRACTURE TREATMENT


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FRACTURE TREATMENT 8

R cognition

cognition

o Diagnosis and evaluation

o Anamnesis4 clinical e(am4 radiograph e(am

o Consider :

fracture locali!ation

types of fracture

complication prediction

treatment techni6ue

FRACTURE TREATMENT


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FRACTURE TREATMENT 9

R duction

duction

o if necessary

o place $one fragments in proper relationship to each other

o Alignment and Apposition

R t ntion

t ntion

o immobili'e fracture free of motion

R habilitation

habilitation

o restore function of invovled part

FRACTURE TREATMENT =


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FRACTURE TREATMENT =

CLOSE FRACTURECLOSE FRACTURE

$scherne ( )*+, - classification of closed fracture$scherne ( )*+, - classification of closed fracture

evel 7 : fracture &ith shallo& a$rasion or oedema on s0in and

su$cutaneous tissue

evel : higher fracture &ith contusion of soft tissue and oedema

evel < : severe injury &ith o$viously soft tissue damage and

compartement syndrome threats

FRACTURE TREATMENT >


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FRACTURE TREATMENT >

).). #eduction#eduction Close reduction

?pen reduction

/./. Immobili'ationImmobili'ation

Traction

Dressing - ,ips /

Internal Fi(ation

"(ternal Fi(ation

0.0. E1cersiseE1cersise

FRACTURE TREATMENT ?


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FRACTURE TREATMENT ?

?pen reduction

Traction

FRACTURE TREATMENT B


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FRACTURE TREATMENT B

ongarm hanging cast

Figureofeight splint dressing

FRACTURE TREATMENT #"


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Figureofeight dressing

ongleg plaster

FRACTURE TREATMENT #"

FRACTURE TREATMENT ##


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FRACTURE TREATMENT ##

OPEN FRACTUREOPEN FRACTURE

2ustillo 3 Anderson classification of open fracture2ustillo 3 Anderson classification of open fracture

Type I : have small opening - @ 7 cm / in the s0in and no signficant

muscle necrosis or stripping of $one periosteum

Type II : have larger s0in disruption - 7cm4 @ 7Bcm /4 no significant

stripping of periosteum4 gross contamination

Type IIIA : have e(tensive lacerations of tissue flaps - 7Bcm /4 or lesser

s0in lesion &ith gross contaminationType III9 : have significant stripping of periosteum4 re6uire soft tissue flap for

coverage

Type IIIC : have major vascular injury that re6uires repair

FRACTURE TREATMENT #!


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FRACTURE TREATMENT #!

o Treated &ith emergency surgery to minimi!e the ris0 of infection

and nonunion

o De$ridement

o ound closing

o Fracture sta$ili!ation - fi(ation /

o 'ostoperative care

FRACTURE TREATMENT #7


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FI24#E )

,rade IIIC distal ti$ia injury of 5yearold involved in high velocity

motorcycle accident3




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FI24#E /

,rade III9 foot injury of Eyearold run over $y an ice cream truc03




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FI24#E 5

#ersajet de$ridement and

gravity irrigation3


FRACTURE TREATMENT #=


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FI24#E 6

Final appearance after

de$ridement and irrigation3

FRACTURE TREATMENT #=

FRACTURE TREATMENT #>


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FRACTURE TREATMENT #>

FI24#E )0> month postoperative anteroposterior

radiograph after

de$ridement4 treatment of infection4 $one

grafting and

open reduction internal fi(ation3

FRACTURE TREATMENT #?


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internal fi1ation material%cre&4 pen4 metal plate4 circumferential

$ands4 etc

FRACTURE TREATMENT #?

FRACTURE TREATMENT #B


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FRACTURE TREATMENT #B

AMPUTATIONAMPUTATION

o 'atient &ith severely injured e(tremity

o early amputation indicated under follo&ing circumstances :

The lim$ is nonvia$le

the patient has shoc0 and severe multisystem injuries4

couldn2t tolerate a prolonged salvage procedure

the patient has severe chronic medical illness - D) 1

vascular disease /


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Diagnosis Dan Penanganan Fraktur - Andri R. Winoto, SpOT

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Transcript of Diagnosis Dan Penanganan Fraktur - Andri R. Winoto, SpOT