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

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Presentation on theme: "Dr.Wahyu Eko Widiharso, Sp.OT RS.BINA HUSADA 2011"— Presentation transcript:

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

2

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


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