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8/3/2019 Fracture [Compatibility Mode]
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Fracture
Fracture
Ramses Indriawan
Department of Surgery
NTB Province General HospitalMataram
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Fracture is a breakin the structural continuity of thebone
Fracture is a breakin the structural continuity of thebone
What is a fracture?
it consist ofit consist of
Closed fracture (simple fracture) Open fracture (compound fracture)
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Diskontinuitas struktur tulang
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The Mechanism of FractureThe Mechanism of Fracture
How fracture happens?
Single traumatic incidence
Repetitive stress
Abnormal weakening of thebone
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Fractures of single traumaticincidence,
Fractures of single traumaticincidence,
Single Traumatic Incidence
can e ue tocan e ue to
Direct force
Indirect force
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and result inand result in
twisting spiral
bending transverse
Single Traumatic Incidence
combination of bending and
compressing
combination of twisting, bendingand compressing
pulling
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Spiral Oblik
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Steps of Fracture HealingSteps of Fracture Healing1. Tissue destruction and hematom
How do fracture heals?
2. Inflammation and cellularproliferation (within 6 hours)
3. Callus formation
4. Consolidation
5. Remodeling
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PENYEMBUHAN FRAKTUR
1. Std. Destruksi / Hematom
2. Std. Inflamasi & Proliferasi sel
3. Std. Pembentukan kalus4. Std. Konsolidasi
5. Std. Remodelling
Fraktur Union Konsolidasi Remodelling
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Causes of Non-UnionCauses of Non-Unionno/ unstable fixation (motion between
Some fractures never healed
(non union)
infection on fracture site
too much gap between fracture
segment lack of blood supply
Others (metabolic, age, general
condition)
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NON UNION
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Pain and tenderness
What are the clinical signs of
fracture?
Deformity
Abnormal mobility and crepitus
Neurovascular injury
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Treatment of Fractureconsists of
Treatment of Fractureconsists of
How do we treat fractures?
EMERGENCY CARE
DEFINITIVE TREATMENT
REHABILITATION
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Immobilize the extremities
Immobilize the extremities
What do you do in emergency
care?
How? SplintingHow? Splinting
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Prevention of soft tissue injury Immobilization to relief pain
Why is splinting important?
Lower the incidence of clinical fatembolism and shock
Patient transportation and tofacilitate radiographic studies
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Definitive Treatment ofFractureDefinitive Treatment ofFracture
What are the definitive
treatments of fractures?
L ED REDU TI N OPEN REDUCTION INTERNAL
FIXATION
OPEN REDUCTION EXTERNALFIXATION
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ORIF (OPEN REDUCTION AND INTERNAL FIXATION)
Plate - screw Fixasi External
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Types of Immobilizationin closed reductionTypes of Immobilizationin closed reduction
Fracture and dislocation
PLASTER OF PARIS
FIBERGLASS CAST
SKIN TRACTION in children
SKELETAL TRACTION
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CARA GIP
Stockingette Padding
PLESTER SLAB
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Bryant s / Gallows
traction
Buck Extension
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RUSSEL TRACTION
TRAKSI BERIMBANG( SUSPENDED OR
FLOATING TRACTION )
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Indication for OperativeTreatment Indication for Operative
Treatment
When do we need to perform surgery
to immobilize a fracture?
a ure o c ose re uc on Contra - indication of closed
reduction
Fracture with displaced jointsurfaces
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Indication for OperativeTreatmentIndication for Operative
Treatment Fracture due to metastasis of
When do we need to perform surgery
to immobilize a fracture? (2)
Fracture associated with arterialinjury
Multiple injuries The need for early mobilization Cost reduction
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in these fractures,closed reduction isNOT recommended
examples
1. Galleazzifracture1. Galleazzifracture
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2. Distal radio-ulnar fracture inchildren2. Distal radio-ulnar fracture inchildren
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3. Montegiafracture3. Montegiafracture
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4. Central hip-
dislocationfracture
4. Central hip-
dislocationfracture
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Rehabilitation Following
Fractures
Rehabilitation Following
Fractures
Maintenance of oint motion
How do we perform
rehabilitation of a fracture?
Muscle exercise Gait training
Ambulation aid
Heat therapy
Massage
Orthoses prostheses
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