Fracture

&
Dislocation
Antonius Permadi, dr,m.Kes, SpOT

Definition
Break of structural continuity of the bone
It may :
simple Crack
Complete break

Definition
Special Term in children (Open epiphysis)

Epiphysiolysis

Definition
Displace Joint surface
It May :
Subluxation
Complete dislocation

Pathophysiology
Fracture and/or dislocation can occur separetly
or combine in one patient
Basicly are result of :
Single traumatic incident
Repetitive stress / load

Abnormal weakening of the bone ( Pathologic fracture )

Fracture due to TRAUMA

Most fracture cause by sudden and excessive
force, that may be DIRECT or INDIRECT force

Fracture type
Based on Underlying skin integrity (wound)
Open or Closed
Based on fracture anatomy
Simple
Comminutif (>Two fragments)

Open Fracture
Break of skin integrity on fracture area
Classified by Gustillo (1990s)
Grade

Wound

Soft Tissue Injury

Bone injury

< 1 cm

Minimal

Simple Fr

II

> 1 cm

Moderate
Some muscle damage

moderate comminution

Severe damage

Highly comminution

Comp syndrome

Soft tissue cover possible

IIIA

> 1 cm

IIIB

> 10 cm

Severe soft tissue loss

IIIC

> 10 cm

As III B + Vascular lesion

Fracture complication
Sistemic Complication
Fat Embolism syndrome
Sepsis
Local Complication

Acute
Vascular injury
Nerve injury
Compartment syndrome
infection
Gas gangrene
Haemarthrosis

Sub acute
Ligament injury
Nerve entrapment
tendon lesion
joint stiffness

Chronic
Delayed union
Malunion
Non-union
Avascular necrosis
OA
Joint instability

Compartment syndrome

Increase intracompartment pressure > 35 mmHg

Cardinal signs : 5 Ps
Pain
Paraesthesia
Pallor
Paralysis
Pulselesness

Management
Health care provider (doctor, nurse, etc) MUST be able :
Diagnose
Determine the complication
Emergency treatment (temporary stabilization)
Definitive treatment (Orthopedic speciality)

Principles

Do No Further Harm

Principles
Life Saving procedure should be done First
Check the ABCs Patency

Stable

Diagnose
Basicly consist of several item to describe
Close or Open
Region or part of the bone (femur, antebrachii, etc)
Location of the fracture (Proximal, middle, distal)
Complication

Close Fracture Femur 1/3 Proximal

Diagnose
Should be done by :
Physical examination
Radiology examination
Plain X Ray
CT-Scan
MRI

Physical Exam
Done by LOOK - FELL - MOVE system
LOOK :
Deformity, swelling, bruise, wound, bone expose
FELL :
Tenderness, DISTAL ARTERI PULSE
DONT DO CREPITATION MOVEMENT !!
MOVE :
Function of the nerve distal to the fracture site

Radiology Exam
X-Ray is Mandatory
Remember the rule of TWO
Two views ( Most are AP / Lateral views)
Two Joints
Two limbs
Two occasions

Treatment
Treatment of fracture consist of
Temporary treatment in Emegency Room (ER)
Splinting, sling, wound dressing, temporary wound closure

Two Joint Imobilization

Definitive treatment
Depend on the Fracture type (Open or Closed)
Close Fracture can be treat either conservative or operative treatment
Open Fracture MUST be treat operatively with ORIF or OREF
Dislocation of the joint should be treat as emergency procedure (ASAP)

Conservative Tx

Conservative Tx

Immobilization for Clavicle fracture

Operative Tx

ORIF

Prothese

Open Fracture Tx
The treatment Principles are :
1. Wound debridement
2. Antibiotic Prophylaxis
3. Fracture stabilization
4. Early wound cover