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Refrat Orthopedi

Fraktur collum remur

Shaktana Kusumaningrat

01.206.5291


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INTRODUCTION

Bones have many functions:

as forming the framework of the body

where muscles attach

protective organs

as the hemopoetik


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DEFINITION

A fracture is the breaking of continuity of bone or cartilage which is

generally caused by the i.nvoluntary

While the collum of the femur fracture is a fracture that occurs at the

collum of the femur


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EPIDEMIOLOGI

Most of the fractures in the elderly caused by an accident in the house.

It happened in women three times greater than that osteoporosis is a

major predisposing factor

More than 250,000 hip fractures occur in the United States each year(50% including collum fracture of the femur), and this number is

expected to double by the year 2040. 8o% occur in women, and the

incidence to be 2-fold every 5 to 6 years in women aged over 30 years

Volpin et al reported as much as 4.7% in 1946 on Israeli

military. Zahger et al reported higher rates of femoral collum fracture in

women israel military


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REVIEW REFERENCES

DEFINITION

Understanding of bone fracture is the breaking of continuity and or

cartilage which is generally caused by the forced Ruda (Mansjoer,

2000). While Colum femur fracture is a fracture of the femurterjadipada Colum. Fracture of neck of femur is intracapsular fractures

that occur in the proximal femur, which includes the neck of the femur

is the start of the distal surface of the femoral head up to the

proximal portion of intertrokanter


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Etiology

Neck of femur fracture often occurs in women caused by a combination

of fragility tulangakibat aging process and post-menopausal

osteoporosis. Fractures can berupafraktur subkapital, transervikal and

basalt, which is located inside the hoop kesemuannya sendipanggul orintracapsular, intertrochanter and sub trochanter fractures are located

extra-capsular


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Trauma

Divided into two, namely:

Direct trauma, the impact on bone. Usually people fall in a tilted

position in which the major trokhanter direct hit with hard objects(road).

Indirect trauma, the impact and fracture titk pedestal far apart,

for example jajtuh slip bathroom in the elderly


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ANATOMI

Bone of the femur is the strongest, longest, and heaviest in the body

and has a function that is essential for normal movement. This bone

consists of three parts, namely the femoral shaft or diafisis,

metaphysical proximal and distal metaphysical. The femoral shaft istubular sections with slight anterior bow, which lies between the

femoral trochanter minor to condylus. The upper end of the femur has

the caput, collum, and trochanter major and minor.


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Section caput is more or less two thirds of the ball and articulates with the

acetabulum of os coxae shape articulatio coxae. In the center there is a small

indentation caput called the fovea capitis, where the ligament attachment of the

caput. Most of the blood supply for the caput femoris delivered along thisligament and enters the bone at the fovea. Section collum, which connects the

head of the femur shaft, running down, rear, lateral, and makes an angle of

approximately 125 degrees (in females slightly smaller) to the long axis of the

femur shaft. The magnitude of this angle needs to be remembered because it can

be changed by the disease.


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Caput femoris artery receives blood supply from three sources: (1)

intraoseosa flowing vessels in the neck, which would be damaged if the

neck is fractured and moving, (2) vessels in the retinaculum that curved

from the capsule to the neck, which can be damaged by fractures orpressure by effusion, and (3) vessels in the ligamentum teres, which has

not been developed in the early years of life and even later in life only

to give a little blood supply


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DESCRIPTION CLINIC

Clinical manifestations of fracture is obtained a history of trauma, loss

of function, signs of inflammation and severe form of acute pain, local

swelling, redness / discoloration, and heat at the fracture area. In

addition it was also marked by deformity, may be angulation, rotation,or shortening, and crepitus. If the fracture occurs in the extremities

or joints, the LGS will be encountered limitations (range of

motion). Pseudoartrosis and abnormal movements.


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INVESTIGATION SUPPORTING

Not all signs and symptoms are present in each fracture, so that the

necessary investigations. Investigations to establish the diagnosis is

examination of the X-images, which must be done with two projections

of the anterior-posterior and lateral. With the X-photos can be seen

the presence or absence of fracture, extensive, and the state of bone

fragments. This check is also useful to follow the process of bone

healing.

Diagnosis of fracture depends on the symptoms, physical signs and x-

ray examination of the patient. Typically patients complain of an injury

to the area. When based on clinical observations suspected fracture,

then treat as a fracture until proven otherwise.


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CLASSIFICATION

There are two types of fractures of the femur

Intrakapsuler fracture;

Through the head of the femur

Just below the femur (capital fracture)

Through the neck of the femur

Fractures ekstrakapsuler

Occurs outside the joint and capsule, through the femurtrokhanter larger / smaller / on the introkhanter

Section occurs distal to the femoral neck but not more than 2

inches below trokhanter


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Classification of fractures of the femur (in garden):

Stage I: incomplete (called berabduksi / impacted)

Stage II: complete without shifting

Stage III: complete with a shift of some

Stage IV: complete with a full shift

Cl ifi ti f f t f th f


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Classification of fractures of the femur

(in garden)


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Classification according to pauwel:

Type I: fractures with fracture line 30 0

Type II: fractures with fracture line 50 0

Type III: fractures with fracture line 70 0


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Classification according to pauwel


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HANDLING Conservatives with an indication of the limited

Operative therapy

Almost all are always done because:

Keep accurate and stable reduction

Required the rapid mobilization in the elderly to prevent complications

Type operative:

Mounting pin

Mounting plate / screw

Arthroplasty; performed in patients aged above 55 years old, in the form:

Excision arthroplasty (pseudoartrosis according to Girdlestone)

Hermiathroplasty

Arthropasty total


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COMPLICATIONS Complications of a general nature; venous thrombosis, pulmonary

embolism, pneumonia, decubitus

Necrosis of the femoral caput avaskuler

If location is more to the proximal fracture is likely to occur

necrosis avaskuler greater

Non-union

Because of poor vascularization, the reduction being inaccurate,

inadequate fixation and location of the fracture is intra-artikuler

Osteoarthritis

Shortened limbs

Malunion

Malrotation of external rotation

Koksavara


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thank you

thank you

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