1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo
-
Upload
wesley-hidayat -
Category
Documents
-
view
14 -
download
3
description
Transcript of 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo
![Page 1: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/1.jpg)
EMERGENCY OFEMERGENCY OF
THE FRACTURETHE FRACTUREDr. Tedjo Rukmoyo, SpOT, Spine(K)
![Page 2: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/2.jpg)
• Breath A
• Blood B
• Brain C
• Bladder D
• Bowel E
• Bone F
![Page 3: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/3.jpg)
Primary Survey Identifies immediate lifethreatening
A. Airway ObstructionB. PneumathoraxC. HematothoraxD. Pericardialtemponade
Secondary Survey Assessmentidentifies limb threatening
- Evaluation occult hemorrhage- Other injuries
TRAUMA
![Page 4: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/4.jpg)
DETERMINE SEVERITY OF THE INJURIESDETERMINE SEVERITY OF THE INJURIES
• Glasgow Coma scale
• Abbreviated injury score
• Triangle extremity severity score
![Page 5: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/5.jpg)
GCSGCS
![Page 6: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/6.jpg)
ABBREVIATED INJURY SCOREABBREVIATED INJURY SCORE
![Page 7: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/7.jpg)
MESSMESS
![Page 8: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/8.jpg)
INDICATION ABSOLUTE AMPUTATIONINDICATION ABSOLUTE AMPUTATION
• Rupture arteries > 6 hours
• Non reconstructable defect
• If further limb salvage Threaten life
![Page 9: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/9.jpg)
INDENTIFICIES AS SOON AS POSIBLEINDENTIFICIES AS SOON AS POSIBLE
• Arterial disruption
• Nerve disruption
• Neurologic disturbances
![Page 10: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/10.jpg)
ARTERIAL ARTERIAL FRYKMAN SIGNFRYKMAN SIGN::
• HARD SIGN:- Pulselessness- Massive bleeding- Rapidly expanding haematom- Palpable thrill- Audible bruit over haematom
• SOFT SIGN:- History of arterial bleeding- Non pulsatic haematom over artery- Neurologic deficit Adjacent artery- Proximity of wound Over artery
![Page 11: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/11.jpg)
OTHER’S:OTHER’S:
• Acral pale• Hypothermia• Negative capillary refilling• Negative vena back flow• Oxymetri : < 80 – 90• Negative pulse on USG• Negative Blood on puncture• Ankle Brachial index < 0,9
![Page 12: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/12.jpg)
DEFINITIVE EVALUATION OF DEFINITIVE EVALUATION OF ARTERIAL ARTERIAL DISRUPTION:DISRUPTION:
• Angiogram
• Exploration
Arterial Repair:- < 6 hours of injury- Don’t require both vessel- Should be coordinated with skeletal stabilization
![Page 13: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/13.jpg)
COMPARTMENT SYNDROME:COMPARTMENT SYNDROME:
Osseo fascia pressure end Capillary perfusion
pressure < intracompartmental pressure:– Pain on passive stretching– Pale– Pulselessness– Paresthesia– Paralysis
TX: - Evaluation – elevation limb - Fasciotomy
Intracompartment pressure ≥ 30 mmHg Diastolic Pressure
![Page 14: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/14.jpg)
NERVE INJURYNERVE INJURY
• Neuropraxia : Nerve stretch
• Axonotemesis : Partial destruction Axon
Epineurium intact
• Neurotmesis : Complete disruption
![Page 15: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/15.jpg)
SPECIAL ATTENTION:SPECIAL ATTENTION:
Certain fractures pattern & Dislocation Nerve injury
• Anterior Gleohumeral dislocation- Axillary nerve• Humeral shaft fractures – radial nerve• Radial head fractures / monteggia fracture – posterior
interosseous nerve• Supracondylar humerus fractures – anterior interosseous
nerve• Hip dislocation – sciatic nerve• Knee dislocation – peroneal nerve – Tibial nerve
![Page 16: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/16.jpg)
TX:TX:
• Neuropraxia : Conservative
• Axonotmesis : Conservative
Nerve Injury Rupture : Suture Epineurium
![Page 17: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/17.jpg)
DISLOCATIONDISLOCATION
• Recognition
• Reduction
• Retention
• Rehabilitation
Evaluate : Neurovascular state
![Page 18: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/18.jpg)
Emergency inEmergency inFractures & DislocationFractures & Dislocation
• Pain shock neurogenic / spinal• Shock hypovolemic bleeding
– Fr. Pelvis– Malgaigne fr.
• Dispneu - rib fracture- fr. Cervical- haemato/ pneumo thorax- fat emboli
• Disability: - infection open fracture- urinary retention fr. Pubis- neurogenic disturbance
![Page 19: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/19.jpg)
• Dislocation of the head of humerus & femur
• Other dislocation, esp. spine
• Open fractures
• Ruptures tendo
• Ruptures ligament
FracturesFracturesDislocationDislocation
FracturesFracturesDislocationDislocation
DISABILITY
![Page 20: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/20.jpg)
Treatment inTreatment inFractures & DislocationFractures & Dislocation
• Recognition
• Reduction
• Retaining
• Rehabilitation
![Page 21: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/21.jpg)
Diagnostic of FracturesDiagnostic of Fractures
• Deformity
• False movement
• Crepitation
• X-ray / CT Scan
![Page 22: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/22.jpg)
GENERAL PRINCIPLEGENERAL PRINCIPLE
1. Firstly, Do not Harm ≠ Iatrogenic complications
2. Base treatment on accurate diagnosis prognosis
![Page 23: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/23.jpg)
TREATMENT:TREATMENT:
1. First Decision :- Require reduction ?- What type of reduction ?
- Open- Closed
2. Second Decision : Type of immobilization?- External- Internal
![Page 24: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/24.jpg)
SPECIFIC AIMS OF FRACTURES SPECIFIC AIMS OF FRACTURES TREATMENTTREATMENT : :
• To relieve pain
• Obtain and maintain satisfactory position of fragmentation
• To allow & encourage bony union
• To restore optimum function
![Page 25: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/25.jpg)
THE AIMING OF SPESIFIC METHODS OF THE AIMING OF SPESIFIC METHODS OF TREATMENT:TREATMENT:
• Union
• Function
• Anatomical alignment
![Page 26: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/26.jpg)
SPECIFIC METHODS OF TREATMENT:SPECIFIC METHODS OF TREATMENT:
• Protection alone• Immobilization by external splinting• Closed reduction by manipulation• Closed reduction by continuous traction followed by
immobilization• Closed / open reduction followed by external fixation• Closed / open reduction – internal fixation• Closed reduction followed by bracing• Excision of fracture fragment and replacement by an
endoprosthesis
![Page 27: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/27.jpg)
Protection AloneProtection Alone
![Page 28: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/28.jpg)
Protection AloneProtection Alone
![Page 29: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/29.jpg)
Immobilization Immobilization by External Splintingby External Splinting
![Page 30: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/30.jpg)
Fractures treated with External Fractures treated with External Splinting without ReductionSplinting without Reduction
![Page 31: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/31.jpg)
Closed Reduction by ManipulationClosed Reduction by Manipulation
![Page 32: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/32.jpg)
Fracture can be treated by Closed Fracture can be treated by Closed Reduction followed by ImmobilizationReduction followed by Immobilization
![Page 33: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/33.jpg)
Continuous Skin Continuous Skin TractionTraction
![Page 34: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/34.jpg)
Continuous Skin Continuous Skin TractionTraction
![Page 35: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/35.jpg)
Fractures can be treated by continuous Fractures can be treated by continuous tractiontraction
![Page 36: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/36.jpg)
![Page 37: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/37.jpg)
![Page 38: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/38.jpg)
Must be Must be treated by treated by open open reduction – reduction – internal internal fixationfixation(ORIF)(ORIF)
![Page 39: 1. Emergency Ofthe Fracture-kuliah Int_dr. Tedjo](https://reader035.fdocuments.us/reader035/viewer/2022062421/55cf924b550346f57b953f32/html5/thumbnails/39.jpg)
Excision – Replaced by ProsthesisExcision – Replaced by Prosthesis