Discussion Tibial Fibula Fracture Rafael Gustillo Anderson
-
Upload
asad-pratama-putra -
Category
Documents
-
view
240 -
download
4
Transcript of Discussion Tibial Fibula Fracture Rafael Gustillo Anderson
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)