copy of refrat orthopedi slide - copy
TRANSCRIPT
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Refrat Orthopedi
Fraktur collum remur
Shaktana Kusumaningrat
01.206.5291
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INTRODUCTION
Bones have many functions:
as forming the framework of the body
where muscles attach
protective organs
as the hemopoetik
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DEFINITION
A fracture is the breaking of continuity of bone or cartilage which is
generally caused by the i.nvoluntary
While the collum of the femur fracture is a fracture that occurs at the
collum of the femur
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EPIDEMIOLOGI
Most of the fractures in the elderly caused by an accident in the house.
It happened in women three times greater than that osteoporosis is a
major predisposing factor
More than 250,000 hip fractures occur in the United States each year(50% including collum fracture of the femur), and this number is
expected to double by the year 2040. 8o% occur in women, and the
incidence to be 2-fold every 5 to 6 years in women aged over 30 years
Volpin et al reported as much as 4.7% in 1946 on Israeli
military. Zahger et al reported higher rates of femoral collum fracture in
women israel military
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REVIEW REFERENCES
DEFINITION
Understanding of bone fracture is the breaking of continuity and or
cartilage which is generally caused by the forced Ruda (Mansjoer,
2000). While Colum femur fracture is a fracture of the femurterjadipada Colum. Fracture of neck of femur is intracapsular fractures
that occur in the proximal femur, which includes the neck of the femur
is the start of the distal surface of the femoral head up to the
proximal portion of intertrokanter
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Etiology
Neck of femur fracture often occurs in women caused by a combination
of fragility tulangakibat aging process and post-menopausal
osteoporosis. Fractures can berupafraktur subkapital, transervikal and
basalt, which is located inside the hoop kesemuannya sendipanggul orintracapsular, intertrochanter and sub trochanter fractures are located
extra-capsular
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Trauma
Divided into two, namely:
Direct trauma, the impact on bone. Usually people fall in a tilted
position in which the major trokhanter direct hit with hard objects(road).
Indirect trauma, the impact and fracture titk pedestal far apart,
for example jajtuh slip bathroom in the elderly
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ANATOMI
Bone of the femur is the strongest, longest, and heaviest in the body
and has a function that is essential for normal movement. This bone
consists of three parts, namely the femoral shaft or diafisis,
metaphysical proximal and distal metaphysical. The femoral shaft istubular sections with slight anterior bow, which lies between the
femoral trochanter minor to condylus. The upper end of the femur has
the caput, collum, and trochanter major and minor.
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Section caput is more or less two thirds of the ball and articulates with the
acetabulum of os coxae shape articulatio coxae. In the center there is a small
indentation caput called the fovea capitis, where the ligament attachment of the
caput. Most of the blood supply for the caput femoris delivered along thisligament and enters the bone at the fovea. Section collum, which connects the
head of the femur shaft, running down, rear, lateral, and makes an angle of
approximately 125 degrees (in females slightly smaller) to the long axis of the
femur shaft. The magnitude of this angle needs to be remembered because it can
be changed by the disease.
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Caput femoris artery receives blood supply from three sources: (1)
intraoseosa flowing vessels in the neck, which would be damaged if the
neck is fractured and moving, (2) vessels in the retinaculum that curved
from the capsule to the neck, which can be damaged by fractures orpressure by effusion, and (3) vessels in the ligamentum teres, which has
not been developed in the early years of life and even later in life only
to give a little blood supply
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DESCRIPTION CLINIC
Clinical manifestations of fracture is obtained a history of trauma, loss
of function, signs of inflammation and severe form of acute pain, local
swelling, redness / discoloration, and heat at the fracture area. In
addition it was also marked by deformity, may be angulation, rotation,or shortening, and crepitus. If the fracture occurs in the extremities
or joints, the LGS will be encountered limitations (range of
motion). Pseudoartrosis and abnormal movements.
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INVESTIGATION SUPPORTING
Not all signs and symptoms are present in each fracture, so that the
necessary investigations. Investigations to establish the diagnosis is
examination of the X-images, which must be done with two projections
of the anterior-posterior and lateral. With the X-photos can be seen
the presence or absence of fracture, extensive, and the state of bone
fragments. This check is also useful to follow the process of bone
healing.
Diagnosis of fracture depends on the symptoms, physical signs and x-
ray examination of the patient. Typically patients complain of an injury
to the area. When based on clinical observations suspected fracture,
then treat as a fracture until proven otherwise.
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CLASSIFICATION
There are two types of fractures of the femur
Intrakapsuler fracture;
Through the head of the femur
Just below the femur (capital fracture)
Through the neck of the femur
Fractures ekstrakapsuler
Occurs outside the joint and capsule, through the femurtrokhanter larger / smaller / on the introkhanter
Section occurs distal to the femoral neck but not more than 2
inches below trokhanter
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Classification of fractures of the femur (in garden):
Stage I: incomplete (called berabduksi / impacted)
Stage II: complete without shifting
Stage III: complete with a shift of some
Stage IV: complete with a full shift
Cl ifi ti f f t f th f
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Classification of fractures of the femur
(in garden)
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Classification according to pauwel:
Type I: fractures with fracture line 30 0
Type II: fractures with fracture line 50 0
Type III: fractures with fracture line 70 0
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Classification according to pauwel
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HANDLING Conservatives with an indication of the limited
Operative therapy
Almost all are always done because:
Keep accurate and stable reduction
Required the rapid mobilization in the elderly to prevent complications
Type operative:
Mounting pin
Mounting plate / screw
Arthroplasty; performed in patients aged above 55 years old, in the form:
Excision arthroplasty (pseudoartrosis according to Girdlestone)
Hermiathroplasty
Arthropasty total
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COMPLICATIONS Complications of a general nature; venous thrombosis, pulmonary
embolism, pneumonia, decubitus
Necrosis of the femoral caput avaskuler
If location is more to the proximal fracture is likely to occur
necrosis avaskuler greater
Non-union
Because of poor vascularization, the reduction being inaccurate,
inadequate fixation and location of the fracture is intra-artikuler
Osteoarthritis
Shortened limbs
Malunion
Malrotation of external rotation
Koksavara
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