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FRACTURES and JOINT INJURIES

DARMADJI ISMONO dr, SpB, SpBO(K), FICS DEPARTMENT OF ORTHOPAEDIC SURGERY and TRAUMATOLOGY

SCHOOL of MEDICINE PADJADJARAN UNIVERSITY

MULTIPLE TRAUMA
• Penggolongan gawat darurat adalah atas dasar sistim atau fungsi, bukan atas dasar spesialisasi.
• B1= B2= B3= B4= B5= B6= Breath Blood Brain Bladder Bowel Bone

MULTI DISCIPLINE APPROARCH (team) OVERLAPPED: • ORTHOPAEDIC & NEURO SURGERIES • PLASTIC & THT & ORTHOPAEDIC and ORAL SURGERIES .

Textbook of Disorders and Injuries of the Musculoskeletal System • Robert Bruce Salter • Second Edition • Turek’s ORTHOPAEDICS Principles and Their Application (Fifth Ed ) .

General Incidence A Fracture Normal Living Bone • Fracture – Bone – Epiphyseal plate – Cartilagenous Structural break in its continuity .

Extent: • • .TERM 1. Site: • • • Diaphyseal Metaphyseal Epiphyseal / intra articulair Complete Incomplete • • • Hairline Buckle greenstick 2.

Relation of the Fracture Fragments to each other: – – – – – – Shifted sideways Angulated Rotated Distracted Overriding Impacted .TERM: • 3. Configuration – – – – Tranverse Oblique Spiral comminuted • 4.

Complication . Relationship of the fracture to the external environment – open X closed fractures • From within • From without • 6.TERM: • 5.

2. and local physical examination (ATLS): • • Looking (inspection) Feling – – – – – Swelling Deformity Abnormal movement Echymosis crepitus .The Diagnosis of Fractures 1. History Assesment of the patient’s general conditions.

Radiographic examination: – antero-posterior – lateral • 4.The Diagnosis of Fractures • 3. CT Scan (computed tomography) .

Initial 2. Late Volkmann’s contractur Pseudoarthrosis Sudeck’s atrophy . Early Volkmann’s ischemia 3.COMPLICATION 1.

puffy swelling. arterial spasm/ compression/ thrombosis . Local Skin complications Vascular complication . Compartment syndrome (pain. paresthesia) . pallor.Initial and Early Complication A.

2. 4. 3. 5.Late Complication 1. 6. 7. Joint stiffness Bony complication Mal-union Delayed union Non-union/ pseudoarthrosis Sudeck’s post-traumatic painful osteoporosis Muscular complication .

Volkmann’s Ischemia • Slint catheter Rorabeck: • Wick catheter Mubarak: • Pressures over: • Normal resting intra compartment: – 30 mmHG • 0 – 8 mmHg • Absolute indication for decompression. .

Neurological complication 4. Joint complication • B.2: – – – – Gangrenne Volkmann’s ischemic contracture Intermittent claudication Gas gangrene ( clostridium welchii ) 3. Visceral complication 5. Remote Complication .Initial and Early Complication • A.

Birth fractures 4. Stress fracures 2.Special Tipes of Fractures: 1. Pathological fractures 3. Epiphyseal plate fractures .

Firstly do no harm. 3. 5. 2. Select treatment with specific aims Cooperate with the laws of nature Be realistic and practical in your treatment Select treatment for patients as an individual . 4.The General Principles of Fracture Treatment 1.

2.Specific Methods of Treatment for Closed Fractures 1. Skin traction Skeletal traction . 3. Protection alone (without reduction / immobilization) Immobilization by external splinting (without reduction) Closed reduction by manipulation followed by immobilization: Plaster of paris cast 4. Closed reduction by continuous traction followed by immobilization: 1. 2.

. Closed reduction by manipulation followed by external skeletal fixation. 6. Closed reduction followed by functional fracture bracing.Specific Methods of Treatment for Closed Fractures: 5.

Open reduction followed by internal fixation. . Closed reduction by manipulation followed by internal skeletal fixation. 8.Specific Methods of Treatment for Closed Fractures: 7.

Specific Methods of Treatment for Closed Fractures: • 9. Excision of a fracture fragment and replacement by an endoprosthesis. Moore’s prosthesis .

segmental fracture. neurovascular injury Type 4: amputation.Treatment for Open Fractures: Gustilo and Anderson • Type 1: < 1 cm low energy • • Type 2: < 10 cm moderate energy Type 3: A. C: > 10 cm high energy. B. high –velocity gunshot. • .

6. 2. 5. 3. 4. Cleansing of the wound Excision of devitalized tissue (debridement) Treatment of the fracture Closure of the wound Antibacterial drugs Prevention of tetanus .Treatment for Open Fractures: 1.

Stage of consolidation (radiographic union) AO (arbeitsgemein shaft für osteosynthese fragen) ASIF(association for osteosynthesis) primary bone healing secondary bone healing .Healing of a fracture: 1. Stage of clinical union 2.

Non-union = pseudoarthrosis . Mal union 2.Abnormal Healing of Fractures 1. Delayed union 3.

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