RESUME GANGGUAN MUSKULOSKELETAL

FARCTURE AND DISLOKASI

Disusun Untuk Memenuhi Tugas Dalam Mata Kuliah Bahasa Inggris 3

Oleh :

NAMA : YANTI YULIANA PURBA

NIM : PO7220119 1628

KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

POLITEKNIK KESEHATAN TANJUNGPINANG

PRODI DIII KEPERAWATAN

TAHUN 2022
SUMMARY FRACTURE
The musculoskeletal system is a system that plays a role in supporting, protecting
and moving the body. The skeleton is the frame for the structure of the body and protects
the internal organs that are vulnerable from damage. Muscles with the help of joints,
ligaments and tendons allow bones to move. This system consists of 206 bones, which
support body movement and protect internal organs, tendons and ligaments, which
connect bones to muscles (Risnanto & Insani, 2014).
Musculoskeletal disorders include fractures, dislocations, sprains, strains and
compartment syndrome. In everyday life which is increasingly crowded with the
activities of each human being and to keep up with the times, humans will not be
separated from normal musculoskeletal functions, especially bones which are the main
means of movement for humans, bones form a supporting and protective framework for
body parts and places for attachment of muscles. muscles that move the body's skeleton,
bone function can be disrupted due to fracture (Lindgren et al., 2010).
Fracture is one of the causes of disability, one of which is a result of trauma due
to an accident. According to Wiarto (2017), a closed fracture is a type of fracture that is
not accompanied by a wound on the outer surface of the skin so that the broken bone is
not in contact with the outside. An open fracture is a type of fracture in which there is a
wound in the fractured area so that part of the bone is exposed to external air, usually
accompanied by profuse bleeding. Broken bone also protrudes from the skin surface, but
not all open fractures make the bone protrude. Open fractures require faster treatment
because of infection and other complicating factors.
The incidence of fractures in Indonesia is 1.3 million every year with a population
of 238 million, which is the largest in Southeast Asia (Wrongdignosis, 2011). The most
fractures in Indonesia are lower extremity fractures because the lower extremities have
many injuries and the prevalence of closed fractures is higher than open fractures with a
percentage of 77.8%. (Riskesdas, 2018). According to the World Health Organization
(WHO), the number of fracture accidents in the world will continue to increase with the
number of vehicles increasing. Productive age is the age range of injury due to accidents,
as well as the elderly can occur fractures due to decreased bone mass so that fractures
occur.
 According to Wiarto (2017), the types of fractures based on radiology are:

1. A transverse fracture is a fracture in which the fracture line is perpendicular to the long
axis of the bone. This fracture, the broken bone segments are repositioned or reduced back
to their original place, then these segments will be stable and are usually controlled with a
cast splint.
2. Cuminitive fracture is a break in the integrity of the tissue consisting of two bone
fragments.
3. An oblique fracture is a fracture in which the fracture line makes an angle with the bone
4. A segmental fracture is two adjacent fractures of one bone that separates the central
segment from its blood supply, this type of fracture is usually difficult to treat.
5. An impaction fracture or compression fracture occurs when two bones strike the bone
between the vertebrates.
6. Spiral fractures are fractures that result from torsion of the extremity. These fractures
cause little soft tissue damage and tend to heal quickly with immobilization.
According to Doenges (2000), fractures can be divided into 150, but the main five are:

7. Incomplete: fracture involving only the cross section of the bone. One side is broken;
others are usually just bent (greenstick).
8. Complete: The fracture line involves the entire cross section of the bone, and the bone
fragments are usually displaced.
9. Closed (Simple): the fracture does not extend through the skin.
10. Open (complete): bone fragments extend through the muscle and skin, where the potential
for infection.
11. Pathological: fracture occurs in bone disease with no or only minimal trauma.
Signs and symptoms of a fracture are pain, loss of function, deformity, shortening of the
extremity, crepitus, local swelling, and discoloration.

12. First, the pain persists and increases in severity until the bone fragments are immobilized,
the muscle spasm accompanying the fracture is a natural form of splint designed to
minimize movement between bone fragments.
13. Second, after a fracture occurs the parts are unusable and tend to move unnaturally instead
of normal, the fracture shift causes deformity, the extremity can be identified by
 comparison with a normal extremity. Extremities cannot function properly because normal
muscle function depends on the integrity of the bones to which the muscles are attached.
14. Third, in long fractures, there is actual shortening of the bone due to contraction of the
muscles attached above and below the fracture site.
15. Fourth, when the extremities are examined, there is a palpable bone creak called crepitus
which is palpable due to friction between the fragments with one another.
16. And finally, localized swelling and discoloration of the skin occurs as a result of the
trauma and bleeding that follows the fracture. These signs usually occur only a few hours
or days after the injury (Dyer et al, 2016)
According to Appley & Solomon (2018), fractures are caused by

1. Injuries, which are divided into:

17. Direct injury, i.e. the bone is broken at the point of impact; soft tissue is also damaged. A
direct blow usually splits the bone crosswise or bends it above the fulcrum creating a
fracture with a 'butterfly' fragment. Damage to the overlying skin is common; If crushing
occurs or in a high energy injury, the fracture pattern will account for extensive soft tissue
damage.
18. Indirect injury, i.e. the bone is broken at a distance from where the force was applied; Soft
tissue damage at the fracture site is inevitable
19. Repetitive stress, or fatigue fractures, these fractures occur in normal bone subjected to
repetitive heavy loading, usually in athletes, dancers or military personnel who have a
grueling training program or when the intensity of exercise increases significantly from
baseline. Heavy loading creates minute deformations that initiate the normal process of
remodeling - a combination of bone resorption and new bone formation according to
Wolff's law. When exposure to stress and deformation is repeated and prolonged, bone
resorption occurs more rapidly than replacement (formation of new bone) and leaves areas
that can be fractured. Similar problems occur in patients with chronic inflammatory
disease who are being treated with steroids or methotrexate, which alter the normal
balance of bone resorption and replacement.
20. Abnormal bone deformities (pathological fractures), i.e. fractures that can occur even with
normal stresses if the bone has been weakened by changes in its structure or due to a
 disease process (e.g. in patients with osteoporosis, osteogenesis imperfecta or Paget's
disease, bisphosphonate therapy) or through lytic lesions (eg bone cysts or metastases).
According to Andra & Yessie (2013), fracture etiology is divided into:

1. Direct violence, causing fractures at the point of violence. Such fractures are often open
fractures with transverse or oblique fracture lines.
2. Indirect violence causes fractures in places far from where the violence occurred. The
fracture is usually the weakest part in the violent vector conduction path.
3. Violence due to muscle pull, this is very rare. Strength can be twisting, bending and
pressing, a combination of the three and pulling.
According to (Istianah & Umi, 2017) general medical management in fracture
management follows the principles of medical treatment in general, namely, first and foremost,
do not injure the patient (primum non nocere). Additional iatrogen injury to the patient occurs as
a result of malpractice or overuse. Second, treatment is based on the correct diagnosis and
prognosis. Third, cooperate with the laws of nature and fourth choose treatment by paying
attention to each individual patient. The purpose of this management is based on four main
objectives, namely:

a. Relieve pain : Pain that arises in fractures is not due to the fracture itself, but because of the
injured tissue around the broken bone. To reduce the pain, painkillers can be given and
immobilization techniques (not moving the fractured area). Immobilization techniques can be
achieved by means of splints and casts.

- A splint by placing a hard object around the bone

- A plaster cast is a strong material that is wrapped around the broken bone.
b. Generates and maintains the ideal position of the fracture. Splints and casts cannot maintain
position for long periods of time. For this reason, more stable techniques are needed, such as
the installation of continuous traction, external fixation or internal fixation depending on the
type of fracture itself.

- Pulling (traction) Using a load to hold a limb in place.

- Internal and external fixation Surgery to place metal plates or rods on broken bones.
 - In order for bone reunification to occur Usually broken bones will begin to unite in 4
weeks and will be fused perfectly within 6 months. However, sometimes there is a
disruption in the union of bones so that a bone graft is needed.
- Restore function as before. Prolonged immobilization can result in muscle wasting and
joint stiffness. Therefore, mobilization efforts are needed as soon as possible. For the
fracture itself, the principle is to restore the original position (reposition) and maintain
that position during the fracture healing period (immobilization).
Orthopedic management can be done according to clinical conditions and existing capabilities
for fracture management. Some of the interventions that can be done are as follows

- Protection without repositioning and immobilization

- Immobilization with fixation
- Reposition by manipulation followed by immobilization
- Reposition with traction
According to (Jong, 2010) diagnostic examinations in fracture patients are:

- Radiological examination
- Laboratory examination
- Arthroscopic examination
- Electrodiagnostic examination
Complications of fracture according to (Jong, 2010) include:

- Early complications
1. Arterial damage
2. Compartment syndrome
3. Fat embolism syndrome (FES)
4. Infection
5. avascular necrosis
6. Shock
- Old complications
1. Delayed union
2. Non-union
3. Mal-union
Conclusion.:

Fractures are caused by trauma where there is excessive pressure on the bone
which is usually caused directly and indirectly and is often associated with sports, work
or injuries caused by motor vehicles. The cause of fractures is most often caused by
trauma, especially in children, when the bones are weakened or when the pressure is light
(Doenges, 2013).

According to Wiarto (2017), a closed fracture is a type of fracture that is not

accompanied by a wound on the outer surface of the skin so that the broken bone is not in
contact with the outside. An open fracture is a type of fracture in which there is a wound
in the fractured area so that part of the bone is exposed to external air, usually
accompanied by profuse bleeding. Broken bone also protrudes from the skin surface, but
not all open fractures make the bone protrude. Open fractures require faster treatment
because of infection and other complicating factors. Complexity fractures are fractures
that occur in two conditions, namely fractures in the extremities, while dislocations occur
in the joints.

SUMMARY DISLOKASI
1. DEFINITION
A condition in which the bones that make up a joint are no longer connected
anatomically or the bone separates from the joint. The protrusion or separation of the
head of the joint from the bowl, dislocation is an emergency that requires immediate help.
Joint dislocation or luxation is the displacement of the bone surfaces that form joints
against other bones (Zuriati, 2019). Dislocations are usually caused by physical factors
that force the joint to move more than its normal range, which causes a failure of
pressure, either on the bony components of the joint, ligaments and fibrous capsule, or on
bone or soft tissue (Damayanti et al., 2019).
Joint dislocations also often occur in athletes, namely slipping of the joint hump from its
place. If a joint has been dislocated, the ligaments in that joint will loosen, so that the
joint is easily dislocated again (habitual dislocation). Handling that can be done when a
 dislocation occurs is to immediately pull the joint with a longitudinal axis (Setiawan,
2011).

2. CAUSE AND EFFECT ESSAY

The etiology of dislocation in 60% of cases is caused by trauma from falls, traffic
accidents, domestic accidents, violence, and other causes such as excessive mouth
opening when yawning, laughing, singing, prolonged mouth opening from oral and ENT
procedures, forceful mouth opening. Anesthesia and endoscopic procedures contribute
about 40% (Septadina, 2015). Some of the most common dislocations are caused by
sports injuries, usually soccer and hockey, as well as sports where there is a risk of
falling, for example: falling from skiing, gymnastics, volleyball. Basketball players and
soccer players most often experience dislocations of the hands and fingers from
accidentally catching the ball from another player, followed by trauma not related to
sports for example, a hard impact on the joint during a motor accident causing the
dislocation.

3. DESCRIPTIVE ESSAY
Dislocations can be classified into several, namely, Congenital dislocations occur
from birth due to growth errors. Pathological dislocation due to disease of the joints
and/or tissues around the joints, such as tumors, infections, or bone osteoporosis. This is
due to reduced bone strength. And lastly, Traumatic Dislocation is an orthopedic
emergency (blood supply, nervous system damage and experiencing severe stress, tissue
death due to anoxia) due to edema (due to hardening). Occurs due to strong trauma that
can remove bone from the surrounding tissue and may also damage the structure of
joints, ligaments, nerves, and the vascular system. Most occur in adults. Based on the
clinical type, it is divided into Acute Dislocation, which usually occurs in the shoulder,
elbow, and hip. Accompanied by acute pain and swelling around the joint. While
Recurrent Dislocation is a trauma Dislocation in the joint followed by the frequency of
dislocation that continues with minimal trauma, it is called repeated dislocation.
Commonly occurs in the shoulder joint and patello femoral joint. Dislocations are usually
associated with fractures/fractures caused by displacement of the ends of the broken
 bones due to the force of trauma, muscle tone or contraction and tension. The medical
management of joint dislocation that can be done is pharmacological by giving non-
narcotic analgesic drugs. Analsik that serves to treat muscle pain, joints, headaches, back
pain. The side effect of this drug is agranulocytosis. Bimastan serves to relieve mild or
moderate pain, acute or chronic conditions including joint pain, muscle aches, pain after
childbirth. Side effects of this drug are nausea, vomiting, agranulocytosis, aeukopenia.
And secondly Surgery (Orthopedic surgery) is a medical specialty that specializes in the
medical and surgical management of patients who have arthritis conditions affecting the
major joints, hips, knees and shoulders through minimally invasive surgery and joint
replacement surgery. While for non-medical dislocation reduction can be done: returned
to its original place using anesthesia if the dislocation is severe. The second with RICE
(rest, ice, compression, elevation).

4. CONCLUSION
From the data and facts that have been described above, our group can conclude
that a dislocation is the release of compression of bone tissue from the joint unit. This
dislocation can be only a displaced bone component or a complete detachment of a bone
component from its proper place [from the joint bowl]. A joint whose ligaments have
been dislocated, usually becomes loose. As a result, the joint will be easily dislocated
again. If the dislocation is accompanied by a fracture, the repair is difficult and requires
hospitalization. The earlier the joint restoration attempt is made, the better the healing
will be.