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FRACTURES andJOINT INJURIES

DARMADJI ISMONO dr, SpB, SpBO(K), FICS

DEPARTMENT OF ORTHOPAEDIC SURGERY and TRAUMATOLOGY

SCHOOL of MEDICINE

PADJADJARAN UNIVERSITY

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MULTIPLE TRAUMA

Penggolongan gawatdarurat adalah atasdasar sistim atau

fungsi, bukan atasdasar spesialisasi.

B1= Breath

B2=Blood

B3= Brain

B4= Bladder

B5= Bowel

B6= Bone

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MULTI DISCIPLINE APPROARCH

(team)

OVERLAPPED:

ORTHOPAEDIC &

NEURO SURGERIES

PLASTIC & THT &ORTHOPAEDIC and

ORAL SURGERIES

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Textbook of Disorders and Injuries

of the Musculoskeletal System

Robert Bruce Salter

Second Edition

Tureks

ORTHOPAEDICS

Principles and TheirApplication

(Fifth Ed )

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General Incidence

A Fracture Normal Living Bone

Fracture

Bone Epiphyseal plate

Cartilagenous

Structural break in its

continuity

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TERM

1. Site:

Diaphyseal

Metaphyseal

Epiphyseal / intra

articulair

2. Extent:

Complete

Incomplete Hairline

Buckle

greenstick

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TERM:

3. Configuration

Tranverse

Oblique

Spiral comminuted

4. Relation of the FractureFragments to each other:

Shifted sideways

Angulated Rotated

Distracted

Overriding

Impacted

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TERM:

5. Relationship of the

fracture to the external

environment open X closed

fractures

From within

From without

6. Complication

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The Diagnosis of Fractures

1. History

2. Assesment of the patients

general conditions, and

local physicalexamination (ATLS):

Looking (inspection)

Feling

Swelling

Deformity Abnormal movement

Echymosis

crepitus

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The Diagnosis of Fractures

3. Radiographic

examination:

antero-posterior

lateral

4. CT Scan

(computed tomography)

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COMPLICATION

1. Initial

2. Early

Volkmanns ischemia

3. Late

Volkmanns contractur

Pseudoarthrosis

Sudecks atrophy

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Initial and Early Complication

A. Local

Skin complications

Vascular complication

. arterial spasm/

compression/

thrombosis

. Compartmentsyndrome (pain,

pallor, puffy swelling,paresthesia)

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Late Complication

1. Joint stiffness

2. Bony complication

3. Mal-union

4. Delayed union

5. Non-union/

pseudoarthrosis

6. Sudecks post-traumati

painful osteoporosis

7. Muscular complication

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Volkmanns Ischemia

Slint catheterRorabeck:

Normal resting intracompartment:

08 mmHg

Wick catheterMubarak:

Pressures over:

30 mmHG

Absolute indicationfor decompression.

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Initial and Early Complication

A.2: Gangrenne

Volkmanns ischemic contracture Intermittent claudication

Gas gangrene ( clostridium welchii )

3. Neurological complication

4. Visceral complication5. Joint complication

B. Remote Complication

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Special Tipes of Fractures:

1. Stress fracures

2. Pathological

fractures3. Birth fractures

4. Epiphyseal plate

fractures

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The General Principles of Fracture Treatment

1. Firstly do no harm.

2. Select treatment with specific aims

3. Cooperate with the laws of nature

4. Be realistic and practical in your treatment5. Select treatment for patients as an

individual

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1. Protection alone (withoutreduction / immobilization)

2. Immobilization by external

splinting (without reduction)3. Closed reduction by

manipulation followed byimmobilization:

Plaster of paris cast

4. Closed reduction by

continuous traction followedby immobilization:

1. Skin traction

2. Skeletal traction

Specific Methods of Treatment

for Closed Fractures

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for Closed Fractures:

5. Closed reduction

followed by

functional fracturebracing.


manipulation

followed by external

skeletal fixation.

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manipulation

followed by internalskeletal fixation.

8. Open reduction

followed by internal

fixation.

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9. Excision of a

fracture fragment andreplacement by an

endoprosthesis.

Moores prosthesis

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Treatment for Open Fractures:

Gustilo and Anderson

Type 1: < 1 cm

low energy

Type 2: < 10 cmmoderate energy

Type 3: A, B, C:

> 10 cm

high energy, highvelocitygunshot, segmental fracture,neurovascular injury

Type 4: amputation.

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Treatment for Open Fractures:

1. Cleansing of the wound

2. Excision of devitalizedtissue (debridement)

3. Treatment of the fracture

4. Closure of the wound

5. Antibacterial drugs

6. Prevention of tetanus

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Healing of a fracture:

1. Stage of clinical union

2. Stage of consolidation(radiographic union)

AO (arbeitsgemein shaft frosteosynthese fragen)

ASIF(association for

osteosynthesis)primary bone healing

secondary bone healing

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Abnormal Healing of Fractures

1. Mal union

2. Delayed union

3. Non-union =

pseudoarthrosis

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THANK YOU

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