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

3. SMF Bedah FK UKI

4. 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

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

6. Open fracture
ANKLE
tibia

7. GUSTILO CLASSIFICATION

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

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

10. INCOMPLETE FRACTUR

11. COMPLETE FRACTURE

12. DISPLACED COMPLETE RACTURE

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

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

15. Traffic accident

16. BY CYCLE

17. TRAFFIC ACCIDENT

18. Traffic accident

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

20. TRAUMA
OPEN FRACTURE
IN THE SCENE

21. LOCAL EXAMINATION
LOOK
FEEL
MOVE

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

23. OPEN FRACTURE

24. FEEL
Pressure pain dan axial pain

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

26. 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

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

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

29. 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)

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

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

32. 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

33. DEBRIDEMENT

34. STABILIZATION

35. 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

36. antibiotic

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

38. 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.

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

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

41. THANK YOU