ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY
MOESLEM UNIVERSITY OF INDONESIA

KNEE FRACTURE

Presented by:
Amalia Dwi Ananda
110 210 0099

Advisor :
dr. Alfa Januar

Supervisor :
Dr. dr. Muh. Sakti Sp.OT

Orthopaedic and Traumatology Department

Medical Faculty of Moeslem University Indonesia
Makassar, 2015
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Definition
 A fracture is a break in the structural
continuity of bone.
 If the overlying skin remains intact it
is a closed fracture.
 If the skin or one the body cavities is
breached it is an open fracture.

Nalyagam S. Principles of Fractures. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth edition.
UK: 2010. p. 687-693.
Anatomy

Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal: 251, 266-8, 286-322.
Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal: 251, 266-8, 286-322.
Wiesel, S. Essentials of Orthopaedic Surgery, 3rd Edition. USA: 2007. P. 454-7.
 Etiology FRACTURE
Fracture can caused by trauma, stress fracture, and pathological fractures

• High-Energy such as motor vehicle

Trauma accident or fall from a significant height
• Low energy trauma

Stress Fractures • Athletes, ballet dancers

Pathological
Fractures • Patient with osteoporosis

Nalyagam S. Principles of Fractures. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth edition.
UK: 2010. p. 687-693.
 Mechanism ofMECHANISM
FractureOF INJURY

Low energy
Direct High energy Indirect trauma
trauma
• Pathologic
• Motor vehicle fractures 
accident elderly
• Gunshot injury • Stress fractures
 military
recruits or
runners
Transverse and
butterfly
fracture Spiral and
oblique fracture

Nalyagam S. Principles of Fractures. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth edition.
UK: 2010. p. 687-693.
 +
MECHANISM OF INJURY

Spiral pattern Short oblique Triangular

Tranverse
(twisting) pattern ‘butterfly’
pattern (tension)
(compression) fragment
(bending)

Nalyagam S. Principles of Fractures. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth edition.
UK: 2010. p. 687-693.
Diagnosis
Pain, Swelling, Deformity,
Loss of Function
Mechanism of trauma

1. Look
2 2. Feel
1
Physical 3. Move
Anamnesis
Examination 4. NVD

1. Two views
4 3 2. Two joints
Laboratory X-Ray
Examination 3. Two limbs
(rule of twos)
4. Two injuries
5. Two occasions

Solomon. L. et al. Diagnosis in Orthopaedic in Apley’s System of Orthopedics and Fractures 9th Edition. New
CLASSIFICATION
Distal Femur Fracture
AO Classification
Type A: Extra articular
Type A1: Simple, two-part supracondylar
fracture
Type A2: Metaphyseal wedge
Type A3: Comminuted supracondylar fracture

Type B: Unicondylar
Type B1: Lateral condyle, sagittal
Type B2: Medial condyle, sagittal
Type B3:
Coronal

Type C : Bicondylar
Type C1: Noncomminuted supracondylar “T”
or “Y” fracture
Type C2: Comminuted supracondylar fracture
Type C3: Comminuted supracondylar and
intercondylar fracture

Mostofi SB. Fracture Classification in Clinical Practice. London: Springer. 2006. 53-60.
 Treatment
Conservative Operative

Analgetic Plate and screws

Traction Intramedullary nailing

Close reduction + External fixation

cast/brace immobilization

Keebe, G. Key Topic in Orthopaedic Trauma Surgery. London: Bios Scientific. 2000. P. 46-8, 146-7, 287-9
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 420-8, 439-
45, 455-63
Nalyagam S. Injuries of The hip and femur. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth
edition. UK: 2010. p. 871.
 CLASSIFICATION
Patellar Fracture
Saunders Classication
Nondisplaced
Transverse
Vertical
Stellate
Inferior/ superior pole
Comminuted

Mostofi SB. Fracture Classification in Clinical Practice. London: Springer. 2006. 53-60.
 + Treatment

Conservative Operative

Open reduction and internal

fixation (K-wire, TBW,
Analgetic cerclage wire,lag screw)

Close reduction +
cast/brace immobilization Partial or total patellectomy

Keebe, G. Key Topic in Orthopaedic Trauma Surgery. London: Bios Scientific. 2000. P. 46-8, 146-7, 287-9
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 420-8, 439-
45, 455-63
Nalyagam S. Injuries of the knee and leg. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth
edition. UK: 2010. p. 888.
 CLASSIFICATION
Tibial Plateau Fracture
Schatzker Classification
Type I:
 Lateral plateau, split fracture

Type II:
 Lateral plateau, split depression

fracture

Type III:
 Lateral plateau, depression

fracture

Type IV:
 Medial plateau fracture

Type V:
 Bicondylar plateau fracture

Type VI: Plateau fracture with metaphyseal-

diaphyseal dissociation.

Mostofi SB. Fracture Classification in Clinical Practice. London: Springer. 2006. 53-60.
 + Treatment

Conservative Operative

Plate and screws

Analgetic
Arthroscopy assisted
reduction and fixation
Close reduction +
cast/brace immobilization External fixation

Keebe, G. Key Topic in Orthopaedic Trauma Surgery. London: Bios Scientific. 2000. P. 46-8, 146-7, 287-9
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 420-8, 439-
45, 455-63
Nalyagam S.. Injuries of the knee and leg. In: Solomon L. Apley’s System of Orthopaedics and Fractures. Ninth
edition. UK: 2010. p. 891-893.
 + Goals of fracture management
Recognize • Fracture site, types of fracture

• For adequate apposition and

Reduction normal alignment of bone

Retain • Maintain the reduction

Rehabilitation • Restore function

Solomon. L. et al. Injury’s of the Knee and Leg in Apley’s System of Orthopaedics and Fractures 9th
Edition. UK: Arnold. 2010.
 +
Treatment
Conservative (Non-operative)
Indication :
 Closed fracture with non-displacement
or minimal displacement
 Children patient
 Stable fracture

Solomon. L. et al. Injury’s of the Knee and Leg in Apley’s System of Orthopaedics and Fractures 9th
Edition. UK: Arnold. 2010.
 +
Treatment
Operative
The indications for operative :
1. Open fractures.
2. Multiple fracture
3. Neurovascular compromize.
4. Unstable fracture

Solomon. L. et al. Injury’s of the Knee and Leg in Apley’s System of Orthopaedics and Fractures 9th
Edition. UK: Arnold. 2010.
 Complication
Early Delay Late

• Compartement • Infection • Malunion,

syndrome • Osteoarthritis nonunion, delay
• Vascular injury • Fat emboli union
• Joint stiffness
• Peroneus verve
injury
• Refracture
• Loss of knee
motion

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott Williams & Wilkins. 2006.p. 420-8, 439-
45, 455-63
Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal: 251, 266-8, 286-322.
REFERENCES
1. Kottmeier, Stephen. American Academy of Orthopaedic Surgeons. Distal Femur (Thighbone)
Fractures of the Knee.[online]. 2008 [cited 2015 November 9 ]; Available from: URL:
http://orthoinfo.aaos.org/topic.cfm?topic=a00364
2. Nalyagam S. Principles of Fractures. In: Solomon L. Apley’s System of Orthopaedics and
Fractures. Ninth edition. UK: 2010. p. 687-693.
3. Bucholz, Robert W.; Heckman, James D. Fractures of The Femur. In: Court-Brown, Charles M.
Rockwood & Green's Fractures in Adults, 7th Edition. UK: Lippincott Williams & Wilkins. 2006. p.
1868-76.
4. Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition. USA: Lippincott
Williams & Wilkins. 2006.p. 420-8, 439-45, 455-63
5. Keebe, G. Key Topic in Orthopaedic Trauma Surgery. London: Bios Scientific. 2000. P. 46-8, 146-
7, 287-9
6. Wiesel, Sam. Essentials of Orthopaedic Surgery, 3rd Edition. USA: 2007. P. 454-7.
7. Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal:
251, 266-8, 286-322.
8. Mostofi SB. Fracture Classification in Clinical Practice. London: Springer. 2006. 53-60.
9. Miller MD, Thompson SR, Hart JA. Review of Orthopaedics 6th Edition. Philadelphia; Saunder
Elsevier. 2012. p. 315-6.
10. Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi. Penerbit PT Yarsif Watampone, Jakarta,
2009. Hal 82-85, 92-94, 355-361, 364
11. Apley GA, Solomon L. Buku ajar ortopedi dan fraktur sistem Apley. Edisi ke-7. Jakarta, 1995.
Widya Medika.
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THANK YOU