DR. KETUT MARTIANA*PATAH TULANG DAN SENDI

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*DEFINISI PATAH TULANGAdalah hilangnya kontinyuitas tulangDapat diakibatkan oleh trauma maupun keadaan patologis

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Macam-macam frakturFraktur akibat trauma yang adekwatAkibat kecelakaan lalu lintasKecelakaan kerjaJatuh dari ketinggianFraktur patologisTrauma minimal pada tulang yang sudah patologis: tumor,infeksi, osteoporosis

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Macam-macam frakturFraktur terbukaFraktu yang disertai dengan luka, dimana tulang pernah atau sedang berhubungan dengan lingkungan luarSyarat: luka berjarak < 5 cm dari patahan tulangFraktur tertutupFraktur yang tidak disertai luka

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Transverse / sederhanaObliqueSpiralAkibat trauma yang memuntirComminutive fragmen lebih dari 2 buahGreenstickKhusus pada anak-anakMacam bentuk fraktur

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Penyembuhan TulangFase hematomFase proliferasi selFase kalusFase konsolidasiFase remodelling

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*ABCReposisiImmobilisasiFiksasi /stabilisasiRehabilitasi

Prinsip Perawatan Fraktur

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Jenis Reposisi

Reposisi tertutup (close reduction)Reposisi terbuka (Open reduction)

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Jenis ImobilisasiCast imobilisationTraction imobilisationInstrumentation imobilisation

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Macam TraksiTraksi kulit / skin tractionDari bahan plesterTulang di tarik melalui kulitMaksimum 2 minggu dan beban 5 kgTraksi tulang / skeletal tractionK- wire atau steinmann pinLangsung menarik tulangBeban sampai 20 kg

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*JENIS INSTRUMENTASIINTERNAL FIKSASI

EKSTERNAL FIKSASI

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*DI NEGARA MAJUIn North America, and I suspect in most other technically advanced countries, closed methods of fracture management are in a marked decline. The ability to produce anatomical alignment and maintain it by internal fixation, particularly by interlocking nails, is apparently making such methods pass. It has been our observation during the past 5 years that orthopaedic residents are incapable of applying casts with any degree of dexterity, although they are very expert in inserting a variety of nails. Similarly, the application of traction is an arcane, antique procedure of historical interest aloneCharles A. Rockwood, JR 1996

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*KOMPLIKASI FRAKTURlokalNonunion and MalunionInfectionNerve InjuryVascular Injury Compartment SyndromeRefracture Muscle and Tendon Entrapment and Adherence

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*KOMPLIKASI FRAKTURsistemikShock1.Hematogenic (oligemia)2.Neurogenic (caused primarily by nervous influences)3.Vasogenic (initially decreased vascular resistance and increased vascular capacity)4.Cardiogenic (caused by either failure of the heart as a pump or diminished cardiac output from various causes)

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*TABLE 8-1 Classes of Acute Hemorrhage Class IClass IIClass IIIClass IVBlood loss (mL)7501000-12501500-18002000-2500Blood loss (units)1-22-33-45Blood loss* (%)1520-2530-3540-50Pulse rater (bpm)72-84>100>120>140Blood pressure (mm Hg)118/82110/8070-90/50-6035Urine output (mL/h)30-3525-305-15NegligibleCentral nervous systemmental statusSlightly anxiousMildly anxiousAnxious and confusedConfused-lethargicFluid replacementCrystalloidCrystalloidCrystalloid + BloodCrystalloid + Blood *

Percentage of blood volume in a standard 70-kg man. Assume normal of 72 bpm. Assume normal of 120 / 80 mm Hg. (Alexander, R.H., and Proctor, H.J.: Shock. In Committee on Trauma (eds): Advanced Trauma life Support ManualProgram for Physicians, p. 86. Chicago, American College of Surgeons, 1993.)

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*KOMPLIKASI FRAKTURsistemik

Fat Embolism Syndrome/Acute Respiratory Distress Syndrome

high-energy long-bone fracture2 or 3 days after traumarespiratory distresspulmonary edematemperature 39 to 40C Tachypneaconfusion, stupor, or comacraniocerebral trauma ?PerdarahanInfeksi / Sepsis

DR. KETUT MARTIANA

*DR. KETUT MARTIANA*Prognosistergantung dariUmurLokasi frakturTerbuka/tertutupMacam imobilisasiKomplikasirehabilitasi

DR. KETUT MARTIANA