7/28/2019 Patah Tulang Dan Sendi

1/17

4/1/2013DR. KETUT MARTIANA 1

PATAH TULANG DAN

SENDI

Dr. Ketut Martiana

DEPT. OF ORTHOPAEDICS SURGERYAIRLANGGA UNIVERSITY/

DR. SOETOMO HOSPITALSURABAYA

7/28/2019 Patah Tulang Dan Sendi

2/17

4/1/2013DR. KETUT MARTIANA

2

DEFINISI PATAHTULANG

Adalah hilangnyakontinyuitas tulang

Dapat diakibatkanoleh trauma maupun

keadaan patologis

7/28/2019 Patah Tulang Dan Sendi

3/17

4/1/2013DR. KETUT MARTIANA

3

Macam-macam fraktur

Fraktur akibat trauma

yang adekwatAkibat kecelakaan lalu

lintas

Kecelakaan kerja

Jatuh dari ketinggian

Fraktur patologis Trauma minimal pada

tulang yang sudahpatologis: tumor,infeksi,

osteoporosis

7/28/2019 Patah Tulang Dan Sendi

4/17

4/1/2013DR. KETUT MARTIANA

4

Macam-macam fraktur

Fraktur terbuka Fraktu yang disertai dengan luka,

dimana tulang pernah atau sedangberhubungan dengan lingkungan luar

Syarat: luka berjarak < 5 cm dari

patahan tulang Fraktur tertutup

Fraktur yang tidak disertai luka

7/28/2019 Patah Tulang Dan Sendi

5/17

4/1/2013DR. KETUT MARTIANA

5

Transverse / sederhana

Oblique

Spiral Akibat trauma yang

memuntir

Comminutive

fragmen lebih dari 2 buah Greenstick

Khusus pada anak-anak

Macam bentuk fraktur

7/28/2019 Patah Tulang Dan Sendi

6/17

4/1/2013DR. KETUT MARTIANA

6

Penyembuhan Tulang

Fase hematom

Fase proliferasi sel Fase kalus

Fase konsolidasi

Fase remodelling

7/28/2019 Patah Tulang Dan Sendi

7/174/1/2013DR. KETUT MARTIANA 7

ABC Reposisi

Immobilisasi

Fiksasi /stabilisasi

Rehabilitasi

Prinsip Perawatan Fraktur

7/28/2019 Patah Tulang Dan Sendi

8/174/1/2013DR. KETUT MARTIANA 8

Jenis Reposisi

Reposisi tertutup(close reduction)

Reposisi terbuka(Open reduction)

7/28/2019 Patah Tulang Dan Sendi

9/174/1/2013

DR. KETUT MARTIANA 9

Jenis Imobilisasi

Cast imobilisation Traction

imobilisation

Instrumentation

imobilisation

7/28/2019 Patah Tulang Dan Sendi

10/174/1/2013

DR. KETUT MARTIANA 10

Macam Traksi

Traksi kulit / skin traction Dari bahan plester

Tulang di tarik melalui kulit

Maksimum 2 minggu dan beban 5kg

Traksi tulang / skeletal traction K- wire atau steinmann pin

Langsung menarik tulang

Beban sampai 20 kg

7/28/2019 Patah Tulang Dan Sendi

11/174/1/2013

DR. KETUT MARTIANA 11

JENIS INSTRUMENTASI

INTERNALFIKSASI

EKSTERNAL

FIKSASI

7/28/2019 Patah Tulang Dan Sendi

12/174/1/2013

DR. KETUT MARTIANA 12

DI NEGARA MAJU

In North America, and I suspect in most other technicallyadvanced countries, closed methods of fracturemanagement are in a marked decline. The ability toproduce anatomical alignment and maintain it byinternal fixation, particularly by interlocking nails, isapparently making such methods pass. It has been ourobservation during the past 5 years that orthopaedicresidents are incapable of applying casts with any

degree of dexterity, although they are very expert ininserting a variety of nails. Similarly, the application oftraction is an arcane, antique procedure of historicalinterest alone

Charles A. Rockwood, JR 1996

7/28/2019 Patah Tulang Dan Sendi

13/174/1/2013

DR. KETUT MARTIANA 13

KOMPLIKASI FRAKTUR

lokal Nonunion and Malunion

Infection

Nerve Injury Vascular Injury

Compartment Syndrome

Refracture

Muscle and TendonEntrapment andAdherence

7/28/2019 Patah Tulang Dan Sendi

14/174/1/2013

DR. KETUT MARTIANA 14

KOMPLIKASI FRAKTURsistemik

Shock1. Hematogenic (oligemia)

2. Neurogenic (caused primarily bynervous influences)

3. Vasogenic (initially decreasedvascular resistance and increasedvascular capacity)

4. Cardiogenic (caused by eitherfailure of the heart as a pump ordiminished cardiac output fromvarious causes)

TABLE 8 1

7/28/2019 Patah Tulang Dan Sendi

15/17

4/1/2013DR. KETUT MARTIANA 15

TABLE 8-1

Classes of Acute Hemorrhage

Class I Class II Class III Class IV

Blood loss (mL) 750 1000-1250 1500-1800 2000-2500

Blood loss (units) 1-2 2-3 3-4 5

Blood loss* (%) 15 20-25 30-35 40-50

Pulse rater (bpm) 72-84 >100 >120 >140

Blood pressure (mm Hg) 118/82 110/80 70-90/50-60 35

Urine output (mL/h) 30-35 25-30 5-15 Negligible

Central nervous systemmental status Slightly anxious Mildly anxious Anxious andconfused Confused-lethargic

Fluid replacement Crystalloid Crystalloid Crystalloid + Blood Crystalloid + 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): AdvancedTrauma life Support ManualProgram for Physicians, p. 86. Chicago, American College of Surgeons,1993.)

7/28/2019 Patah Tulang Dan Sendi

16/17

4/1/2013DR. KETUT MARTIANA 16

KOMPLIKASI FRAKTUR

sistemik Fat Embolism Syndrome/AcuteRespiratory Distress Syndrome

high-energy long-bone fracture

2 or 3 days after trauma

respiratory distress

pulmonary edema

temperature 39 to 40C

Tachypnea

confusion, stupor, or coma

craniocerebral trauma ?

Perdarahan

Infeksi / Sepsis

7/28/2019 Patah Tulang Dan Sendi

17/17

4/1/2013DR KETUT MARTIANA 17

Prognosis

tergantung dari

Umur

Lokasi fraktur

Terbuka/tertutup Macam imobilisasi

Komplikasi

rehabilitasi