COMPLICATION ON HEALING FRACTUREDenny Purbawijaya (406147036)Pembimbing: dr. Dhevariza, Sp OTKepaniteraan Bedah RSUD Ciawi

BiodataNama: Tn EJenis Kelamin: Laki-lakiUmur: 20 tahun

Riwayat penyakitKeluhan utama: terasa ngilu di lokasi patah tulang paha sebelumnya.Riwayat penyakit: 1 minggu ini, Os merasakan ngilu dilokasi patah tulang paha kiri sebelumnya. Sejak september 2014, Os sudah dioperasi ORIF karena patah tulang paha kiri akibat jatuh dari motor.

Treatment in FractureCast SplintageTraction BracingInternal fixationExternal fixation

Complication Cast SplintageTight CastThe cast put on too tightlyThe limb swellsClinical finding:Diffuse painSigns of vascular compressionTreatment:Elevate the limbOpen the cast/ splint (if the pain persists)Throughout its lengthThrough all the padding down the skin

Complication Cast SplintagePressure sores Pressing upon the skin over a bony prominence (the patella, heel, elbow or head of the ulna)Clinical Finding:Localized pain (Over pressure spot)Treatment: Make a window in the cast

Complication Cast SplintageSkin abrasion / lacerationa complication of removing plasters, especially if an electric saw is used.Clinical finding:Nipping/ Pinching during plaster removal

Loose castOnce the swelling has subsided, the cast is no longer hold the fracture.Treatment: Replace the cast

Complicaton of TractionCirculation embarrassment traction tapes and circular bandages may constrict theCirculation (especially in children)

Nerve injuryleg traction may predispose to peroneal nerve injury and cause a dropfoot; the limb should be checked repeatedly to see that it does not roll into external rotation during traction

Complicaton of TractionCirculation embarrassment traction tapes and circular bandages may constrict theCirculation (especially in children)

Nerve injuryleg traction may predispose to peroneal nerve injury and cause a dropfoot; the limb should be checked repeatedly to see that it does not roll into external rotation during traction

Internal fixationInfectionthe operation (aseptic and antiseptic) and quality of the patients tissues Treatment: 1. antibiotics for 2-3 days2. Debridement

Non unionImplant failureRefracture

Internal fixationImplant failurea failure of the implantation procedure to produce satisfactory results.Treatment:patient with fracture internally xed should walk with crutchesStay away from partial weightbearing for 6 weeks or longer

Internal fixationRefractureCaused by removal implant too soon.1 year is minimum to remove the implant. (18-24 month safer)

Non Union

Delayed UnionFailure of a fracture to consolidate within the expected time - which varies with site and nature of the fracture and with patient factors such as age.Factor that prediposing delayed union:

Severe soft tissue damageInadequate blood supply.Infection.Insufficient splintage.Excessive traction.Older age.Low vitamin D level.Infection.Complicated/compound fracture.Osteoporosis.

Non Unionno signs of healing after 6 months (depending upon the site of fracture). Non-union is one endpoint of delayed union.

Factors disposing to non-union

Too large a space for bony remodelling to bridge. Interposition of periosteum, muscle or cartilage.Bony site with a limited blood supply

Mal unionthe bone fragments join in an unsatisfactory position, usually due to insufficient reduction.

External FixationDamage soft tissue structure

Transxing pins or wires may injure nerves or vessels, or may tether ligaments and inhibit joint movementOverdistraction

no contact between thefragmentsPin track infection

Managements of blisterMost blisters caused by friction or minor burns The fluid-filled blister keeps the underlying skin clean, which prevents infection and promotes healingDo puncture a blister if it is large, painful, or irritated.

How to manage the blisters

If want to pop the blister, use a sterilized needle or razor blade (to sterilize it, put the point or edge in a flame until it is red hot, or rinse it in alcohol).If the fluid is white or yellow, the blister may be infected and needs medical attention.Do not remove the skin over a broken blister. The new skin underneath needs this protective cover.Apply an antibiotic ointment or cream.Look for signs of infection to develop, including pus drainage, red or warm skin surrounding the blister, or red streaks leading away from the blister.

Pin tract InfectionPin-tract infection (PTI) defined as signs and symptoms of infection around a pin or wire that required increasing the frequency of local cleansing, protecting the pin site with dressing, using an oral or intravenous (IV) antibiotic, removing the pin or wire, or performing surgical dbride ment.Sign and symptom:

Redness, warmth and swelling at the pin sites. A small amount of redness is normal.Extremely tender pin sites.Persistent fever of 100.5 Fahrenheit or higher temperature taken orally.Thick, cloudy, white, yellow or green drainage from the pin sites. Clear yellow or slightly bloody drainage is normal.Odor at the pin sites.

Management operative Pre operativeAseptic and antiseptic prosedure Peri operativeIrrigated with cold saline when drillingUse hydroxyapatite-coated pinsNon touch techniqueDressing the pin sites with an alcoholic solution of chlorhexidine-soaked swab

Post OperativePin tract care (twice-daily cleaning of the pin-skin interface with an alcoholic solution of chlorhexidine and clean gauze) antibiotic agents