Dr.Wahyu Eko Widiharso, Sp.OT RS.BINA HUSADA 2011 OPEN FRACTURE

SMF Bedah FK UKI

FRAKTUR 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

OPEN FRACTURE DEFINITION picture DEFINITION is break of bone, epifisis and cartilage adjacent with outside . CAUSE BY: TRAFFIC ACCIDENT/TRAUMA

Open fracture ANKLE tibia

GUSTILO CLASSIFICATION

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

FRAKTUR COMPLETE/ UNCOMPLETE FRACTURE LINE FORM FRACTURE LINE DISPLACED /UNDISPLACED CLOSED OR OPEN FRACTURE

INCOMPLETE FRACTUR

COMPLETE FRACTURE

DISPLACED COMPLETE RACTURE

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

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

Traffic accident

BY CYCLE

TRAFFIC ACCIDENT

Traffic accident

PHISYCAL EXAMINATION ATLS ABCD C-SPINE EXAMINATION OF HEAD,CHEST,ABDOMEN MULTIPLE TRAUMA/FRACTURE SHOCK

TRAUMA OPEN FRACTURE IN THE SCENE

LOCAL EXAMINATION LOOK FEEL MOVE

LOOK DEFORMITY abnormal MOVEMENT , angulation, rotation dan discrepency FUNGSIOLAESA lost of function

OPEN FRACTURE

FEEL Pressure pain dan axial pain

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

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

AIM OF TREATMENT TO PROMOTE HEALING AND FUNCTION OF BONE AS SOON AS POSSIBLE.

AIM OF TREATMENT 1.RELEAVE PAIN 2.GOOD REPOSITION 3.PROMOTE HEALING 4.PROMOTE FUNCTION 5.REHABILITATION

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

MANAGEMENT OPEN FRACTURE 6.Fracture stabilisation 7.Open wound 5-7 days 8.Bone Graft 9.Rehabilitation

OPEN FRACTURE TREATMENT SERI 1.WOUND CLEANING MECHANICAL IRIGATION WITH Na Cl TO REMOVED STRANGE BODY

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

DEBRIDEMENT

STABILIZATION

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

antibiotic

OF management Prevent Anti Tetanus ATS/Toxoid Rural area accident give Penicilin procain

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

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

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

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