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DISLOCATION
Nucki N Hidajat, dr, MS, SpBO (K), FICS
Department Orthopaedi & Traumatology
Faculty of Medicine, Padjadjaran University
Dr Hasan Sadikin Hospital - Bandung
Orthopaedic tree
orthos
paedos
introduction
introduction
Congenital deformities,
infections and inflammation,
Neoplasms, fracture and
associated trauma,
degenerative.
fracture
Definition
A fracture is a break in the
structural continuity of bone,
or cartilage, or epiphyseal
plate
Pathologic fracture
How
fracture
happen?
Descriptive terms
pertaining of Fractures
1.
2.
3.
4.
5.
6.
Site.
Extent
Configuration
Relationship of the fragments
Relation to external
environment
complications
1.Anatomical site
Diaphyseal
Metaphyseal
Epiphyseal
Intra-articular
Fracture dislocation
2. Extent
Complete
Incomplete
Hard tissue
Soft tissue
extent
3. configuration
Transverse
Oblique
Spiral
Comminuted
segmented
4. Relation of fragments
Undisplaced
Displaced
Translated
Angulated
Rotated
Distracted
Overriding
impacted
Open fracture
Open fracture
Fracture
Soft tissue injuries
Contaminant from
external environment
High risk :
1.
2.
3.
Type II
Type III
IIIA
IIIB
IIIC
6. complication
Uncomplicated
Complicated
Neurovascular
Compartment syndrome
infection
Diagnosis of fracture
History
1.
Mechanism of injury,
environment, pre-injury status,
finding at the incident site, prehospital care
Physical examination
2.
1.
2.
3.
Look
Feel
Move/ask
Investigation
3.
1.
2.
3.
Lab.
X-ray
Scanning
Mechanism of
injury
Physical examination
General
Air way
Breathing
Circulation
Local
conditions
conditions
Look
Feel
move
Physical examinations
Look
Evidence of pain
Swelling
Deformity
Wounds
Feel
Sharply locallized pain
Aggravation of pain
Test artery & nerve
Move
crepitus
Abnormal movement
Diagnostic imaging
X-ray
(rule of Two)
Two joints
Two views
Two limbs
Two injuries
Two occasions
CT
Scan
MRI
Secondary (callus
formations)
1.
2.
3.
4.
Inflammation
Callus formation
consolidation
remodeling
Pre-hospital management
According ATLS procedure.
1. Primary survey
2. Secondary survey
A-B-C-D-E
Reduction
Immobilization
Cover the wounds
transportation
immobilization
3.
4.
Relieve pain
To obtain and maintain satisfactory
position of the fracture fragments
To allow bony union
Restore optimum function
Protection alone
Immobilization with or
without reduction
Closed reduction
followed by traction
CR followed by
external fixation
ORIF
Excision of fragment
fracture
Immobilization by traction
Intra-articular fracture
Avulsion fracture
Soft tissue
interposition
4.
5.
6.
7.
Grossly unstable
fracture
Coexistent with
vascular injury
Pathologic fracture
# in children cross
epiphyseal plate
External
Fixation
Excision
fragment fracture
complications
Immediately
Early
Bleeding
Injury to the nerve
Soft tissue
Infections
Delayed Union
Joints stiffness
Late
Malunion
Osteoarthritis
AVN
Fracture specific
Fracture in children
Pathologic fracture
In porotic bone
Abnormal bone structure
Abnormal metabolic process in bone
Joints
dislocations
DISLOKASI
Keluarnya bagian tulang di persendian dari
posisi yang normal
Lokasi : hip, shoulder, elbow, finger, patella,
knee, ankle, acromioclavicular
Gejala : hilangnya bentuk normal disertai
hambatan gerak
DISLOKASI
Dislokasi Posterior Sendi Panggul
Akut Traumatik
Harus segera reduksi
Dalam anestesi umum
Teknik ; Allis, Bigelow, Hipocrates
Re-evaluasi neurovasluler problem
Imobilisasi sampai soft tissue healing
Bila disertai fraktur ----reduksi terbuka
Dislokasi elbow
Reduksi tertutup mudah
dilakukan
Imobilisasi 3 minggu
Re-evaluasi neurovaskuler
Bahan bacaan