You are on page 1of 30

Tony Suharsono

fracture is a break in the continuity of bone


and is defined according to its type and extent
A fracture is a break in a bone and can occur at
any age and in any bone
Fractures occur when the bone is subjected to
stress greater than it can absorb
When the bone is broken, adjacent structures
are also affected, resulting in soft tissue edema,
hemorrhage into the muscles and joints, joint
dislocations, ruptured tendons, severed nerves,
and damaged blood vessels

complete fracture involves a break across the


entire cross-section of the bone and is
frequently displaced (removed from normal
position).
Incomplete fracture (eg, greenstick fracture), the
break occurs through only part of the crosssection of the bone.
A comminuted fracture is one that produces
several bone fragments.
A closed fracture (simple fracture) is one that
does not cause a break in the skin.
An open fracture (compound, or complex) is

Open

Fracture
Open fractures are graded accordingto
the following criteria:
Grade I is a clean wound less than 1 cm
long
Grade II is a larger wound without extensive
soft tissue damage
Grade III is highly contaminated, has
extensive soft tissue damage, and is the
most severe.

Pain

The pain is continuous and increases in

severity until the bone fragments are


immobilized
Loss of function
Deformity
Shortening
Crepitus
Swelling and discoloration

Bone

is a dynamic, changing tissue


Within 48 to 72 hours after the injury a hematoma
(blood clot) forms at the fracture site because
bone has a rich blood supply
Various cells that begin the healing process are
attracted to the damaged bone. In about a week or
so, a nonbony union called a callus develops and
can be seen on x-ray examination.
As healing continues, osteoclasts (bonedestroying
cells) resorb any necrotic bone
Osteoblasts (bone-building cells) make new bone
as a replacement. This process is sometimes
referred to as bone remodeling.

Ray
Menentukan lokasi/luas/jenis fraktur
Dua posisi (AP/Lat), dua sendi terlibat
Bone Scanning
Menunjukkan tingkat keparahan
fraktur, identifikasi kerusakan jar lunak
Arteriogram
Jika terdapat kerusakan vaskuler

Perform

a primary assessment and initiate


appropriate intervention
Evaluate the neurovasculer status
Secure any impaled object
Remove rings, other jewelry, and tight
clothing from injured extremity
Immobilize extremities beyond the joint
above and below the site of injury
Reevaluate neurovasculer status after
reposition or imobilization
Apply ice pack to areas of swelling

Reduction

restoration of the fracture fragments to

anatomic alignment and rotation


closed reduction or open reduction may be
used to reduce a fracture
Usually,the physician reduces a fracture as
soon as possible to prevent loss of elasticity
from the tissues through infiltration by edema
or hemorrhage
Before fracture reduction and immobilization,
the patient is prepared for the procedure;
permission for the procedure is obtained, and

Closed

Reduction
bringing the bone fragments into
position through manipulation and
manual traction
The immobilizing device maintains the
reduction and stabilizes the extremity
for bone healing
X-rays are obtained to verify that the
bone fragments are correctlyaligned

Open

Reduction
Internal fixation devices may be
used to hold the bone fragments in
position until solid bone healing
occurs
Internal fixation devices ensure
firm approximation and fixation of
the bony fragments

Immobilization

After the fracture has been reduced, the

bone fragments must be immobilized,


or held in correct position and
alignment, until union occurs
Immobilization may be accomplished
by external or internal fixation

Maintaining

and restoring function


Swelling is controlled by elevating the injured
extremity and applying ice
Neurovascular status (circulation, movement,
sensation) is monitored, and the orthopedic
surgeon is notified immediately if signs of
neurovascular compromise are identified
Isometric and muscle-setting exercises are
encouraged to minimize disuse atrophy and to
promote circulation
Participation in activities of daily living (ADLs)
is encouraged to promote independent

Immobilization

of fracture fragments
Maximum bone fragment contact
Sufficient blood supply
Proper nutrition
Exercise: weight bearing for long
bones
Hormones: growth hormone, thyroid,
calcitonin, vitamin D

Extensive
Bone

local trauma

loss
Inadequate immobilization
Space or tissue between bone
fragments
Infection
Local malignancy
Age

Fat

Embolism Syndrome
Fat embolism is a potentially life
threatening complication of long bone
trauma, blunt trauma, and
intramedularry manipulation
This syndrome manifest anywhere from
4 hours to several days after injury or
orthopedic surgery.
Fat globules, release from bone
marrow, can embolize and occlude

Osteomyelitis

Osteomyelitis is an infection of the bone,

most commonly a result of direct


contamination from open fracture,
penetrating wound, or surgical
procedures
it takes 10 to 14 days from the time of
infection exposure before radiographs
will demonstrate visible changes
The most common causative organism is
staphylococcus aureus

Compartment

Syndrome
Compartment syndrome develops when the
presure in a muscle compartment exceeds the
intraarterial hydrostatic pressure, causing
collapse of capilaries and venules, which lead to
iskhemia and tissue necrotic
The exact pressure at which this develops is
unclear, but intracompartment pressure greater
than 30 mmHg generally are considered greatly
elevated
A grace periode of about 6 hours exists before
irreversible soft tissue demage occurs

Bleeding
Delayed

union and non union


Avascular necrosis of bone
Reaction to internal fixation devices

Neurovascular

assessment
Use five P to evaluate limb
circulation, sensation and motor
function
Pain : a description of pain is
helpful
Pallor
Pulses
Parasthesia

Inspection, the

injured area for the

following:
Color
Disrupted skin integrity
Extremity position
Edema, swelling, or echhimosis
Range of motion
Symmetry, alignment, deformity

Palpation, the

injury to identify the

following :
Skin temperature
Pain
Bony crepitus, joint instability
Peripheral nerve function : sensory
and motor

Acute

pain
Impaired physical mobility
Risk for peripheral neurovaskuler
dysfunction
Risk for imbalance fluid volume

Teach

patients how to control swelling


and pain associated with the fracture
and with soft tissue trauma and
Assess neurovascular status frequently
Encourages them to be active within
the limits of the fracture
immobilization

Teach

exercises to maintain the health of


unaffected muscles and to increase the
strength of muscles needed for
transferring and for using assistive
devices
Teach patients how to use assistive
devices safely
Patient teaching includes self-care,
medication information, monitoring for
potential complications, and the need for
continuing health care supervision