"Interruption of continuity of bone tissue, joint cartilage, epiphyseal cartilage both total and partial"
Etiology
The inability of bone to resist the load / pressure (bends, twist and pull).
1. Trauma: Direct and indirect
2. Pathology: tumors, osteoporosis, etc.
3. Degenerative
4. Spontaneous: because the pull of a powerful muscle
5. Stress fatigue: fatigue due to repetitive stress
CLASSIFICATION fracture
Etiological classification:
• Fractures traumatic = due to sudden trauma
• pathological fractures due to bone weakness = because previous pathological abnormalities
• = stress fractures due to trauma sustained in a particular place
Clinical Classification:
• Fractures closed = no bone relationship with the outside world
• Open fractures bone = no relationship with the outside world through injury
• Fractures complications = in accompanied complications such as malunion, etc.
Based on the radiological classification:
1. Location = diafisial, metafisial, intraartikuler, fracture with dislocation
2. Configuration = tranversal, oblique, spiral, Z, komunitif, wedge, avulsi, depression, impaction, rupture, segmental, epiphyseal
3. Extension = total, not total, buckle or torus, green stick
4. The relationship between fragment = undisplaced, displaced (side by side, rotation angulasi distraction, over-riding, impaction)
CLINICAL
Classic signs of fracture:
1. Painful
2. Tenderness
3. Deformity
4. Swelling & other inflammatory markers
5. Krepitasi
6. Disfunction
Other signs: shock, bleeding (anemia), the state of vascular, neurological status, injury and tissue damage and signs of complications
Investigations = Radiology, Laboratory
COMPLICATIONS fracture
Short term:
1. Artery and nerve damage (neurovaskuler)
2. Syndroma compartment = space between muscle, tendon, joints, fascia is closed terisis blood / fluid = pressure of blood vessels and nerves
3. = Fat embolism fat droplets of a long bone fracture fragments carried by the pulmonary blood flow to the flow of systemic = embolism. Increased levels of catecholamines due to stress = supports the occurrence of thromboembolism
4. Infection
5. Syock
Long-term:
1. Delayed union
2. Non-union
3. Mal union
4. Avaskuler bone necrosis
5. The reaction internal fixation device
MANAGEMENT
Principles of fracture treatment
Initial Penatalakasanaan
Before definitive treatment, it is necessary:
1. First aid
Clear the airway, closing the wound, stop bleeding, fracture immobilization, ambulance
2. Clinical Assessment
Conducting an assessment of the damage caused by trauma
3. Resuscitation
Overcoming the shock due to hemorrhage with fluid resuscitation and transfusion, providing anti-pain medications
General principles of fracture treatment
1. Do not make things worse
2. Treatment is based on an accurate diagnosis and prognosis
3. Selection pengobatn with special purpose
a. Menghilngkan pain
b. Getting a good position of the fragment
c. Pursuing the occurrence of bone grafting
d. Restoring optimal function scr = rehabilitation
4. Given the laws of natural healing
5. Are realistic and practical in choosing the type of treatment
6. Selection of treatment according to individual patient
The principle of treatment 4R:
1. Recognition
Diagnosis and assessment of fracture
2. Reduction (if necessary)
Restoration of the fracture fragments so that in can be an acceptable position
3. Retention
Fracture immobilization with a fixation
4. Rehabilitation
Restore functional activity to the maximum extent possible
HEALING fracture
1. Phase hematoma
Occur first 24 hours. Blood started to freeze and build up in the area formed fibrin About a fracture and soft-fibrin
2. Proliferation
Precusor cells from proliferating osteoblasts lining the periosteum, forming an active tissue around the bone fragment
3. Callus formation
Tissue cells that grow to form osteoblasts on intercellular matrix of collagen and polysaccharides immature bone calcium = ± 10 days after trauma
4. Consolidation / ossifikasi
Callus harden, the fracture was not palpable ± 3-10 mg after trauma
5. Remodeling
Excess bone removed by osteoclast, bone strength after a few months. In children can be normal, adult occurs thickening
Factors affecting healing
1. Age
2. Nutrition
3. Infection
4. Activity / exercise
5. Location
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