RISKA Step 7 Lbm 4 Modul 9

8/12/2019 RISKA Step 7 Lbm 4 Modul 9

http://slidepdf.com/reader/full/riska-step-7-lbm-4-modul-9 1/57

AMALIA DWI ARISKA

30101206829

SGD 20

STEP 7:

1. What are the etioo!" o# the $ia!%o&ti' i% thi& &'e%ario a%$ the other

etioo!"(

ETI)L)G* )+ +RA,T-RES

ETRI/SI, ,A-SES

DIRE,T I)LE/,E

Traa i& the o&t 'oo% 'a&e o# #ra'tre& i% &a a%ia& a%$ i&

&a" $e to atooie i%4r" or #ai%! #ro a hei!ht. Si%'e $ire't

traa i& rare" $ei5ere$ i% a 'airate$ ao%t to a &e'i' a'e the

re&ta%t #ra'tre i& rare" re$i'tae. The ao%t a%$ $ire'tio% o# #or'e

i 5ar" #ro a''i$e%t to a''i$e%t. Mo&t #ra'tre& re&ti%! #ro 5ioe%t

$ire't traa are either 'oi%te$ or tie.

INDIRECT VIOLENCE

Fractures due to indirect trauma are more predictable than those due to direct trauma.

Generally a orce is transmitted to a bone in a speciic ashion and at a !"ea# lin#!

"ithin the bone$ causin% a racture to occur.

&ENDING FORCE'

&endin% ractures occur "hen orce is applied to a speciic ocal point on a bone tothe e(tent that the traumatic orce o)ercomes the elastic limit o the bone diaphysis.

The initial eect o a bendin% orce is a cortical brea# opposite the site o the trauma.

The periosteum "ill remain intact on the side o the orce "hile tearin% o)er the

racture on the opposite side. *ith additional orce the entire bone snaps$ "ith

attendant tearin% o )ascular and sot tissue structures "ithin or on the diaphysis.

&endin% ractures are %enerally obli+ue or trans)erse$ or they may ha)e a butterly

ra%ment. ,E(ample- do% runnin% across a ield steps into a %opher hole "ith the

hind limb/ the ed%e o the hole is a ulcrum producin% a bendin% racture o the

midshat tibia.0

TOR'IONL FORCE'

Torsional ractures occur "hen a t"istin% orce is applied to the lon% a(is o a bone.

1sually this is a result o one end o a bone bein% placed in a i(ed position "hile the

other end o the bone is orced to rotate. The resultin% racture "ill be a )ery lon%

spiral "ith sharp points and oten sharp ed%es. It is possible or the sharp points or

ed%es to compromise sot tissues or to cut throu%h the s#in and result in an open

racture. Torsional orces %enerally result in short or lon% spiral ractures. ,E(ample-

cat 2umpin% rom a %ara%e roo to a ence mis2ud%es the distance and catches its

hoc# in the ence. The resultin% orce o its body t"istin% a%ainst the i(ed lo"er

e(tremity results in a spiral racture o the tibial diaphysis.0



CO34RE''ION FORCE'

Compressi)e orces alon% the lon% a(is o a bone may orce the smaller diaphyseal or

metaphyseal portion o a bone to impact into the lar%er epiphysis- bony substance is

thereby crushed. 'imilarly a compressi)e orce directed alon% the a(is o the spine

may result in collapse o a )ertebral body. For compressi)e orce to result in racture$

one end o a bone must be in a i(ed position "hile the other end is orced to"ard thei(ed end. Compressi)e orces result in impacted ractures or compression ractures.

,E(ample- lar%e breed puppy 2umps or a risbee and in landin% orces the hoc#

planti%rade into the %round. The ull "ei%ht o the do% then crushes the pro(imal

tibial epiphysis o)er the pro(imal tibial metaphysis.0

'5ERING FORCE'

shearin% racture is caused by a orce transmitted alon% the a(is o a bone$ "hich is

then transerred to a portion o the same bone that lies peripheral to the a(is or across

a 2oint to other bones that are not protected by the a(is o the bone. The orce shears

o that bony portion unable to continue transmission o the orce alon% the a(is. The

racture line in a shear racture "ill be parallel to the direction o the applied orce.'hearin% orces result in the racture o bony prominences not placed alon% the direct

a(is o a diaphysis. ,E(ample- n immature miniature breed do% is dropped rom its

o"ner6s arms to a hard surace. The orce transmitted up the radius and ulna$ across

the elbo" 2oint and into the distal humerus "ill shear o the lateral humeral condyle.0

I/TRI/SI, ,A-SES

+RA,T-RES D-E T) M-S,-LAR A,TI)/

+ra'tre& 'a&e$ " 5ioe%t 'o%tra'tio% o# a &'e are 'ae$ a5&io%

#ra'tre&. The" a" o''r e'a&e o# 5ioe%t i&oetri' 'o%tra'tio% t are

a&&o'iate$ ore 'oo%" ith traa that re&t& i% #or'e# &'ar

&horte%i%!. The&e #ra'tre& #ree%t" o''r i% iatre a%ia& hie

the h"&ea ate reai%& oe%. S'h &'ar #or'e& are ore i;e" to

&earate a 'artia!i%o& %io% tha% the e5e%ta o%" %io% o# atre

a%ia&.

)ulsion ractures aectin% bony prominences that ser)e as the ma2or ori%in or

insertion o a muscle are seen routinely. The processes commonly a)ulsed include the

acromion$ scapular tuberosity$ %reater humeral tubercle$ olecranon$ ischial tuberosity$

%reater trochanter$ tibial tuberosity$ and the calcaneus o the ibular tarsal bone.

4T5OLOGIC FRCT1RE'

4atholo%ic ractures occur because o underlyin% bony or systemic disease that causes

one$ many$ or all bones o an animal6s s#eletal system to be abnormal and thus more

susceptible to racture. 4atholo%ic ractures may occur rom any type o trauma-

bendin% orce$ torsional orce$ compressi)e orce$ or shearin% orce. Oten the only

orce necessary to cause racture is the animal6s "ei%ht/ thus$ spontaneous racture

occurs "ithout o)ert trauma.

4atholo%ic racture may occur throu%h any o the ollo"in% types o bony patholo%y-

neoplasia$ bone cysts$ osteoporotic bone caused by secondary N54O$ nutritional

hyperparathyroidism$ locali7ed bone inection ,osteomyelitis0$ osteoporotic bone



caused by disuse ollo"in% prolon%ed e(ternal i(ation or remo)al o a ri%id

internalde)ice

patholo%ic racture can occur in any bone$ in any location "ithin a bone$ and ta#e

any shape. The dia%nosis o underlyin% patholo%y is usually o more importance than

immediate bone i(ation. Once the patholo%ic basis or the racture has beendia%nosed and speciic correcti)e measures initiated$ the racture or ractures can be

treated. Treatment o all patholo%ic ractures$ includin% those due to neoplasms$ can

be successul.

http-88cal.)et.upenn.edu8pro2ects8saortho8chapter9::8::mast.htm

2. Wh" $i$ the o" 'a%<t o5e hi& e#t ar a%$ e#t e!(3. Wh" $i$ the o" #ee ai% i% the area o# the #ra'tre(

• It<& e'a&e o# i%=aatio% rea'tio% that 'a&e$ reea&i%! o#

i%=aatio% e$iator i;e hi&tai% or ro&ta!a%$i% et' >i% the

ti&&e? a%$ it<& re&a5e " %o&&" re'etor i% the eri#er %er5o& a%$the i& are !oi%! to the rai% ai%

• @e'a&e the #ra'tre i e $aa!e$ the &o#t ti&&e& a%$ the% the

oo$ 5e&&e i e $aa!e$ too &o the =i$ i e ea$ to the

ti&&e a%$ a;e &ei%! a%$ the &ei%! i re&& &e%&or"

%er5o& a%$ the% 'a&e$ ai%• It 'a% 'a&e$ " a% i%5o%tar" &'e 'o%tra'tio% that o''re

aro%$ the #ra'tre. Wh" the o"<& e#tBe! i& &horter tha% hi& ri!ht e!(

Per!e&era% #ra;tr :Seteah #ra;tr e%!;a > 'oete ? #re!e%B#re!e% ia&a%"a

er!e&er. Sea!aia% oeh ;e;ata% 'e$era it &ea!ia% oeh

!a"a erat $a% &ea!ia% ;are%a tari;a% otot "a%! ee;at

a$a%"a. Per!e&era% ia&a%"a $i&et $e%!a% i&tiah ao&i&i

e%4a4ara% ata ;eiri%!a% > ai!%e%t ? rota&i $a%

erah%"a a%4a%! $aat tertari; $a% teri&ah ata $aat

ta%! ti%$ih a;iat &a&e otot e%"ea;a%

ere%$e;a% ta%!

Ser : @; A4ar )rtoe$i $a% +ra;tr Si&te Ae" e$i&i ;e7 Wi$"a e$i;a

C. Wh" the o" &t e &i%te$(+or #ra'tre e &e ioiiatio% &i%t.B Re$'tio% o# i%=aatio% #ro traa a%$ arthriti&B ,o%tro o# ai%B Pro5i&io% o# eter%a &ortB S&titte #or a&e%t ea; or iaa%'e$ &'e&B E5aatio% o# the ote%tia #or &r!er"

Source: Principal of Splinting and Splint Prescription by Judy

C.Colditz htt:FF.ha%$a.'oFarti'e&F&i%t'ha.$# $o%oa$e$ o% H" 11 2013 at 23.00

http://www.handlab.com/articles/splint_chap.pdf

http://www.handlab.com/articles/splint_chap.pdf



FUNCTIONAL CAST BRACING (FCB)

Functional cast bracing is a metho o! conser"ati"e management o! !ractures

#hich $ermits !unctioning o! the %oints an muscles o! the limb& #hile immobilising the!racture'

Controlle motion $hsiologicall inuce is the single most im$ortant !actor in

osteogenesis (Sarmiento)' This is the basic $rinci$le o! all !unctional bracing '

The main isa"antage o! the $laster cast immobilisation o! limb !ractures is the

sti!!ness o! %oints an circulator stagnation ue to $rolonge immobilisation an isuse

o! the limb' This is a"ioe in !unctional cast bracing'

It is generall use in the management o! is$hseal !ractures o! long bones lie

tibia& humerus' In this metho the $rimar management o! the !racture is reuction an

immobilisation in a $laster cast' At the en o! * to + #ees #hen the so!t tissue reaction

has subsie an the !racture is sticl& the $laster cast is remo"e an the !unctional

cast bracing is one as a second stag. The e,tent o! the $laster is reuce& %oint

mo"ements are $ermitte& an the muscle !unction is encourage' -arl #eight bearing

#ith the cast brace is allo#e in the case o! lo#er limb !ractures'

In the treatment o! !racture tibia& the initial treatment is b reuction an

immobilisation in an abo"e nee $laster slab an cast' A!ter about * #ees a .ateller

tenon bearing t$e o! belo# nee cast #ith an anle hinge is a$$lie an $atient

allo#e #eight bearing' A similar brace #ith the nee %oint is use !or !racture !emur#here the brace e,tens to the groin'

This conce$t o! !unctional cast bracing is a re"i"al o! the earlier methos o! the

/0thcentur French school o! Cham$ionere #ho $ractise minimal immobilisation o!

%oints' It also resembles the still earlier s$linting o! !ractures b 1i$$ocrates' The

Inian sstem o! bone setting $ractise b Asans an usthas consists o! mani$ulation

an s$linting #ith !lat bamboo stri$s an local a$$lication o! herbal lea"es surrouning

the limb an allo#ing graual mo"ements o! neighbouring %oints' This is seen to

$romote union o! !ractures in man cases' This is a !orm o! !unctional cast bracing'

Functional cast bracing has a $lace in selecte cases o! long bone !ractures'

6. What are the i%$i'atio% o# the o%e #ra'tre that ha5e to e &i%te$(

Indications

Fracture management can be divided into nonoperative and operative techniques. The nonoperative technique consists of aclosed reduction if required, followed by a period of immobilization with casting or splinting. Closed reduction is needed if thefracture is significantly displaced or angulated. [3!

"f the fracture cannot be reduced, surgical intervention may be required. "ndications for surgical intervention include thefollowing#

• Failed nonoperative $closed% management

• &nstable fractures that cannot be adequately maintained in a reduced position

• 'isplaced intra(articular fractures $)* mm%



• +atients with fractures that are nown to heal poorly following nonoperative management $eg, femoral nec fractures%[3-!

• arge avulsion fractures that disrupt the muscle(tendon or ligamentous function of an affected /oint $eg, patella

fracture%

• "mpending pathologic fractures

• 0ultiple traumatic in/uries with fractures involving the pelvis, femur , or vertebrae

• &nstable open fractures or complicated open fractures

• Fractures in individuals who are poor candidates for nonoperative management that requires prolonged

immobilization $eg, elderly patients withpro1imal femur fractures%

• Fractures in growth areas in seletally immature individuals that have increased ris for growth arrest $eg, 2alter(

arris types """(4%

• 5onunions or malunions that have failed to respond to nonoperative treatment

Contraindications

Contraindications to surgical reconstruction are as follows#

• 6ctive infection $local or systemic% or osteomyelitis

• 2oft tissues that compromise the overlying fracture or the surgical approach because of poor soft(tissue quality due

to soft(tissue in/ury or burns, previous surgical scars, or active infection

• 0edical conditions that contraindicate surgery or anesthesia $eg, recent myocardial infarction%

• Cases in which amputation would better serve the limb and the patient

7. o to &i%t i% the !oo$ a"(

Cast Care Instructions:

• 7eep the cast clean and dry

• Chec for cracs and breas in the cast

• 'o 58T scratch the sin under the cast by inserting ob/ects inside the sin $this can cause sin infections9sin breadown%

• 6 hairdryer can be used on C88 $58T warm or 8T% setting to blow air under the cast to help with dry, itchy sin

• 'o 58T put any powders or lotion inside the cast

• +revent any small toys, coins, or other ob/ects from being put inside the cast

• :levate the cast above the level of the heart to decrease swelling

• :ncourage wiggling of fingers and9or toes to promote circulation

8. What are the 'a&&i'atio% o# #ra'tre(

A fracture is a partial or complete break in the bone.

When a fracture occurs, it is classied as either open orclosed

• open fracture !Also called compound fracture." # thebone e$its and is %isible through the skin, or a deep&ound that e$poses the bone through the skin.

• closed fracture !Also called simple fracture." # thebone is broken, but the skin is intact.

http://emedicine.medscape.com/article/1246691-overview


























'ractures ha%e a %ariety of names. (elo& is a listing ofthe common types that may occur in children

• greenstick # incomplete fracture. )he broken bone is

not completely separated.

*llustration of greenstick fracture

• trans%erse # the break is in a straight line across thebone.

*llustration of trans%erse fracture

http://popup%28%27/DiseaseHealthInfo/HealthLibrary/orthopaedics/0227-pop.html','600','800','no')





• comminuted # the break is in three or more pieces.

http//&&&.lpch.org/0isease1ealth*nfo/1ealth2ibrary/orthopaedics/fracture.html

Some di3erent types of fracture

• A%ulsion fracture # a muscle or ligament pulls on the bone,

fracturing it.

• Comminuted fracture # the bone is shattered into many

pieces.

• Compression !crush" fracture # generally occurs in the

spongy bone in the spine. 'or e$ample, the front portion of a%ertebra in the spine may collapse due to osteoporosis.

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/orthopaedics/fracture.html


http://popup%28%27/DiseaseHealthInfo/HealthLibrary/orthopaedics/0013-pop.html','600','800','no')





• 'racture dislocation # a oint becomes dislocated, and one of

the bones of the oint has a fracture.

• 4reenstick fracture # the bone partly fractures on one side,

but does not break completely because the rest of the bone can

bend. 5ore common among children, &hose bones are softerand more elastic.

• 1airline fracture # a partial fracture of the bone. 6ften this

type of fracture is harder to detect.

• *mpacted fracture # &hen the bone is fractured, one

fragment of bone goes into another.

• 2ongitudinal fracture # the break is along the length of the

bone.

• 6bli-ue fracture # A fracture that is diagonal to a bone7s

long a$is.

• Pathological fracture # &hen an underlying disease or

condition has already &eakened the bone, resulting in a

fracture !bone fracture caused by an underlying

disease/condition that &eakened the bone".

• Spiral fracture # A fracture &here at least one part of the

bone has been t&isted.

• Stress fracture # more common among athletes. A bone

breaks because of repeated stresses and strains.

• )orus !buckle" fracture # bone deforms but does not crack.

5ore common in children. *t is painful but stable.

• )rans%erse fracture # a straight break right across a bone.

http//&&&.medicalne&stoday.com/articles/89::8;.php

http://www.medicalnewstoday.com/articles/173312.php

http://www.medicalnewstoday.com/articles/173312.php



htt:FF.re%%er'hi$re%&.or!FKi$&eathFPare%t&FGe%eraBeathFA'he&B

Pai%&Ba%$BI%4rie&F@ro;e%B@o%e&.ht

Ka&i;a&i +ra;tr

+ra;tr $aat $ie$a;a% 4e%i&%"a er$a&ar;a% h%!a% ta%! $e%!a%

4ari%!a% $i&e;itar e%t; ataha% ta%! $a% o;a&i a$a ta%! &i&.

(erdasarkan hubungan tulang dengan aringan disekitar

+ra;tr $aat $ia!i e%4a$i :

a" 'raktur tertutup !closed",ia ti$a; ter$aat h%!a% a%tara

#ra!e% ta%!

$e%!a% $%ia ar.

b" 'raktur terbuka !open/compound", ia ter$aat h%!a% a%tara

#ra!e%

ta%! $e%!a% $%ia ar ;are%a a$a%"a er;aa% $i ;it. +ra;tr

ter;a

tera!i ata& ti!a $era4at >e%rt R. G&tio? "ait:

b.8. 0eraat *

i. L;a J1 '

ii. Ker&a;a% 4ari%!a% %a; &e$i;it ta; a$a ta%$a ;a re;

iii. +ra;tr &e$erha%a tra%&5er&a oi; ata ;oi%ti# ri%!a%

i5. Ko%tai%a&i i%ia

b.;. 0eraat **

i. La&era&i 1 '

ii. Ker&a;a% 4ari%!a% %a; ti$a; a& =aF a5&i

iii. +ra;tr ;oi%ti# &e$a%!

http://www.brennerchildrens.org/KidsHealth/Parents/General-Health/Aches-Pains-and-Injuries/Broken-Bones.htm






i5. Ko%tai%a&i &e$a%!

b.:. 0eraat ***

Ter4a$i ;er&a;a% 4ari%!a% %a; "a%! a& eiti &tr;tr ;it otot

$a% %ero5a&;ar &erta ;o%tai%a&i $era4at ti%!!i. +ra;tr ter;a

$era4at III

tera!i ata&:

i. Hari%!a% %a; "a%! e%ti #ra;tr ta%! a$e;at e&;i%

ter$aat

a&era&i a&F=aFa5&i ata #ra;tr &e!e%taF&a%!at ;oi%ti# "a%!

$i&ea;a% oeh traa ere%er!i ti%!!i ta%a eihat e&ar%"a ;ra%

;a.

ii. Kehia%!a% 4ari%!a% %a; $e%!a% #ra;tr ta%! "a%! teraar ata

;o%tai%a&i a&i#.

iii.L;a a$a eh arteriF&ara# eri#er "a%! har& $ierai;i ta%a

eihat ;er&a;a% 4ari%!a% %a;.

(erdasarkan bentuk patahan tulang

a" )rans%ersal

A$aah #ra;tr "a%! !ari& atah%"a te!a; r& terha$a & a%4a%!

ta%! ata e%t;%"a ei%ta%! $ari ta%!. +ra;tr &ea'a i%i

ia&a%"a

$ah $i;o%tro $e%!a% ei$aia% !i&.

b" Spiral

A$aah #ra;tr ea& "a%! e%!eii%!i ta%! "a%! ti a;iat tor&i

e;&treita& ata a$a aat !era;. +ra;tr 4e%i& i%i ha%"a e%i;a%

&e$i;it

;er&a;a% 4ari%!a% %a;.

c" 6blik

A$aah #ra;tr "a%! eii;i ataha% arah%"a iri%! $ia%a !ari&atah%"a



ee%t; &$t terha$a ta%!.

d" Segmental

A$aah $a #ra;tr er$e;ata% a$a &at ta%! a$a &e!e% ta%! "a%!

reta;

$a% a$a "a%! terea& e%"ea;a% teri&ah%"a &e!e% &e%tra $ari

&ai

$arah.

e" <ominuta

A$aah #ra;tr "a%! e%'a; eeraa #ra!e% ata tert&%"a

;etha%

4ari%!a% $e%!a% eih $ari $a #ra!e% ta%!.

f" 4reenstick

A$aah #ra;tr ti$a; &er%a ata !ari& atah%"a ti$a; e%!;a $ia%a

;orte;& ta%! &ea!ia% a&ih th $ei;ia% 4!a erio&ter. +ra;tr

4e%i&

i%i &eri%! ter4a$i a$a a%a; a%a;.

g" 'raktur *mpaksi

A$aah #ra;tr "a%! ter4a$i ;eti;a $a ta%! e%; ta%! ;eti!a

"a%!

era$a $ia%tara%"a &eerti a$a &at 5ertera $e%!a% $a 5ertera

ai%%"a.

h" 'raktur 'issura

A$aah #ra;tr "a%! ti$a; $i&ertai eraha% eta; ta%! "a%! erarti

#ra!e% ia&a%"a teta $i teat%"a &eteah ti%$a;a% re$;&i.

(erdasarkan lokasi pada tulang sis

Ta%! &i& a$aah a!ia% ta%! "a%! era;a% ee%! ertha%

a!ia% i%i reati# eah &ehi%!!a &trai% a$a &e%$i $aat era;iat

ei&aha% &i&

a$a a%a; a%a;. +ra;tr &i& $aat ter4a$i a;iat 4ath ata 'e$eratra;&i. +ra;tr



&i& 4!a ;ea%"a;a% ter4a$i ;are%a ;e'ea;aa% a i%ta& ata a$a &aat

a;ti5ita&

oahra!a. Ka&i;a&i "a%! ai%! a%"a; $i!%a;a% %t; 'e$era ata

#ra;tr &i&

a$aah ;a&i;a&i #ra;tr e%rt Sater arri& :

a" )ipe * : #ra;tr tra%&5er&a eai &i&i eta&i& $ari ee%!

ertha% ro!%o&i& &a%!at ai; &eteah $ia;;a% re$;&i tertt.

b" )ipe ** : #ra;tr eai &ea!ia% ee%! ertha% ti

eai ta%! eta&i& ro!%o&i& 4!a &a%!at ai; $e%!a re$;&i

tertt.

c" )ipe *** : #ra;tr o%!it$i%a eai er;aa% arti;ari& $a%

ei&i& $a% ;e$ia% &e'ara tra%&5er&a eai &i&i eta&i& $ari

ee%! ertha%. Pro!%o&i& '; ai; e&;i% ha%"a $e%!a%

re$;&i a%atoi.

d" )ipe *= : #ra;tr o%!it$i%a eai ei&i& ee%! ertha%

$a% ter4a$i eai ta%! eta&i&. Re$;&i ter;a ia&a%"a e%ti%!

$a% e%"ai re&i;o !a%!!a% ertha% a%4t "a%! eih e&ar.

e" )ipe = : 'e$era re; $ari ee%! ertha% i%&i$e%& $ari

!a%!!a% ertha% a%4t a$aah ti%!!i.

>ntuk lebih elasnya tentang pembagian atau klasikasi fraktur

dapat dilihat

pada gambar berikut ini



htt:FFreo&itor".&.a'.i$Fit&treaF123C6789F22361FF,hater20II.$#

http://repository.usu.ac.id/bitstream/123456789/22361/4/Chapter%20II.pdf




1. Ka&i;a&i• @er$a&ar;a% h%!a%%"a $e%!a% $%ia ar

• +ra;tr tertt >'o&e$?

@ia ti$a; ter$aat h%!a% a%tara #ra!e% ta%!

$e%!a% $%ia ar

• +ra;tr ter;a

@ia ter$aat h%!a% a%tara #ra!e% ta%! $e%!a%

$%ia ar ;are%a a$a%"a er;aa% $i ;it. Me%rt R.

G&tio #ra;tr ter;a a$a 3 $era4at :

a. Dera4at I

o L;a J 1 '

o Ker&a;a% 4ari%!a% %a; &e$i;it ti$a; a$a ta%$a

;a re;o +ra;tr &e$erha%a tra%&5er&a oi; ata ;oi%ti#

ri%!a%

o Ko%tai%a&i i%ia

. Dera4at II

o La&era&i 1 '

o Ker&a;a% 4ari%!a% %a; ti$a; a& =aFa5&i

o +ra;tr ;oi%ti# &e$a%!

o Ko%tai%a&i &e$a%!

'. Dera4at III Ter4a$i ;er&a;a% 4ari%!a% %a; "a%! a& eiti

&tr;tr ;it otot $a% %ero5a&;er &erta ;o%tai%a&i

$era4at ti%!!i.+ra;tr $era4at III tera!i ata& :

o Hari%!a% %a; "a%! e%ti #ra;tr ta%! a$e;at

e&;i% ter$aat a&era&i a&F=aFa5&i ata

#ra;tr &e!e%taF&a%!at ;oi%ti# "a%! $i&ea;a%

oeh traa ere%er!i ti%!!i ta%a eihat e&ar%"a

;ra% ;a

o Kehia%!a% 4ari%!a% %a; $e%!a% #ra;tr ta%! "a%!

teraar ata ;o%tai%a&i a&i#

o L;a a$a eh arteriF&ara# eri#er "a%! har&

$ierai;i ta%a eihat ;er&a;a% 4ari%!a% %a;

>Ma%&4oer Ari# et a. 2000. Kapita Selekta Kedokteran e$ III Hii$ 2. Ha;arta:

Me$ia Ae&'ai&?

0eskripsi 'raktur

a. KoitFti$a; ;oit



+ra;tr ;oit : ia !ari& atah eai &erh e%aa%!

ta%! ata eai ;e$a ;orte;& ta%!

+ra;tr ti$a; ;oit : ia !ari& atah ti$a; eai &erh

e%aa%! ta%! &eerti :

; airi%e #ra'tre >atah reta; rat?; @';e #ra'tre ata tor& #ra'tre : ia ter4a$i iata% $ari

&at ;orte;& $e%!a% ;ore&i ta%! &o%!io&a $i aah%"a

ia&a%"a a$a $i&ta ra$i& a%a;Ba%a;

; Gree%&ti'; #ra'tre : e%!e%ai &at ;orte;& $e%!a% a%!a&i

;orte;& ai%%"a "a%! ter4a$i a$a ta%! a%4a%! a%a;

. @e%t; !ari& atah $a% h%!a%%"a $e%!a% e;a%i&e traa

Gari& atah ei%ta%! : traa a%!a&i ata a%!&%!

Gari& atah oi; : traa a%!a&i

Gari& atah &ira : traa rota&i

+ra;tr ;ore&i : traa a;&iaB=e;&i a$a ta%! &o%!io&a

+ra;tr a5&i : traa tari;a% F tra;&i otot a$a i%&er&i%"a $i

ta%! i&a%"a #ra;tr atea



'. Hah !ari& atah +ra;tr ;oi%ti# : !ari& atah 1 $a% &ai%! erh%!a

+ra;tr &e!e%ta : !ari& atah 1 tai ti$a; erh%!a%. @ia

2 !ari& atah $i&et a #ra;tr i#o;a

+ra;tr tie : !ari& atah 1 tetai a$a ta%! "a%!

erai%a% teat%"a i&a%"a #ra;tr #er #ra;tr ta%!

ea;a%!

$. @er!e&erFti$a; er!e&er

+ra;tr %$i&a'e$ >ti$a; er!e&er? : !ari& atah ;oit tetai

;e$a #ra!e% ti$a; er!e&er erio&te%"a a&ih th



+ra;tr $i&a'e$ >er!e&er? : ter4a$i er!e&era% #ra!e%B

#ra!e% #ra;tr "a%! 4!a $i&et o;a&i #ra!e% tera!i :

; Di&o;a&i a$ o%!it$i% ' 'o%tra'tio% : er!e&era%

&earah & $a% o5erai%!

; Di&o;a&i a$ ai : er!e&era% "a%! ee%t; &$t; Di&o;a&i a$ at& : er!e&era% $i a%a ;e$a #ra!e% &ai%!

e%4ahi

e. Ter;a tertt

#. Koi;a&i ta%a ;oi;a&i

@ia a$a har& $i&et. Koi;a&i $aat era ;oi;a&i $i%i ata

aat o;a ata &i&tei; oeh traa ata a;iat e%!oata%

>Ma%&4oer Ari# et a. 2000. Kapita Selekta Kedokteran e$ III 4ii$ 2. Ha;arta:

Me$ia Ae&'ai&?

• @er$a&ar;a% e%"ea

a. E;&;oria&i ata luka lecet ata gores: 'e$era a$a er;aa%

ei$eri& a;iat er&e%tha% $e%!a% e%$a erer;aa%

;a&ar ata r%'i%!

. 5%& &'i&&: ;a &a"at ata ;a iri& "a%! $ita%$ai $e%!a%

tei ;a era !ari& r& $a% eratra%

'. 5%& a'erat ata ;a roe;: ;a $e%!a% tei "a%! ti$a;

eratra% ata 'oa%!B'ai%! ia&a%"a ;are%a tari;a% ata

!ore&a% e%$a t$. 5%& %'t ata ;a t&;: ;a a;iat t&;a% e%$a

r%'i%! "a%! ia&a%"a ;e$aaa% ;a eih $aria$a ear%"a

e. 5%& or&: ;a ;are%a !i!ita% i%ata%!

#. 5%& 'otio: ;a a;ar

• @er$a&ar;a% a$aFti$a;%"a ;ehia%!a% 4ari%!a%

a. e;&;oria&i

. &;i% a5&io% $e!o5i%! i%4r"

'. &;i% o&&

•

@er$a&ar;a% $era4at ;o%tai%a&ia. ;a er&ih

; ;a &a"at ee;ti#

; &teri ote%&ia teri%#e;&i

; ti$a; a$a ;o%ta; $e%!a% oro#ari%! tra;t& re&iratori&

tra;t& aie%tari& tra;t& !e%itori%ari&

. ;a er&ih ter'ear

; ;a &a"at ee;ti#

; ote%&ia teri%#e;&i : &ia!e i%ia =ora %ora

; ;o%ta; $e%!a% oro#ari%! tra;t& re&iratori& tra;t&

aie%tari& tra;t& !e%itori%ari&



; ro&e& e%"eha% eih aa

; 'o%toh : ae%$e;toi oera&i 5a!i%a

'. ;a ter'ear

; ote%&i teri%#e;&i : &ia!e $ari tra;t& re&iratori& tra;t&

aie%tari& tra;t& !e%itori%ari&; ;a traa ar : a&era&i #ra;tr ter;a ;a e%etra&i

$. ;a ;otor

; a;iat ee$aha% "a%! &a%!at ter;o%tai%a&i

; er#ora&i 5i&era a&e& traa aa


Me$ia Ae&'ai?

Sumber

htt:FF.irar".%54.a'.i$F$#F2&1;eeraata%F20C312001Fa2.$#

http://www.library.upnvj.ac.id/pdf/2s1keperawatan/205312001/bab2.pdf




,LASSI+I,ATI)/ )+ +RA,T-RES @* T*PE

+ra'tre& are 'a&&ie$ i%to a%" t"e& a&e$ o% the &e5erit" o# the #ra'tre

hether it 'o%i'ate& thro!h the &;i% the &hae o# the #ra'tre i%e or the

a%atoi'a o'atio% o# the #ra'tre ithi% a% i%$i5i$a o%e. A &"&te& are

'oatie a%$ o# %e'e&&it" o5era.

I/,)MPLETE +RA,T-RES

A% i%'oete #ra'tre iie& that a o%e ha& %ot 'oete" o&t 'o%ti%it"N

&oe ortio% o# the o%e reai%& i%ta't. There are &e5era t"e& o# i%'oete

#ra'tre&.

GREEN'TIC< FRCT1RE

s the name implies$ a %reenstic# racture resembles the brea# that results "hen a supple

%reen branch o a tree is bent and brea#s incompletely. 1sually the side opposite the bendin%

orce ractures completely$ "hile the side under the orce remains intact. In the immature

animal "ith similarly supple elastic bone$ a bendin% orce "ill produce the incomplete

racture. 'ince a portion o the bone corte( remains intact$ this racture cannot o)erride and

result in limb shortenin%/ ho"e)er$ the limb may deorm alon% its a(is at the point o the

bendin% orce ,Fi%. ::;=0.

+IG. 11B2 I%'oete #ra'tre o# the #eora $iah"&i&.

FI''1RE FRCT1RE

Crac#s or issure lines "ill occur "hen direct trauma is applied to any lon% or lat bone.

Generally the issures are ormed in one corte( o the bone and are co)ered by an intact

periosteum. &ones may ha)e sin%le or multiple issure lines o any coni%uration- trans)erse$

obli+ue$ spiral$ lon%itudinal$ or radiatin% rom a central point. 'ince issure ractures occur

only in a sin%le corte( and represent an incomplete racture$ the ractured bone should

maintain its normal shape.

DE4RE''ION FRCT1REDepression ractures represent areas in "hich multiple issure racture lines intersect. *ith

suicient orce$ the entire area "ill depress rom the direction o orce. This usually occurs in

the cal)arium$ the ma(illa$ or the rontal bone areas o the head.

,)MPLETE +RA,T-RES

,oete #ra'tre& are i%$i'ate$ " the 'oete o&& o# o%" 'o%ti%it"

aoi%! o5erri$i%! a%$ $e#oratio%. ,oete #ra'tre& are #ar ore 'oo%

tha% i%'oete #ra'tre&. The" a" e 'a&&ie$ #rther " the &hae o# the

#ra'tre i%e. The #ooi%! &"&te $e&'rie& 'oete #ra'tre&.

http://cal.vet.upenn.edu/projects/saortho/chapter_11/11F2.jpg





TRN'VER'E FRCT1RE

Tran)erse racture implies a racture line that is trans)erse to the lon% a(is o the bone.

Trans)erse ractures may be relati)ely smooth or may be rou%h or ha)e deep teeth on the

ractured suraces. 3ost are caused by bendin% orces. Rou%hness simpliies anatomical

ali%nment and increases the li#elihood o rotational stability once reduced. Once these

racture ra%ments ha)e been reduced$ ra%ment o)erride should not occur ,Fi%. ::;>0.

O&LI?1E FRCT1RE

Obli+ue racture implies a racture line that is obli+ue to the lon% a(is o the bone. The t"o

cortices o each ra%ment are in the same plane "ithout spiralin%. The ed%es o an obli+ue

racture may be rou%h but are usually smooth. The cortical ed%es are lat$ rather than sharp.

These ractures %enerally result rom bendin%$ "ith superimposed a(ial compression. s a

result o the obli+uity o the racture line$ this racture tends to o)erride or rotate unless

traction is maintained throu%hout the period o healin% ,Fi%. ::;@0.

'4IRL FRCT1RE

'piral racture indicates a racture line that spirals alon% the lon% a(is o the bone/ it is caused by torsional t"istin% or rotational orces. 'piral ractures tend to ha)e e(tremely sharp points

and ed%es$ "hich re+uently accompany sot tissue trauma or an open racture. Reduction o

spiral ractures is diicult "ithout constant traction or internal i(ation$ since these ractures

tend to o)erride and rotate into deormity ,Fi%. ::;A0.

CO33IN1TED FRCT1RE

Comminuted racture implies at least three racture ra%ments$ the racture lines o "hich

interconnect. The indi)idual racture lines that orm the comminuted racture may be

trans)erse$ obli+ue$ or spiral. Comminuted ractures are %enerally caused by hi%h;ener%y

trauma$ as typiied by automobile accidents$ and are a common type o animal racture ,Fi%.

::;B0. Comminuted ractures are diicult to reduce and i( because they ha)e no inherent

stability. Constant e(ternal traction and ali%nment or internal i(ation is re+uired.

+IG. 11B3 Tra%&5er&e #ra'tre i%e. Drai%! rere&e%t& a re$'e$

tra%&5er&e #ra'tre o# the i$&ha#t #eora $iah"&i&.

+IG. 11B )ie #ra'tre i%e. Drai%! rere&e%t& a re$'e$

oie #ra'tre o# the i$&ha#t #eora $iah"&i&.

+IG. 11BC Sira #ra'tre i%e. Drai%! rere&e%t& a re$'e$

&ira #ra'tre o# the i$&ha#t #eora $iah"&i&.

















+IG. 11B6 ,oi%te$ #ra'tre i%e&. Drai%! rere&e%t& a

re$'e$ 'oi%te$ #ra'tre o# the i$&ha#t #eora $iah"&i&.

+IG. 11B7 Mtie #ra'tre&. Drai%! rere&e%t& a re$'e$

#eora %e'; #ra'tre a%$ a re$'e$ tra%&5er&e #ra'tre o# the

$i&ta #eora etah"&i&.

31LTI4LE FRCT1RE

3ultiple racture implies three or more racture ra%ments in a sin%le bone/ ho"e)er$ unli#e

comminuted ractures$ the racture lines do not interconnect. The indi)idual racture linesmay be o any shape. Typically this term describes t"o completely independent ractures

aectin% the same bone$ such as an obli+ue racture o the pro(imal emur and an epiphyseal

racture o the distal emur. Neither o these ractures interconnects. Reduction and i(ation

o a multiple racture re+uires t"o separate reductions and i(ations ,Fi%. ::;0.

I34CTION FRCT1RE

Distin%uishin% bet"een impaction racture and compression racture is diicult/ ho"e)er$

because both terms are used routinely in orthopaedic te(ts$ the dierence "ill be clariied. n

impacted racture implies a racture in "hich a bony ra%ment$ %enerally cortical$ is orced or

impacted into cancellous bone. Typically this occurs at the ends o lon% bones. Reduction o

such ractures re+uires traction to disen%a%e the ra%ments and i(ation to hold the ra%mentsapart. I$ ater racture$ malali%nment is untreated$ bone shortenin% "ill occur because one

end has impacted into the other. This is an uncommon racture in small animals.

CO34RE''ION FRCTION

Compression ractures are similar to impaction ractures$ but the term is used to describe a

racture in "hich cancellous bone collapses and compresses upon itsel. Typically this occurs

in )ertebral bodies ollo"in% trauma to the spine. Compression ractures are rarely reduced$

since the bone "ithin the racture area has been destroyed by the crushin%. These ractures

are stable and heal in place/ ho"e)er$ shortenin% occurs as a result o compression ,Fi%. ::;

0.

+IG. 11B8 ,ore&&io% #ra'tre. Drai%!

rere&e%t& a% %re$'e$ 'ore&&io%

#ra'tio% o# a ar 5ertera o$".

,L)SED +RA,T-RE

A 'o&e$ #ra'tre iie& a #ra'tre that reai%& e%'a&e$ ithi% the &;i% a%$&'atre that &rro%$ it. /o o%$ or 'o&a era%e o5erie& the














epiphyseal plate remains open and cartila%inous. Fracture occurs throu%h the 7one o

hypertrophied cartila%e cells. Reerral to such ractures should speciy the pro(imal or distal

epiphyseal plate. In mature animals$ such ractures are called physeal ractures or racture o

the physis. Fractures o the epiphyseal plate are classiied urther to accurately describe their

shape and se)erity o the racture. The method o 'alter; 5arris is the standard classiication

or all species.,0 ,'ee Fi%s. >@;: throu%h >@;B.0

Type I;Epiphyseal separation- there is displacement o the epiphysis rom the metaphysis at

the %ro"th plate.

Type II; small corner o metaphyseal bone ractures and displaces$ "ith the epiphysis

displaced rom the metaphysis at the %ro"th plate.

Type III;Fracture is throu%h the epiphysis and part o the %ro"th plate$ but the metaphysis is

unaected.

Type IV;Fracture is throu%h the epiphysis$ %ro"th plate$ and metaphysis. 'e)eral racture

lines may be seen.

Type V;Impaction o the epiphyseal plate occurs$ "ith the metaphysis dri)en into the

epiphysis.*ith each pro%ressi)e type$ the racture described becomes increasin%ly diicult to treat and

carries a poorer pro%nosis or return to normal unction.

E4I45'EL FRCT1RE

In the mature animal "ith closed %ro"th plates$ ractures o the epiphysis are termed

epiphyseal ractures. They should be classiied urther by describin% them as ractures o the

pro(imal or distal epiphysis.

CONDLR FRCT1RE

Condylar ractures occur in mature animals and aect the distal ends o the humerus or

emur$ or the pro(imal tibia. 'ince anatomically a condyle is composed o metaphysis$

physis$ and epiphysis$ this descripti)e classiication system is used instead o the pre)ious

three. Condylar ractures are urther deined as medial or lateral$ dependin% on the aspect

ractured. I both condyles racture o the shat as a unit$ the racture is termed

supracondylar. &oth condyles may racture rom the shat and rom each other. This is a

supracondylar8intercondylar racture and may be classiied as a !V$! !$! or !T! racture to

better describe the shape o the racture lines ,Fi%. ::;:0. ny racture o a condyle relects

potential problems i racture o the 2oint surace has occurred.

RTIC1LR FRCT1RE

rticular racture indicates that the subchondral bone and articular cartila%e are in)ol)ed in aracture. 'uch a racture may be classiied urther by indicatin% "hich bone ,pro(imal or

distal0 or "hich speciic 2oint is ractured. Intra;articular racture o the #nee is nonspeciic/

description must speciically indicate racture o the emoral or tibial component. rticular

racture is synonymous "ith intra;articular racture and means racture "ithin a 2oint. The

term periarticular racture is used to reer to racture close to$ but not into$ the 2oint. The term

could be replaced by epiphyseal racture. rticular racture re+uires perect anatomical

reduction and i(ation to pre)ent secondary de%enerati)e 2oint disease.

V1L'ION FRCT1RE

)ulsion reers to a racture o intrinsic etiolo%y$ %enerally caused by muscular contraction.

The prominences that racture are usually separate centers o bone ormation reerred to asapophyses. )ulsion ractures are classiied by the prominence that has been a)ulsed$ such as

http://cal.vet.upenn.edu/projects/saortho/chapter_11/11mast.htm#REFS


http://cal.vet.upenn.edu/projects/saortho/chapter_11/11mast.htm#REFS




a)ulsion o the %reater trochanter. )ulsion ractures tend to displace in the direction o the

muscle pull that caused the racture. Reduction and i(ation is diicult and re+uires constant

traction or internal i(ation.

FRCT1RE;DI'LOCTION

Fracture;dislocation describes 2oint ractures that produce 2oint instability suicient to resultin simultaneous sublu(ation or lu(ation o the aected 2oint. This classiication is incomplete$

since racture;dislocation o the shoulder indicates dislocation o the shoulder but does not

indicate "hich bone$ the scapula or the humerus$ is ractured. Thereore$ a more descripti)e

classiication o the racture must be %i)en. Fracture;dislocations can be diicult to treat

because they represent intra;articular racture plus supportin% tissue la(ity. *hen racture and

dislocation are ound to%ether$ the pro%nosis is poorer than i each problem occurred

separately.

htt:FF'a.5et.e%%.e$Fro4e't&F&aorthoF'hater11F11a&t.ht

T2.-S OF FRACTUR-S

Green stic !racture3 It is the !racture in the oung bone o! chilren #here the

brea is incom$lete& lea"ing one corte, intact '

Close !racture3 A close !racture is one #hre the !racture haematoma oes not

communicate #ith the outsie'

O$en !racture3 (Com$oun !racture) This is one #here the !racture haematoma

communicates #ith the outsie through an o$en #oun' A Com$oun !racture is a

serious in%ur as in!ection ma gain entrance into the bo through the #oun anthereb enanger the limb or e"en li!e'

.athological !racture3 It is a !racture occurring a!ter a tri"ial "iolence in a bone

#eaene b some $athological lesion' This lesion ma be a localise one& lie a

seconar malignant e$osit or a generalise isorer lie h$er$arathroiism or

senile osteo$orosis'

Stress !racture 3 It is a !racture occurring at a site in the bone sub%ect to re$eate

minor stresses o"er a $erio o! time'

Birth !racture3 It is a !racture in the ne# born chilren ue to chil ue to in%ururing eli"er'

ANATO4ICAL T2.-S OF FRACTUR-S

5arious names are gi"en to the !ractures accoring to the t$es o! the !racture lines

as trans"erse& obli6ue an s$iral !ractures'

Comminute !racture 3 1ere the bone is broen into than t#o !ragments'

Steallate !racture3 This occurs in !lat bones o! the sull an in $atella& #here the

!racture lines run in "arious irections !rom one $oint'

http://cal.vet.upenn.edu/projects/saortho/chapter_11/11mast.htm

http://cal.vet.upenn.edu/projects/saortho/chapter_11/11mast.htm



A"ulsion !racture3 This is one& #here a chi$ o! bone is a"ulse b the suen an

une,$ecte contraction o! a $o#er!ul muscle !rom its $oint o! insertion& e'g' the

su$ras$inatus a"ulsing the greater tuberisut o! the humerus'

Im$acte !racture3 This is one #here a "ertical !orce ri"es the istal !ragment o!

the !racture into the $ro,imal !ragment'

7e$resse !racture3 This occurs in the sull #here a segment o! bone gets

e$resse into the cranium'

9. What are the ri&; #a'tor& o# #ra'tre(

• Age' The rate o hip ractures increases substantially "ith a%e. s you a%e$ your bone

density and muscle mass both decrease. Older a%e may also brin% )ision and balance

problems$ alon% "ith slo"er reaction time to a)oid allin% "hen you eel unsteady. Iyou6re inacti)e$ your muscles tend to "ea#en e)en more as you a%e. ll o these

actors combined can increase your ris# o a hip racture.

• 2our se,' *omen lose bone density at a aster rate than men do. The drop in estro%en

le)els that occurs "ith menopause accelerates bone loss$ increasin% the ris# o hip

ractures. 5o"e)er$ men also can de)elop dan%erously lo" le)els o bone density.

• Chronic meical conitions' Osteoporosis is the most po"erul ris# actor or hip

racture$ but other medical conditions may lead to ra%ile bones. These include

endocrine disorders$ such as an o)eracti)e thyroid$ and intestinal disorders$ "hich

may reduce your absorption o )itamin D and calcium.

• Certain meications' Cortisone medications$ such as prednisone$ can "ea#en bone i

you ta#e them lon% term. In some cases$ certain dru%s or the combination o

medications can ma#e you di77y and more prone to allin%.

• Nutritional $roblems' Lac# o calcium and )itamin D in your diet "hen you6re

youn% lo"ers your pea# bone mass and increases your ris# o racture later in lie.

'erious eatin% disorders$ such as anore(ia ner)osa and bulimia$ can dama%e your

s#eleton by depri)in% your body o essential nutrients needed or bone buildin%.

• .hsical inacti"it' *ei%ht;bearin% e(ercises$ such as "al#in%$ help stren%then bones

and muscles$ ma#in% alls and ractures less li#ely. I you don6t re%ularly participate in

"ei%ht;bearin% e(ercise$ you may ha)e lo"er bone density and "ea#er bones.

• Tobacco an alcohol use' 'mo#in% and drin#in% alcohol can interere "ith the

normal processes o bone buildin% and remodelin%$ resultin% in bone loss.

0eterminan 'raktur

a" 'aktor 5anusia

@eeraa #a;tor "a%! erh%!a% $e%!a% ora%! "a%! e%!aai#ra;tr ata





%"a eih a%"a; ter4a$i ;are%a ;e'ea;aa% a i%ta&. Ti%!!i%"a

;a&&

atah ta%! a;iat ;e'ea;aa% ai%ta& a$a a;i a;i $i;are%a;a% a;i

a;i e%"ai eria; e%!e$i $e%!a% ;e'eata% "a%! ti%!!i

&ehi%!!a

e%"ea;a% ;e'ea;aa% "a%! eih #ata $ia%$i%!;a% erea%.

@er$a&ar;a% e%eitia% Hita a$a tah% 2002 $i Rah Sa;it St.

Ei&aeth

Me$a% ter$aat ;a&& #ra;tr &ea%"a; 169 ;a&& $ia%a 4ah

e%$erita

a;i a;i &ea%"a; 68 $a% erea% &ea%"a; 32.

a.:. Akti%itas 6lahraga

A;ti5ita& "a%! erat $e%!a% !era;a% "a%! 'eat a $aat e%4a$i ri&i;o

e%"ea 'e$era a$a otot $a% ta%!. Da"a te;a% a$a &aat eroah

ra!a

&eerti he%ta;a% o%'ata% ata e%tra% $aat e%"ea;a% 'e$era $a%

4i;a

he%ta;a% ata e%tra% "a%! ti '; e&ar a;a $aat e%!arah

a$a

#ra;tr. Setia ta%! "a%! e%$aat te;a%a% ter& e%er& $i ar

;aa&ita&%"a $aat e%!aai ;ereta;a% ta%!. Kea%"a;a% ter4a$i

a$a

;a;i i&a%"a a$a eai% &ea; oa "a%! &eri%! e%!aai e%tra%;a;i

a%tar eai%. Keeaha% &tr;tr ta%! 4!a &eri%! ter4a$i a$a atet &;i

4o!!i%! eari e%$a;i !%%! ata% oahra!a ai% "a%! $ia;;a%

$e%!a%

;e'eata% "a%! eri&i;o ter4a$i%"a e%tra% "a%! $aat e%"ea;a%

atah

ta%!.



a.?. 5assa )ulang

Ma&&a ta%! "a%! re%$ah a;a% 'e%$er%! e%!aai #ra;tr $aria$a

ta%!

"a%! a$at. De%!a% &e$i;it e%tra% $aat a%!&%! e%"ea;a% atah

ta%! ;are%a a&&a ta%! "e%! re%$ah ti$a; a e%aha% $a"a

$ari

e%tra% ter&et. Ma&&a ta%! erh%!a% $e%!a% !ii th

&e&eora%!.

Daa ha i%i era% ;a&i e%ti%! a!i e%!ata% 4ari%!a% ta%!.

Ma&&a

ta%! "a%! a;&ia $aat $i'aai aaia ;o%&&i !ii $a% 5itai% D

ter';i a$a a&a ;a%a; ;a%a; $a% rea4a. Pa$a a&a $ea&a

;eaa% eertaha%;a% a&&a ta%! e%4a$i er;ra%! &eiri%!

e%r%%"a #%!&i or!a% th. Pe%!ra%!a% a&&a ta%! terihat 4ea&

a$a a%ita "a%! e%oa&e. a i%i ter4a$i ;are%a e%!arh horo%

"a%!

er;ra%! &ehi%!!a ti$a; a $e%!a% ai; e%!o%tro ro&e&

e%!ata%

ta%! i&a%"a horo% e&tro!e%.

b" 'aktor Perantara

A!e%t "a%! e%"ea;a% #ra;tr &ee%ar%"a ti$a; a$a ;are%a

era;a%

eri&tia e%"a;it ti$a; e%ar $a% a%!&%! ter4a$i. /a% i&a

$i;ata;a% &ea!ai

&at era%tara taa ter4a$i%"a #ra;tr a$aah traa e%tra%.

@e%tra% "a%! ;era&

&$ah a&ti e%"ea;a% #ra;tr ;are%a ta%! ti$a; a e%aha%

$a"a ata

te;a%a% "a%! $iti;a% &ehi%!!a ta%! reta; ata a%!&%! atah.

Ke;ata% $a%

arah e%tra% a;a% ee%!arhi ti%!;at ;earaha% ta%! "a%!e%!aai #ra;tr.



Me&;i 4ara%! ter4a$i e%tra% "a%! ;e'i 4!a $aat e%"ea;a% #ra;tr

ia ter4a$i

a$a ta%! "a%! &aa a$a &aat eroahra!a ata a;ti5ita& rti% "a%!

e%!!%a;a%

;e;ata% ta%! $i teat "a%! &aa ata $i&et 4!a &tre&& #ra;tr

;are%a

;eeaha%.

c" 'aktor lingkungan

+a;tor i%!;%!a% "a%! ee%!arhi ter4a$i%"a #ra;tr $aat era

;o%$i&i 4aa% ra"a er;aa% 4aa% "a%! ti$a; rata ata era%! a%tai

"a%! i'i%

$aat e%"ea;a% ;e'ea;aa% #ra;tr a;iat ter4ath. A;ti5ita&

e%!e%$ara "a%!

$ia;;a% $e%!a% 'eat $i 4aa% ra"a "a%! a$at ia ti$a; hati hati $a%

ti$a;

eathi ra a i%ta& a;a a;a% ter4a$i ;e'ea;aa%. Ke'ea;aa%

a i%ta&

"a%! ter4a$i a%"a; e%i;a% #ra;tr. @er$a&ar;a% $ata $ari -%it

Pea;&a%a Te;%i& Ma;a Tera$ I%oe%$o;ri%oo!i +K-I $i I%$o%e&ia

a$a tah% 2006

$ari 1690 ;a&& ;e'ea;aa% a i%ta& roor&i "a%! e%!aai #ra;tr

a$aah &e;itar

20.

Pa$a i%!;%!a% rah ta%!!a ;o%$i&i a%tai "a%! i'i% $aat

e%!a;iat;a%

eri&tia ter4ath tertaa a$a a%4t &ia "a%! 'e%$er%! a;a%

e%!aai #ra;tr

ia ter4ath. Data $ari RS-D Dr. Soetoo Sraa"a a$a tah% 200C

ter$aat 83

;a&& #ra;tr a%!! 36 ;a&& #ra;tr ta%! ea;a%! $a% 173 ;a&&

er!ea%!a%



ta%!a% $ia%a &ea!ia% e&ar e%$erita a%ita 60 tah% $a%

e%"ea%"a a$aah

;e'ea;aa% rah ta%!!a.


10.What i hae% i# the &atio% o# arter" $or&ai& e$i& 'a%<t e #et(11.What are the 'hara'teri&ti'&F'i%i'a a%i#e&tatio%& o# #ra'tre(

8. Continuous pain until the bone is immobilized;. After the fracture, the parts that can not be used

and are not naturally inclined to mo%e !mo%ee$ceptional"rather than remain rigid as normal.

:. 'racture fragments shift in the arms or legs causing

deformity !%isible or palpable" e$tremity &hich canbe determined by comparing &ith the normal limb,e$tremity can not function properly due to normalmuscle function depends on the integrity of thebone &here the muscles attach.

?. 6n fracture length, the actual bone shorteningoccursdue to contraction of muscles attached abo%e andbelo& the fracture

@. When e$tremities in check by hand, snapping bonespalpable called crepitus palpable due to friction

bet&een multiple fragments to one another.. 2ocal s&elling and discoloration, the skin occurs as

a result of bleeding follo&ing trauma and fractures.)his marks a ne& can happen after a fe& hours ordays after the inury. !Smeltzer, Suzanne C. ;BB8"

htt:FF$i!ii.%i&.a'.i$Fe&F$i&;1F108F4tt%i&B!$B&iti#atiaBC39CB2B07.aBr.$#

;. /"eri ter& e%er& &aai ta%! $iioii&a&i

*. Seteah ter4a$i #ra;tr a!ia% a!ia% "a%! ti$a; $aat$i!%a;a% $a% 'e%$er%! er!era; &e'ara ti$a; aaiah> !era;a% ar ia&a ?;a%%"a teta ri!i$ &eerti %ora%"a. Per!e&era%#ra!e% a$a #ra;tr e%!a% ata t%!;ai e%"ea;a%$e#orita& > terihat a% teraa ? e;&terita& "a%!$aat $i;etahi $e%!a% ea%$i%!;a% $e%!a%e;&treita& "a%! %ora e;&terita& ta; $aater#%!&i $e%!a% ai; ;are%a #%!&i %ora ototter!a%t%! a$a i%te!rita& ta%! teat ee;at%"aotot.


http://digilib.unimus.ac.id/files/disk1/108/jtptunimus-gdl-sitifatima-5395-2-07.bab-r.pdf







3. Pa$a #ra;tr a%4a%! ter4a$i ee%$e;a% ta%! "a%!&ee%ar%"a;are%a ;o%tra;&i otot "a%! ee;at $iata& $a% aahteat #ra;tr.

<. Saat e;&treita& $i eri;&a $e%!a% ta%!a% teraa

a$a%"a $eri; ta%! "a%! $i%aa;a% ;reit& "a%!teraa a;iat !e&e;a% a%tra #ra!e% &at $e%!a% "a%!ai%%"a.

=. Pee%!;a;a% $a% eraha% ar%a o;a a$a ;itter4a$i &ea!ai a;iat traa $a% er$araha% "a%!e%!i;ti #ra;tr. Ta%$a i%i i&a ar ter4a$i &eteaheeraa 4a ata hari &eteah 'i$era.> SeterSa%%e ,. 2001 %

Ma%i#e&ta&i Ki%i&

a.Me%rt Seter @are >2002? a%i#e&ta&i ;i%i& #ra;tr a$aah %"eri

hia%!%"a #%!&i $e#orita& ee%$e;a% e;treita& ;reit&

ee%!;a;a%

o;a $a% eraha% ar%a "a%! $i4ea&;a% &e'ara ri%'i &ea!ai eri;t:

./"eri ter& e%er& $a% ertaah erat%"a &aai #ra!e% ta%!

$iioii&a&i. Sa&e otot "a%! e%"ertai #ra;tr era;a% e%t;i$ai

aaiah "a%! $ira%'a%! %t; ei%ia;a% !era;a% a%tar #ra!e%

ta%!.

'.Seteah ter4a$i #ra;tr a!ia%Ba!ia% ti$a; $aat $i!%a;a% $a%

'e%$er%!

er!era; &e'ara aaiah >!era;a% ar ia&a?. Per!e&era% #ra!e% a$a

#ra;tr e%!a% $a% t%!;ai e%"ea;a% $e#orita& >terihat a%teraa?

e;treita& "a%! i&a $i;etahi $e%!a% ea%$i%!;a%%"a $e%!a%

e;treita& %ora. E;&treita& ti$a; $aat er#%!&i $e%!a% ai; ;are%a

#%!&i %ora otot ter!a%t%! a$a i%te!rita&%"a ta%! teat

ee;at%"a

otot.



$.Pa$a #ra;tr a%4a%! ter4a$i ee%$e;a% ta%! "a%! &ee%ar%"a

;are%a

;o%tra;&i otot "a%! ee;at $i ata& $a% aah teat #ra;tr. +ra!e%

&eri%! &ai%! ee%!;ai &at &aa ai% &aai 2C &aai C ' >1&aai 2

i%'i?.

Saat e;&treita& $ieri;&a $e%!a% ta%!a% teraa a$a%"a $eri; ta%!

$i%aa;a% ;reit& "a%! teraa a;iat !e&e;a% a%tara #ra!e% &at

$e%!a%

ai%%"a. -4i ;reit& $aat e%!a;iat;a% ;er&a;a% 4ari%!a% %a; "a%!

eih erat.

e. Pee%!;a;a% $a% eraha% ar%a o;a a$a ;it ter4a$i &ea!ai

a;iat

traa $a% er$araha% "a%! e%!i;ti #ra;tr. Ta%$a i%i ia&a ter4a$i

&eteah

eeraa 4a ata hari &eteah 'e$era.

Ti$a; &ea ta%$a $a% !e4aa ter&et ter$aat a$a &etia #ra;tr.

Kea%"a;a% 4&tr ti$a; a$a a$a #ra;tr i%ear ata &r ata #ra;tr

ia;&i

>er;aa% ataha% &ai%! ter$e&a; &at &aa ai%?. Dia!%o&i& #ra;tr

er!a%t%!

a$a !e4aa ta%$a &i; $a% eeri;&aa% &i%arB a&ie%. @ia&a%"a a&ie%

e%!eh;a% e%!aai 'e$era a$a $aerah ter&et.






Ser :

htt:FF.irar".%54.a'.i$F$#F2&1;eeraata%F20C312001Fa2.$#

12.What are the a%a!ee%t& o# #ra'tre(

A%a!e&i; "a%! &eri%! $i!%a;a%

ama 6bat 0osis Jad&al

A&iri% 32CB1000 ! B6 4a &e;ai

Kai Di;o#e%a; C0B200 ! 8 4a &e;ai

/atri Di;o#e%a; C0 ! 8 4a &e;ai

Iro#e% 200B800 ! B8 4a &e;ai





I%$oeta&i% 2CBC0 ! 8B12 4a &e;ai

Ketoro#e% 2CB7C ! 6B12 4a &e;ai

A&a Me#e%aat 2C0 ! 6 4a &e;ai

/aroe% 2C0BC00 ! 12 4a &e;ai

Piro;&i;a 10B20 ! 12B2 4a &e;ai

Te%o;&i;a 20B0 ! 2 4a &e;ai

Meo;&i;a 7C ! 2 4a &e;ai

,ee'oi 100 ! 12 4a &e;ai

/ie&i$e 100 ! 12 4a &e;ai

Ketoroa; 10B30 ! B6 4a &e;ai

A&etai%o#e% C00 ! 6B8 4a &e;ai

Traa$oQ C0B100 ! 8 4a &e;ai

Di;ti $ari: L'a& Meia%a 2003

Ketera%!a%: Traa$o tera&; a%a!e&i; oioi$ $e%!a% ;er4a

&ee;ti# a$a re&etor M- ;ra%!Fti$a; e%i;a% a$i;&i

a&etai%o#e% $a"a a%ti i%=aa&i eah. Wa&a$a heatoto;&i;

@ia ;ea$aa% e%$erita &tai $a% ;a teah $iata&i #ra;tr $aat

$iioii&a&i $e%!a% &aah &at $a% eat 'ara eri;t i%i:1? Tra;&iComminuted fracture $a% #ra;tr "a%! ti$a; &e&ai %t;

intramedullary nailing ai%! ai; $iata&i $e%!a% a%ia&i $iaah a%e&te&i $a% balanced sliding skeletal traction "a%! $ia&a%!

eai tibial pin. Tra;&i o%!it$i%a "a%! ea$ai $ier;a%

&eaa 2 4a %t; e%!ata&i &a&e otot $a% e%'e!ah

ee%$e;a% $a% #ra!e% har& $itoa%! $i o&terior %t;

e%'e!ah ee%!B;%!a%. E%a ea& o% ia&a%"a '; tetai e%$erita "a%!

!e; eer;a% ea% "a%! eih e&ar $ari e%$erita "a%!

;r& eth;a% ea% "a%! eih ;e'i. La;;a% eeri;&aa%

ra$ioo!i& &eteah 2 4a %t; e%!etahi aa;ah erat ea%

teatN ia ter$aat o5er$i&tra'tio% erat ea% $i;ra%!i tetai 4i;a ter$aat ta%! ti%$ih erat $itaah. Peeri;&aa% ra$ioo!i



&ea%4t%"a er $ia;;a% $a ;ai &ei%!! &eaa $a i%!!

"a%! ertaa $a% &etia i%!! &e&$ah%"a %t; ea&ti;a%

aa;ah o&i&i $iertaha%;a%. Hi;a ha i%i ti$a; $ia;;a% #ra;tr

$aat ter&ei eraha% aha% $a% e%"at $e%!a% o&i&i "a%!

r;.2? +i;&a&i i%ter%aIntramedullary nail i$ea %t; #ra;tr tra%&5er&a tetai %t;

#ra;tr ai%%"a ;ra%! 'o'o;. +ra;tr $aat $iertaha%;a% r& $a%

terha$a a%4a%!%"a $e%!a% nail tetai ;&a&i %!;i% ti$a;

'; ;at %t; e%!o%tro rota&i. Nailing $ii%$i;a&i;a% 4i;a ha&i

eeri;&aa% ra$ioo!i eeri ;e&a% aha 4ari%!a% %a;

e%!aai i%tero&i&i $i a%tara 4%! ta%! ;are%a ha i%i hair

&ea e%"ea;a% non-union. Ke%t%!a% intramedullary nailing

a$aah $aat eeri;a% &taiita& o%!it$i%a &erta ;e&e4a4ara%

>ai!%e%t? &erta eat e%$erita $at $ioii&a&i ';'eat %t; e%i%!!a;a% rah &a;it $aa a;t 2 i%!!

&eteah #ra;tr. Ker!ia% eit a%e&te&i traa e$ah taaha%

$a% ri&i;o i%#e;&i. Closed nailing e%!;i%;a% oii&a&i "a%!

ter'eat $e%!a% traa "a%! i%ia tetai ai%! &e&ai %t;

#ra;tr tra%&5er&a ta%a ee%$e;a%. Comminuted fracture ai%!

ai; $iraat $e%!a% locking nail "a%! $aat eertaha%;a%

a%4a%! $a% rota&i.3? +i;&a&i e;&ter%a

@ia #ra;tr "a%! $iraat $e%!a% tra;&i &tai $a% a&&a ;a&terihat a$a eeri;&aa% ra$ioo!i& "a%! ia&a%"a a$a i%!!

;e e%a cast brace $aat $ia&a%!. +ra;tr $e%!a% intramedullary

nail "a%! ti$a; eeri ;&a&i "a%! rigid 4!a 'o'o; %t; ti%$a;a%

i%i.? Cast bracing

>D4a%toro Di 1997.+ra;tr @ata%!

+er.htt:FF.;ae.'o.i$Fe&F'$;Fe&F16+ra;tr@ata%!+er12

0.$#F16+ra;tr@ata%!+er120.ht.$i a;&e& ta%!!a Hi 2011?





htt:FF.irar".%54.a'.i$F$#F2&1;eeraata%F20C312001Fa2.

$#

Treatment may include:

Closed Reduction/Casting: Child is often given conscious sedation for rela1ation and pain control, and the surgeon will put the bones

bac into alignment. There is no incision in a closed reduction. 6fter the bones are in acceptable alignment, the surgeon will put on the

appropriate cast9splint.

Medication: +ain medications are often needed with fractures. Tylenol with codeine eli1ir and9or "buprofen $0otrin% can be used in the

first few days after a fracture9reduction. "f there was an open fracture, then antibiotics will be needed to prevent infection.

Surgery: 2ome fractures will require surgical intervention. Fractures liely to require surgery include#

• Fractures displacing a growth plate9physis

• Fractures e1tending into a /oint

• +athologic fractures $through abnormal bone9tumors%

• 8pen fractures $any sin brea%

• :lbow fractures $supracondylar, lateral condyle fractures%

• ip, +elvis and Femur $thigh% fractures







2urgery may necessitate the placement of pins, screws or plates to maintain alignment as the fracture heals. The surgery may involve

closed reduction and pinning $no incision%, or an open reduction with internal fi1ation $open incision%. +ercuataneous pins are removed

in the office once the fracture has healed, and internal hardware may need to be removed at a later date in the operating room.

Medical TherapyThe general aim of early fracture management is to control hemorrhage, provide pain relief, prevent ischemia(reperfusionin/ury, and remove potential sources of contamination $foreign body and nonviable tissues%. 8nce these are accomplished, thefracture should be reduced and the reduction should be maintained, which will optimize the conditions for fracture union andminimize potential complications.

The goal in managing fractures is to ensure that the involved limb segment, when healed, has returned to its ma1imal possiblefunction. This is accomplished by obtaining and subsequently maintaining a reduction of the fracture with an immobilizationtechnique that allows the fracture to heal and, at the same time, provides the patient with functional aftercare. :ithernonoperative or surgical means may be used.

5onoperative $closed% therapy consists of casting and traction $sin and seletal traction%.

Casting

Closed reduction should be performed initially for any fracture that is displaced, shortened, or angulated. This is achieved byapplying traction to the long a1is of the in/ured limb and then reversing the mechanism of in/ury9fracture, followed by

subsequent immobilization through casting or splinting. 2plints and casts can be made from fiberglass or plaster of +aris.>arriers to accomplishing reduction include soft(tissue interposition and hematoma formation that create tension in the softtissues.

Closed reduction is contraindicated under the following conditions [*?! #

• &ndisplaced fractures

• "f displacement e1ists but is not relevant $eg, humeral shaft fracture%

• "f reduction is impossible $severely comminuted fracture%

• "f the reduction, when achieved, cannot be maintained

• "f the fracture has been produced by traction forces $eg, displaced patellar f racture%

Traction

For hundreds of years, traction has been used for the management of fractures and dislocations that are not able to be treatedby casting. @ith the advancement of orthopedic implant technology and operative techniques, traction is rarely used fordefinitive fracture9dislocation management. Two types of traction e1ist# sin traction and seletal traction.

"n sin traction, traction tapes are attached to the sin of the limb segment that is below the fracture. @hen applying sintraction, or >uc traction, usually ;AB of the patients body weight $up to a ma1imum of ;A lb% is recommended. [<A! 6t weightsgreater than ;A lb, superficial sin layers are disrupted and irritated. >ecause most of the forces created by sin traction are lostand dissipated in the soft(tissue structures, sin traction is rarely used as definitive therapy in adultsD rather, it is commonlyused as a temporary measure until definitive therapy is achieved.

"n seletal traction, a pin $eg, 2teinmann pin% is placed through a bone distal to the fracture. @eights are applied to this pin, andthe patient is placed in an apparatus to facilitate traction and nursing care. 2eletal traction is most commonly used in femurfractures# 6 pin is placed in the distal femur $see image below% or pro1imal tibia ;(* cm posterior to the tibial tuberosity. 8ncethe pin is placed, a Thomas splint is used to achieve balanced suspension.

Femur fracture managed with seletal traction and use of a 2teinmann pin in the distal femur.

http://refimgshow%284%29/



Surgical Therapy

"n ;?=E, the 6ssociation for the 2tudy of "nternal Fi1ation $62"F% created < treatment goals for surgical fracture management.[;*!To date, these goals have not changed and are as follows#

;. 6natomic reduction of the fracture fragments# For the diaphysis, anatomic alignment ensuring that length, angulation,and rotation are corrected is required, whereas intra(articular fractures demand an anatomic reduction of allfragments.

*. 2table internal fi1ation to fulfill biomechanical demands

3. +reservation of blood supply to the in/ured area of the e1tremity

<. 6ctive, pain(free mobilization of ad/acent muscles and /oints to prevent the development of fracture disease

Open reduction and internal fixation (ORIF

The ob/ectives of 8"F include adequately e1posing the fracture site and obtaining a reduction of the fracture. 8nce areduction is achieved, it must be stabilized and maintained.

!irschner "ires

7irschner wires, or 7(wires, are commonly used for temporary and definitive treatment of fractures. owever, 7(wires resistonly changes in alignmentD They do not resist rotation, and they have poor resistance to torque and bending forces. 7(wires arecommonly used as ad/unctive fi1ation for screws or plates and screws that involve fractures around /oints.

@hen 7(wires are used as the sole form of fi1ation, casting or splinting is used in con/unction. The wires can be placedpercutaneously or through a mini(open mechanism. 6s stated by Canale, 7(wire fi1ation GH is adequate for small fragments inmetaphyseal and epiphyseal regions, especially in fractures of the distal foot, wrist, and hand, such as Colles fractures, and indisplaced metacarpal and phalangeal fractures after closed reduction.G[;<! 7(wires are also commonly used as ad/unctive therapyfor many fractures, including patellar fractures, pro1imal humerus fractures, olecranon fractures, and calcaneus fractures.

#lates and scre"s

+lates and screws are commonly used in the management of articular fractures. This use demands an anatomic reduction ofthe fracture fragments and allows for early 80 of the in/ured e1tremity. +lates provide strength and stability to neutralize theforces on the in/ured limb for functional postoperative aftercare $see images below%.



+reoperative radiographs showing a type > anle fracture.

6nle fracture radiograph after open reduction and internal fi1ation.

+late designs vary, depending on the anatomic region and size of the bone the plate is used for. 6ll plates should be appliedwith minimal stripping of the soft tissue.

Five main plate designs e1ist [;*! #

• >uttress $antiglide% plates

• Compression plates

• +rotection plates

• Tension band plate

• >ridge plates

>uttress plates counteract the compression and shear forces that commonly occur with fractures that involve the metaphysisand epiphysis. These plates are commonly used with interfragmentary screw fi1ation. The buttress plate is always fi1ed to thelarger main fracture fragment but does not necessarily require fi1ation through the smaller f ragment, because the platebuttresses the small fragment into the larger fragment. To achieve this function requires appropriate plate contouring foradequate fi1ation and support.

Compression plates counteract bending, shear, and torsional forces by providing compression across the fracture site via theeccentrically loaded holes in the plate. Compression plates are commonly used in the long bones, especially the fibula, radius,and ulna, and in nonunion or malunion surgery.

+rotection plates are used in combination with interfragmentary screw fi1ation. The interfragmentary compression screwsprovide compression at the fracture site. This plate function neutralizes bending, shear, and torsional forces on the lag screwfi1ation, as well as increases the stabili ty of the construct. +rotection plates are commonly used for fractures involving thefibula, radius, ulna, and humerus.

>ridge plates are useful in the management of multifragmented diaphyseal and metaphyseal f ractures. 6chieving adequatereduction and stability without disrupting the soft(tissue attachments to the bone fragments may be difficult and requires sil l inthe use of indirect reduction techniques.





6 tension band plate technique converts tension forces into compressive forces, thereby providing absolute stability. 6ne1ample of this technique is when a tension band plate is used for an oblique olecranon fracture.

6 locing plate acts lie an internal fi1ator .[<;! There is no need to anatomically contour the plate onto the bone, thus reducingbone necrosis and allowing for a minimally invasive technique. ocing screws directly anchor and loc onto the plate, therebyproviding angular and a1ial stability. These screws are incapable of toggling, sliding, or becoming dislodged, thus reducing thepossibility of a secondary loss of reduction, as well as eliminating the possibility of intraoperative overtightening of the screws.The locing plate is indicated for osteoporotic fractures, for short and metaphyseal segment fractures, and for bridging

comminuted areas. These plates are also appropriate for metaphyseal areas where subsidence may occur or prostheses areinvolved.[<*!

Intramedullary nails

The use of intramedullary nails over the past half century has been widely accepted. These nails operate lie an internal splintthat shares the load with the bone and can be fle1ible or rigid, loced or unloced, and reamed or unreamed.

oced intramedullary nails provide relative stability to maintain bone alignment and length and to limit rotation. "deally, theintramedullary nail allows for compressive forces at the fracture site, which stimulates bone healing. "ntramedullary nails arecommonly used for femoral and tibial diaphyseal fractures $see image below% and, occasionally, humeral diaphyseal fractures.The advantages of intramedullary nails include minimally invasive procedures, early postoperative ambulation, and early 80.

0idshaft femur fracture managed with open reduction and internal fi1ation performed with use of anintramedullary nail.

$xternal fixation

"n ;?A-, :uropean physician 6lbin ambotte developed the technique of e1ternal fi1ation for the management of fractures.[<3!:1ternal fi1ation provides fracture stabilization at a distance from the fracture siteIwithout interfering with the soft(tissuestructures that are near the fracture. This technique not only provides stability for the e1tremity and maintains bone length,alignment, and rotation without requiring casting, but it also allows for inspection of the soft(tissue structures that are vital forfracture healing.

"ndications for e1ternal fi1ation $temporarily or as definitive care% are as follows#

• 8pen fractures that have significant soft(tissue disruption $eg, type "" or """ open fractures%

• 2oft(tissue in/ury $eg, burns%




• +elvic fractures $see image below% +elvic fracture managed with e1ternal fi1ation.

• 2everely comminuted and unstable fractures

• Fractures that are associated with bony deficits

• imb(lengthening procedures $see image below% "lizarov fi1ator.

• Fractures associated with infection or nonunion

13.What are the 'oi'atio%& o# #ra'tre(

CO4.LICATIONS OF FRACTUR-

These com$lications can be immeiate elae or late' 4an o! these are$re"entable an hence great care shoul be taen to minimise their incience'

Immeiate com$lications

Immeiate com$lications are usuall cause b the "iolence $roucing the !racture

an these occur at the time o! !racture or immeiatel a!ter' These can be general

com$lications lie shoc or local com$lications lie in%ur to "essels& in%ur to ner"es or

"iscera in the "icinit'

7elae com$lications






These are com$lications& setting in a!ter a !e# as u$to a !e# #ees' In!ection in

o$en !ractues causing non8s$eci!ic #oun in!ection or s$eci!ic in!ections lie tetanus

an gas gengrene occur in the !irst !e# as' The other com$lications are Fat embolism&

5olmann9s ischaemia& elae ner"e in%ur an 4ositis ossi!icans'

Late Com$lications

These occur as late results o! the in%ur or o! its mismanagement' These inclue (/)

4alunion& (b) Nonunion& (c) Cross union& () Sti!!ness an contracture o! %oints& (e) .ost

traumatic osteoarthrosis& (!) Late ner"e $als (Tar $aralsis)'

Sometimes the in%uries to the ner"es an "essles are cause b the lac o! e!!icient

s$linting an in%uicious hanling o! the !racture limb uring trans$ort' The most

serious com$lications is an o$en !racture is in!ection' Some o! the im$ortant

com$lications are iscribe belo#'

Complications

Complications of casts

Complications of casts include the development of pressure ulcers, thermal burns during plaster hardening, andthrombophlebitis. The 68 62"F group commented that prolonged cast immobilization, or cast disease, can be responsible forcreating circulatory disturbances, inflammation, and bone disease that result in osteoporosis, chronic edema, soft(tissueatrophy, and /oint stiffness.[;*! These problems may be avoided by providing functional aftercare.

Complications of traction

Complications of traction include the development of pressure ulcers, pulmonary9urinary infections, permanent footdropcontractures $if the foot is positioned in equinus%, peroneal nerve palsy, pin tract infection, and thromboembolic events $eg,deep venous thrombosis ['4T!, pulmonary embolism%. These complications stem from a lac of patient mobility, muscleatrophy, weaness, and stiffness that result from a fracture.

Complications of external fixation

Complications of e1ternal fi1ation include pin tract infection, pin loosening or breaage, interference with /oint motion,neurovascular damage when pins are placed, malalignment caused by poor placement of the fi1ator, delayed union, andmalunion.

Complications of fractures and surgical management

Complications of fractures and surgical management include neurologic and9or vascular in/ury, C2, infection, thromboembolicevents, avascular necrosis, and posttraumatic arthritis.

• 5eurologic and vascular in/ury

o 5eurologic and vascular in/uries can occur in any fracture and are more liely in cases with increasing

fracture deformity. +eripheral nerve in/ury is suspected if a patient e1periences motor or sensory deficiencies. 0anagementof neurologic in/ury involves immediate reduction of the fracture and possible nerve e1ploration, with subsequent follow(upto assess whether or not neurologic function returns.

o 6rterial in/ury is suspected if the patientJs pulses are diminished or absent in the affected limb. "f there is

evidence of arterial in/ury, immediate realignment of the limb is performed, and the pulses and perfusion are checed again."f the pulses do not return, angiography is indicated, with concomitant involvement of vascular surgeons. 6rterial in/uries areespecially prevalent in cases of nee dislocations, pro1imal tibial fractures, and supracondylar humerus fractures.

• Compartment syndrome

o C2, initially reported by von 4olmann in ;E-*,[<! is a potentially limb( and life(threatening condition. C2

occurs when tissue pressure e1ceeds perfusion pressure in a closed anatomic space. This condition can occur in anycompartment, such as the hand, forearm, upper arm, abdomen, buttoc, thigh, and leg, but it most commonly occurs in theanterior compartment of the leg.

o The natural history of C2 involves tissue necrosis, functional limb impairment, and renal failure secondary

to rhabdomyolysis, which may lead to death if untreated. C2 can occur after traumatic in/ury to an e1tremity, after ischemia$eg, after hemorrhage or thromboembolic event%, and, in rare cases, with e1ercise. Clinically, patients e1perience pain thatis out of proportion to the degree of in/ury and pain with passive stretching of the involved muscles, as well as pallor,paresthesia, and poiilothermia. +ulselessness, however, is a late finding of C2.

o Compartment pressures can be ob/ectively measured. "ntracompartmental pressures greater than 3A mm

g or a diastolic blood pressure minus intracompartmental pressure that is greater than 3A mm g is an indication for

surgical intervention. 'efinitive therapy consists of surgical fasciotomy of the affected compartments.• "nfection# Complications of surgical intervention include local infection in the form of cellulitis or osteomyelitis and

systemic infection in the form of sepsis. :arly recognition of a local infection may prevent the development of sepsis and,



thus, decrease patient morbidity. The most common pathogen isStaphylococcus aureus. 8ther pathogens include group 6streptococci, coagulase(negative staphylococci, and enterococci. 6ppropriate antibiotics should be administered if an infectionis suspected. 2erial C(reactive protein and erythrocyte sedimentation rate measurements should be obtained and may beused to assess treatment response to antibiotics. "f infection cannot be eradicated with antibiotics, "K' of the surgical woundmay be necessary, with removal of orthopedic hardware, but only if the hardware is not performing its role.

• Thromboembolic events# Thromboembolic events may occur after orthopedic trauma with prolonged patient

immobilization. +atients with significant fractures who are immobile for ;A days or longer have a -B incidence of thrombosis.[;<!

+rophyla1is is effective in decreasing the incidence of '4T in the immobilized e1tremity,[<-!

but it has not been shown to beeffective in decreasing the incidence of fatal pulmonary embolism. "n addition, prophylactic anticoagulation carries with it itsown set of serious and life(threatening complications, such as bleeding. >efore using '4T prophyla1is, the riss and benefitsof such therapy must be thoroughly e1plained to the patient.

• 6vascular necrosis# 6vascular necrosis $645% is caused by disruption of the blood supply to a region of bone.

evascularization of the avascular bone can lead to nonunion, bone collapse, or degenerative changes. 645 is mostcommonly associated with fractures of the femoral head and nec, scaphoid, talar nec and body, and pro1imal humerus.

• +osttraumatic arthritis# +osttraumatic arthritis is common in intra(articular fractures, particularly in intra(articular

fractures that are not adequately reduced. 0anagement of posttraumatic arthritis depends on the /oint involved and caninclude arthroscopic debridement, osteotomy, arthroplasty, or arthrodesis.

• Complications of bone healing

o 'elayed union is defined as a fracture that has not healed after a reasonable time period $the time in which

it was e1pected to heal% has passed.

o 5onunion is defined as a fracture with no possible chance of healing, no matter how long the initial

treatment is carried out. is factors for nonunion are summarized in the Table. 0anagement consists of treatment of the

cause of the nonunion and can include eradication of infection, [<E! stabilization of the fracture, removal of interfering softtissues, bone grafting,[<?!and medical9nutritional modifications of comorbidities.

o 0alunion is defined as healing of bone in an unacceptable position in any plane, which leads to a disability

for the patient, cosmesis, or the potential for the development of posttraumatic arthritis. Treatment involves surgicalcorrection of the anatomic abnormality.

1.o the h"&ioo!" o# #ra'tre heai%!(

BIOLOG2 OF FRACTUR- 1-ALING

It is im$ortant to unerstan the biological $rocess o! !racture healing an the

!actors in!luencing& as it hel$s one to unerstan the $rinci$les o! treatment' This

$rocess "aries in cortical an cancerous bone'

Fracture healing in cortical bone

The $rocess o! healing o! a !racture is in man res$ects similar to the $rocess o!

healing o! an incise #oun' In the healing o! an incise #oun& the ga$ is !irst !ille

#ith bloo #hich clots an later the haematoma is in"ae an re$lace b granulation

tissue' As the e$ithelium gro#s o"er the ga$& the granulation tissue becomes a !ibrous

scar' In the healing o! a !racture a similar staging can be seen in the earlier $hases'

1o#e"er& the en result in the healing o! a bone is the !ormation o! mineralise

mesenchmal tissue (callus) uniting the broen ens o! bone'

Fracture healing #ill be consiere as a series o! $hases #hich occur in se6uence

but also o"erla$ to a certain e,tent'

(I) In!lammator .hase'

a' Stage or haematoma !ormation'

b' Stage o! granulation tissue'

(II) Re$arati"e .hase'



a' Stage o! !ibrocartilaginous callus'

b' Stage o! bon callus'

(III) Remoelling .hase'

Stage o! 1aematoma3 :hen a bone breas& the ga$ is !ille #ith bloo !rom the

ru$ture $eriosteal an enosteal "essels' This bloo istens the so!t tissues an clots

to !orm a haematoma' This $rocess taes about /8; as'

Stage o! granulation tissue3 The so!t tissues in the region unergo the usual changes

o! acute ase$tic in!lammation #ith "asoilatation an e,uation o! $lasma an

leucoctes' The clotte bloo is in"ae b !ine ca$illaries an oung connecti"e tissue

cells an con"erte into granulation tissue in about ; #ees' The cellular element in this

mass consists o! multi$otent mesenchmal cells #hich are ca$able o! i!!erentiating into

!ibroblasts& chonroblasts an osteoblasts'

Stage o! callus3 The granulation tissue ne,t matures into a !ibrocartilaginous mass

#hich hols the !ragments together'

Because o! the $eculiarities o! microcirculation in cortical bone there is some

egree o! cellular eath in the ens o! the !racture bone' The !unamental healing

res$onse o! bone to in%ur is b the $rimar callus res$onse'

Anchoring callus !orms a little istance a#a !rom !racture site to stabilise the

!ragments' In orer to brige ga$s& the briging e,ternal callus !orms to establish

contact bet#een !racture ens an $romote union' 4eullar callus !orms late !rom themeullar ca"it to unite #ith the callus !rom the o$$osite en' Thus& accoring to the

situation an !unction o! callus istribute aroun the !racture site the callus is

escribe as !ollo#s' a) Anchoring callus& b) Briging callus& c) Uniting callus an )

Sealing callus(Fig' /+' <)'

The !ibrocartilaginous mass is con"erte !irst into spongy immature bone an later

into mature lamellar bone, $roucing bon union bet#een the !ragments in about =8/;

#ees' This con"ersion taes $lace in some areas b membranous ossi!ication an in

other areas b enochonral ossi!ication' B this time clinical union o! the !racture is

com$lete'

Stage o! Remoeling3 Once the !racture has been satis!actoril brige& the ne#l

!orme bone aa$ts to its ne# !unction' The site o! !racture unergoes remoeling b

muscular an #eight bearing stresses an an slight e!ormit gets correcte b

mouling' This remoeling $rocess taes u$ to a ear an is seen better in chilren'

.rimar bone healing3 1ealing o! !ractures has also been achie"e b arti!icial

methos o! mechanical com$ression bet#een the !racture !ragments' In this& e,ternal

birging callus is su$$resse an healing is e$enent one o! the acti"it o! meullar

callus an irect osteonal $enetration' 1ence& there is no raiologicall "isible callus'

This has been calle >.rimar bone healing? in the techni6ue o! com$ression $lating o!

!ractures'



Fracture healing in Cancellous bone

In !ractues at the meta$hseal ens o! long bones an in soli bones lie "ertebrae&

the healing $rocess is i!!erent' There is no terminal bone eath as in cortical !ractures'

:hen there is irect contact o! !ragments& healing occurs b the $rocess o! creeping substitution' Ne# trabeculae !orme b intramembranous ossi!ication are lai o#n on

the original trabeculae to $rouce bone bet#een the t#o !ragments' No briging callus

is !orme' Once union is estabilishe remoelling occurs'

FACTORS :1IC1 INFLU-NC- FRACTUR- 1-ALING

Fracture treatment is not $urel a 6uestion o! e!!ecti"e !racture reuction an

!i,ation built a com$le, biological $rocess' The natural tenenc !or a !racture is to

unite ' :hen ela or !ailure o! union occurs& the causes are either local !actors at the

site o! !racture or e!ects in the methos em$loe in treatment' Causes inter!ering #ith

the healing o! !ractures are3

a) Im$er!ect immobilisation3 (i) Too little e,tent o! immobilisation' an (ii) Too

short a

$erio o! immobilisation'

b) 7istraction 3 Too hea" a $ull o! the istal !ragment b seletal traction'

c) Surgical inter"ention 3 This em$ties the !rcture haematoma an stri$s the

$eriosteum&

inter!ering #ith the bloo su$$l an slo#ing the healing $rocess'

Local causes

a) In!ection 3 This is the commonest cause !or elae union or non8union in

o$en !ractures'

b) Inae6uate bloo su$$l to one !ragment3 Certain sites are notorious !or slo#

union or

non8union e'g' (i) Fracture nec o! !emur' The bloo su$$l to the hea o! the

!emur is

$oor' (ii) Fracture sca$hoi' The bloo su$$l to the $ro,imal !ragment is$oor'

c) Inter$osition o! so!t tissues bet#een the !ragment $re"ents bon a$$osition

an inter!eres

#ith healing'

) T$e o! !racture3 Trans"erse !ractures unite slo#l com$are to obli6ue or

s$iral

!ractures'



e) T$e o! bone3 Fracture at the cancerous ens o! bone unite better than those in

the mi

sha!t o! long bones #here cancellous bone is minimal'

General Causes

Fractures in chilren unite "er ra$il #hereas elae union is common in the

age' Other !actors lie $rotein an "itamin e!iciences& general iseases lie s$hilis

an iabetes $la onl a small $art in in!luencing the rate o! healing'

Bio8Com$ression at the !racture site through $rotecte #eight bearing at the

$ro$er time $romotes healing o! the !ractures'

1C.What i& the ;i%$ o# #ra'tre a&e$ o% the &'e%ario >$ia!%o&ti'?(16.What are the h"&i'a eai%atio% to $ia!%o&e the #ra'tre(

Anamnesis

a" Client *dentity

*ncludes name, gender, age, address, religion,

language

used, marital status, education, employment,

insurance,

blood type, no. registers, date of hospital admission,

diagnosis

medical.

b" 5ain Complaint

*n general, the main complaint in the case &as a

fracture

pain. )he pain can be acute or chronic depending on

the duration and

attack. )o obtain a complete assessment of thepain client used

!8" Pro%oking *ncident if there are e%ents that

become a factor

factors that aggra%ate and mitigate / reduce pain

!;" Duality of Pain What kind of pain that is felt or

described the client. *s burning, throbbing, or

stabbing.

!:" Eegion radiation, relief &hether the pain may

subside, &hetherpain radiating or spreading, and &here the pain



occurs.

!?" Se%erity !Scale" of Pain ho& much pain is felt

the client, can be based on a pain scale or clients to

e$plain ho& much pain a3ects the ability to

function.!@" )ime ho& long the pain lasts, &hen, if gets

&orse at night or during the day.

c" 0isease 1istory o&

0ata collection is done to determine cause

of the fracture, &hich &ill help in making a plan of

action against the client. )his can include the

chronology of the disease that it can later be

determined strength that occurs and the a3ected

part of the body. *n addition, by kno&ing the

mechanism of inury accidents can be kno&n other

accidents

d" 1istory of past illness

At this assessment found probable cause

fractures and bone instruct ho& long it &ill connect.

Certain diseases such as bone cancer that causes

pathological fractures that are often diFcult to

connect. 'urthermore, &ith &ounds in diabetic foot

osteomyelitis is %ery at risk of acute or chronic

diabetes and also inhibit bone healing process

e" 'amily 0isease 1istory

'amily of diseases associated &ith bone disease is

one of the predisposing factors of fractures, such as

diabetes, osteoporosis is common in some breeds,

and bone cancer &hich tends to be genetically

inherited

Psychosocial 1istory

A client7s emotional response to the disease and the client7s

role in the family and society as &ell as the response or

inuence in their daily li%es either in the family or in the

community

6%er%ie&

Worth mentioning

!8" 4eneral condition good or bad that is recorded signs,



such as

!A" A&areness of people

G Composmentis immediately oriented &ith perfect

orientation

G Apathy looks sleepy but easily aroused and checking%ision, hearing and touching normal

G sopor can be aroused &hen stimulated &ith rude and

continuously

G Coma no response to stimuli

G Somnolence can be aroused &hen stimulated can be

asked and ans&ered the -uestion, &hen the stimulation

stops su3erers sleep again.

!(" *n pain, disease state acute, chronic, mild, moderate,

se%ere and usually in cases of acute fracture, muscle

spasms, and loss of taste.

!C" =ital signs are normal because there is no disruption

both function and form.

!0" eurosensori, such as tingling, &eakness, and deformity.

!H" Circulation, such as hypertension !sometimes seen as a

response to pain / an$iety", hypotension !in response to

blood loss", decreased pulse in the distal part of inured,

Capilary rel slo&ed, pale on the a3ected side, and a

hematoma on the side of the inury.

A%a%e&i&

@ia ti$a; a$a ria"at traa erarti #ra;tr atoo!i&. Traa

har& $ieri%'i ;aa% ter4a$i%"a $ia%a ter4a$i%"a 4e%i&%"a

eratBri%!a% traa arah traa $a% o&i&i a&ie% ata

e;&treita& "a%! er&a%!;ta% >e;a%i&e traa?. Ha%!a%

a %t; e%eiti ;eai traa $i teat ai% &e'ara

&i&tei; $ari ;eaa ;a eher $a$a $a% ert


Me$ia Ae&'ai?P+

Di'ari ;e%!;i%a% ;oi;a&i &eerti &"o; a$a #ra;tr

tie #ra;tr e5i&. +ra;tr ter;a : ta%$aBta%$a &e&i& a$a

#ra;tr ter;a "a%! e%!aai i%#e;&i. Peeri;&aa% &tat&

o;ai&:

o'; 'ari aa;ah ter$aat :

•

De#orita&• +%'tio% a&ea



• Lihat 4!a ;ra% a%4a%! ta%!

#ee: aa;ah ter$aat %"eri te;a%

o5e

• Kreita&i• /"eri ia $i!era;a%

• Seeraa !a%!!a%B!a%!!a% #%!&i%"a !era;a% "a%!

ti$a; $ia;;a%


Me$ia Ae&'ai?

1. I%&e;&i :

• @a%$i%!;a% $e%!a% a!ia% "a%! &ehat

• Kea$aa% e%$erita &e'ara ;e&erha%• E;&re&i a4ah ;are%a %"eri

• Li$ah ;eri%! ata a&ah

• A$a%"a ta%$aBta%$a a%eia ;are%a er$araha%

• Aa;ah ter$aat ;a a$a ;it $a% 4ari%!a% %a;

%t; ee$a;a% #ra;tr tertt ata ter;a

• E;&tra5a&a&i $arah &;ta% $aa eeraa 4a ata

&aai eeraa hari

• Perhati;a% a$a%"a $e#orita& i&a%"a a%!a&i

rota&i $a% ;ee%$e;a%

• La;;a% &r5ei a$a &erh th aa;ah a$a traa

a$a or!a%Bor!a% ai%.

• Perhati;a% ;o%$i&i e%ta e%$erita

• Kea$aa% 5a&;ari&a&i

2. Paa&i

Paa&i $ia;;a% &e'ara hatiBhati oeh ;are%a e%$erita

ia&a%"a e%!eh &a%!at %"eri.

aBha "a%! har& $ierhati;a% :

• Teeratr &eteat "a%! e%i%!;at

• /"eri te;a% %"eri te;a% "a%! er&i#at &er&ia

ia&a%"a $i&ea;a% oeh ;er&a;a% 4ari%!a% %a;

"a%! $aa a;iat #ra;tr a$a ta%!

• Kreita&i $aat $ia;a; $e%!a% eraaa% $a% har&

$ia;;a% &e'ara hatiBhati.

• Peeri;&aa% 5a&;er a$a $aerah $i&ta traa era

aa&i arteri ra$iai& arteri $or&ai& e$i& arteri tiiai&o&terior &e&ai $e%!a% ;; "a%! ter;e%a.



• Pe%!;ra% t%!;ai tertaa a$a t%!;ai aah

%t; e%!etahi a$a%"a ere$aa% a%4a%! t%!;ai.

PP

P Peeri;&aa% ra$ioo!i;

Diat 2 #oto $ari aarah AP $a% atera

Diat ro"e;&i "a%! te!a; r&

A$a;aa%"a $iat ro"e;&i Kh&& i&a%"a ro"e;&i

a;&ia #ra;tr a$a #er ro;&ia ata her&

ro;i&a

>ra$ioo!" $ia!%o&ti'?

DIAG/)SIS )+ +RA,T-RE

I% o&t i%&ta%'e& the 'i%i'a &i!%& a&&o'iate$ ith #ra'tre a;e $ia!%o&i&%'oi'ate$. Atho!h the o%er o# a% a%ia o#te% i ha5e o&er5e$ the

#ra'tre$ o%e o'ati%! a #ra'tre 'a% at tie& e $i't. I% the&e i%&ta%'e&

the ra'titio%er %ee$& a &"&teati' o!i'a aroa'h to $ia!%o&e the #ra'tre.

+IG. 11B10 ,o%$"ar #ra'tre&. >A?

Latera hera 'o%$"e #ra'tre.

>@? I%ter'o%$"ar a%$

&ra'o%$"ar #ra'tre& o# the

$i&ta her& >a OTO #ra'tre?. >'?

I%ter'o%$"ar a%$ &ra'o%$"ar

#ra'tre& o# the $i&ta her& >a

O* #ra'tre?.

D'F1NCTION

Dysunction is most commonly e(empliied by lameness. In the orthopaedic e(amination the

ocal site o the lameness must be ound and the dia%nosis pursued. Dysunction may also

include paralysis "ith spinal racture$ unconsciousness accompanied by cranial racture$ or

masticatory dysunction "ith mandibular racture.

Impairment or loss o unction is a constant si%n o complete racture and is the result o pain

or loss o mechanical support. Only in cases o incomplete or impacted racture may some

"ei%ht be borne by the bone. The careul obser)er "ill determine the dierence bet"een loss

o unction due to pain alone and that due to inability to bear "ei%ht. The smaller the animal$

the more diicult it is to ma#e this distinction. Toy 4e#in%ese$ 4omeranians$ and all cats

re+uire considerable care in determinin% the presence o this si%n.

4IN

4ain o)er the site o racture is common. In incomplete ractures this may be the only clinical

indication. Direct tenderness can be misleadin%$ since it may be due to a contusion or other

sot issue dama%e caused by a blo". Indirect tenderness is a more accurate si%n o racture. It

is produced by pressure in the lon% a(is o the bone e(erted at its t"o e(tremities. I there is a brea# in the continuity o the shat$ such pressure "ill cause pain at the racture site that is




+uite distinct rom the pain o in2ured sot tissue parts. I an animal is e(amined durin% the

state o local tissue shoc#$ that is$ "ithin = to > minutes ater the accident$ pain may not be

a conspicuous si%n.

LOCL TR13

E(amination o the area around a racture may demonstrate s"ellin%$ hematoma$ contusion$or laceration i the racture is open. Oten because o e(treme s"ellin%$ the e(aminer "ill be

unable to palpate crepitation. Local s"ellin%$ althou%h present in many other conditions$ is

one o the most constant si%ns o a racture. Immediately ater in2ury the s"ellin% may be

sharply outlined as a result o bleedin% rom the bone and the sot parts. n indistinctly

outlined s"ellin% that occurs later is caused by edematous iniltration. Generally the s"ellin%

increases or =@ to @ hours$ then %radually subsides ,particularly under treatment0. *hen

applyin% banda%es and splints immediately ollo"in% racture$ it is important to bear in mind

that s"ellin% "ill subside.

&NOR3L 4O'T1RE OR LI3& 4O'ITIONING

bnormalities o positionin%$ "hen o acute onset associated "ith trauma$ usually relect aracture. Deormity$ a de)iation rom the normal anatomical structure$ may be caused by

displacement o the bony rame"or# as in a racture or dislocation$ but it may also be caused

by chan%es in coni%uration due to a neoplasm. The displacement o bone ra%ments that

produces deormity in a racture may be an%ular$ lon%itudinal$ or rotational. Lon%itudinal

displacements may cause shortenin%$ reerred to as o)erridin%$ or may result in separation o

the ra%ments$ termed distraction ,e.%.$ ractures o the olecranon0. In most cases the primary

displacement is determined by the direction and orce o an in2ury and is maintained and

oten increased by the contraction o muscles. I in doubt about positionin%$ comparison "ith

the opposite limb or side o the body part is ad)ised.

CRE4IT1'

Crepitus is a si%n o racture that is considered patho%nomonic. &ony crepitus is the %rittin%

sensation transmitted to the palpatin% in%ers by the contact o the bro#en bone ends on each

other. There are other orms o crepitus ,pseudocrepitus0 such as occurs in some cases o

arthritis$ partial lu(ations o the patella$ or lu(ations o the co(oemoral 2oint. The absence o

crepitus does not necessarily indicate the absence o a racture. The interposition o a piece o

sot tissue bet"een the ra%ments "ill pre)ent crepitus. It is also absent "hen the ends o the

bones are so ar apart that they cannot be brou%ht into contact$ or "hen they are impacted.

Crepitation should be elicited "ith the utmost precaution because o the dan%er o causin%

urther dama%e to bony ra%ments and surroundin% sot tissue. Vi%orous palpation$ "hich

may turn a routine closed racture into a contaminated open one should be a)oided.

&NOR3L 3O&ILIT

alse point o motion is also patho%nomonic. It occurs i there is a complete racture o the

shat o a lon% bone/ it does not occur in an incomplete or impacted racture. 3obility near a

2oint may be diicult to dierentiate rom normal or abnormal mobility o the 2oint itsel. In

order to a)oid additional trauma$ the same precaution should be ta#en in elicitin% this

symptom as in elicitin% crepitus.

RDIOGR45IC 'IGN'

Fracture$ either dia%nosed or suspected$ should be documented by radio%raphy. t least t"o

)ie"s includin% the 2oints abo)e and belo" the racture are needed. Fracture o 2oints orspecial anatomical locations may re+uire additional radio%raphs or special positionin%.





out !rom the nature o! the "iolence& either a irect in%ur on the bone or inirect in%ur

b a t#ist& !all or muscular "iolence'

.ain3 The $atients com$lain o! $ain an inabilit to use the limb'

7e!ormit3 The $resence o! deformity in along bones a a!ter in%ur is a e!inite signo! !racture'

Local bon tenerness3 This is the most im$ortant clinical sign !or the $resence o! a

!racture' The tenerness must be localise in a $articular $oint in the course o! the

bone'

Creits3 Although creitus !elt uring the e,amination o! the $art iagnostic o!

!racture& it should not be purposely elicited as it causes se"ere $ain an it ma $rouce

!urther is$lacement an in%ur o! so!t tissues'

Abnormal mobilit3 Abnormal mo"ement in a segment o! the limb enotes!racture'

4easurements3 Shortening o! a segment o! a limb a!ter in%ur inicates a !racture

#ith o"er riing o! the !ragments'

17.What are the &orti%! eai%atio% to $ia!%o&e the #ra'tre(

Raiological e,amination3 The in%ure $art& incluing the %oint abo"e an belo#& shoul

be raiogra$he in t#o "ie#s' The raiogra$h #ill con!irm the $resence o! the !racture

an #ill also sho# the is$lacement o! the !ragments'

a" 2ocal circumstances

H$amination of the musculoskeletal system are as

the follo&ing

8. 2ook !inspection"

Pay attention to &hat can be seen as follo&s

!A" Sikatriks !scar tissue either natural or man#

made such as scar".!(" 'istula reddish or bluish color !li%ide" or

hyperpigmentation.

!C" A lump, s&elling, or basin &ith things that are

not normal !abnormal"

!0" )he position and shape of the e$tremities

!deformity"

!H" )he position of the !gait, in time to check the

room"

;. 'eel !palpation"At the time of going to palpation, the patient



impro%ed rst position from the neutral position

!anatomical position". (asically this is an

e$amination

&hich pro%ide information in both directions, both

the e$aminer and the client.)o be noted are

!A" Changes in trauma surrounding temperature

!&arm" and moisture.

!(" *f there is s&elling, if there are uctuations or

edema especially around oints

!C" tenderness !tenderness", crackles, note the

location of abnormalities !8/: pro$imal, middle, or

distal"

!0" 5uscle tone at a time of rela$ation or

contraction, lumps contained in or attached to the

bone surface. *t also e$amined neuro%ascular

status. *f there are lumps, bumps ha%e described

the nature of the surface, consistency, the base or

surface mo%ement, pain or not, and its size.

!H" 5uscle strength the muscle can not contract

!8", contraction and there is little time pressure

fall !;", is able to &ithstand gra%ity but &ith a

touch of fall !:", less muscle strength !?", muscle

strength intact !@". !Carpenito, 8III"

:. 5o%e !especially the mo%ement range of

motion"

After checking the feel, then for&arded by mo%ing

e$tremities and note &hether there is a complaint

of pain. )his e$amination is to determine &hether

there is a mo%ement disorder !mobility" or not.

5o%ement is seen acti%e and passi%e mo%ements.

!Arif 5utta-in, ;BB"

Peeri;&aa% e%%4a%! :

• +oto oo&

• Too!rai&a%"aa$a #ra;tr 5ertera ata ;o%$i& tiia

• ,TBS,A/

• MRI

• Ra$ioi&oto &'a%%i%!.



Documents

RISKA Step 7 Lbm 4 Modul 9