Dr.Wahyu Eko Widiharso, Sp.

OT

RS.BINA HUSADA 2011

SMF Bedah FK UKI

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Putusnya hubungan kesinambungan/ diskontinuitas tulang dan atau tulang rawan Fraktur tertutup :Bila kulit sekitar intak Fraktur terbuka :Bila ada luka, sehingga kemungkinan terjadi kontaminasi atau infeksi

SMF Bedah FK UKI

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CAUSE BY: TRAFFIC ACCIDENT/TRAUMA . epifisis and cartilage adjacent with outside .DEFINITION  PICTURE DEFINITION is break of bone.

ANKLE TIBIA .

Gustilo Classification I Low energy. wound less than 1 cm II Wound greater than 1 cm with moderate soft tissue damage High energy wound greater than 1 cm with extensive soft tissue damage III IIIA IIIB IIIC Adequate soft tissue cover Inadequate soft tissue cover Associated with arterial injury .

Fraktur tertutup 2. Fraktur terbuka SMF Bedah FK UKI 8 . Berdasarkan hub dengan dunia luar : 1.I.

     COMPLETE/ UNCOMPLETE FRACTURE LINE FORM FRACTURE LINE DISPLACED /UNDISPLACED CLOSED OR OPEN FRACTURE .

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GENERAL EXAMINATION. B. Pemeriksaan X`ray  .  Anamnesa Pemeriksaan Fisik A.LOCAL EXAMINATION.

PAIN HILANGNYA FUNGSI LUKA .  TRAUMA :KLL/ non KLL MEKANISME TRAUMA     POLYTRAUMA. OR LOCAL FRACTURE. MULTIPLE FRACTURE.

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     ATLS ABCD C-SPINE EXAMINATION OF HEAD.CHEST.ABDOMEN MULTIPLE TRAUMA/FRACTURE SHOCK .

OPEN FRACTURE IN THE SCENE .

   LOOK FEEL MOVE .

 DEFORMITY abnormal MOVEMENT . angulation. rotation dan discrepency  FUNGSIOLAESA lost of function .

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Pressure pain dan axial pain .

   Crepitation Pain of movement ROM and Strengt of muscle Abnormal movement.  .

Classical fracture easy to diagnose Non Classical Fractur need radiological examination  Minimal 2 AP/Lateral projection Axial. Chidren : need opposite side   Include 2 joint . alar and obturator.

. TO PROMOTE HEALING AND FUNCTION OF BONE AS SOON AS POSSIBLE.

RELEAVE PAIN 2.PROMOTE HEALING 4.     1.GOOD REPOSITION 3.REHABILITATION .PROMOTE FUNCTION 5.

     1.ANTIBIOTIC FROM EMERGENCY ROOM.ADEQUATE DEBRIDEMENT DAN IRIGATION 5.REPEAT DEBRIDEMEN (24-72 HOURS) .INITIAL EVALUATION (ATLS) 3.OPEN FRACTURE IS EMERGENCY CASE 2. OPERATING THEATER AND POST OPERATION 4.

Fracture stabilisation 7.Open wound 5-7 days 8.Rehabilitation .Bone Graft 9.    6.

 1.WOUND CLEANING MECHANICAL IRIGATION WITH Na Cl TO REMOVED STRANGE BODY .

FAT.DEBRIDEMENT  3.STABILIZATION TISSUE NECROTIC EXC. NO VASC. FASCIA AND MUCLE BONE FRAGMENT GRADE I INTERNAL FIKSASI GRADE II/III EXTERNAL FIXATION TRACTION .TISSUE SKIN. 2. SUB CUTAN.

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 4.antibitic Golden period 6-7 hours Leave it open Skin graft Prevent infection Broad spectrum Cephalosporin Aminogcoside 3-5 days .WOUND CLOSURE  5.

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 Prevent Anti Tetanus ATS/Toxoid Rural area accident give Penicilin procain .

SISTEMIC : FAT EMBOLISM . Tetanus Ganggren.LOCAL VASKULAR : COMPARTMENT SYND TRAUMA VARKULAR NEUROLOGIS : LESI MED. .SHOCK BLEEDING. SEPSIS AND DEATH. EARLY COMPLICATION 1.SPINAL 2.

 LATE COMPLICATION JOINT STIFFNESS/CONTRACTURE DISUSE ATROFI MALUNION NONUNION DELAYED UNION GROWTH DISTURBANCE CHRONIC OSTEOMYELITIS .

 DIAGNOSA FRAKTUR : Historycal examination Physical examination Radiological examination Open fracture Managemen Fracture Complication   .