Académique Documents
Professionnel Documents
Culture Documents
Jafri Hasan,MD
Definition
Structural break in continuity
of bone, cartilaginous joint
surface, or epiphyseal plate
caused by trauma
How to diagnose
Anamnesis :
Trauma (direct, indirect, gunshot)
Feeling something breaks
Pain
Abnormality
How to diagnose
Primary survey :
A,B,C,D,E
stabilize
Secondary survey :
From head to toe
How to diagnose
Physical examination local status:
Look : swelling, bruish, wound
deformity :
S : shortening
A : Angulation
R : Rotation
Feel : tenderness, crepitation,
Move : ROM (rarely performed)
Case
How to Describe
History
Physical examination
Radiograph:
plain X-ray
Density
can differentiate between air, soft tissue and bone
Rules of 2 :
2 projection
2 joints
2 sites
2 occasion
How to Describe
S : Site
E : Extent
C : Configuration
R : Relationship between fracture fragment
E : Environment
C : Complication
S : Site
What part of
A Bone:
B Epiphysis Proximal
Metaphysis Distal
C
Diaphysis / shaft
D
E
S : Site
Which bone?
Femur, tibia, radius,
ulna, ???
S : Site
What side ?
Right or Left?
E : Extent
Complete configuration
Incomplete
Hairline.
Green stick
Torus/buckle fracture
Incomplete
C : Configuration
Simple :
T : Transverse
O: Oblique
S : Spiral
Complex :
Comminutive
Segmental
Simple Complex
Comminutive
Segmental
R : Relationship..
Undisplaced
Displaced
S : Shifted sideways (ad longitudinam)
A : Angulated (ad axin)
R : Rotated
D : Distraction (ad longitudinam cum distractionum)
O : Over riding (ad longitudinam cum contractionum)
I : Impacted
Shifted sideways
Distraction
Angulasi
Overriding
impacted
Rotasi
E : Environment
Closed
Fracture is not exposed to the environment
Open
A break in the skin and underlying soft tissue leading
directing into or communicating with the fracture and
its hematoma
Grading Gustilo Anderson grade I,II,III
Open fracture
Described by Gustilo system
Based on soft tissue damage, force and fracture
configuration
Type I Open Fractures
Inside-out injury
Clean wound
Minimal soft tissue
damage
No significant
periosteal stripping
Type II Open Fractures
Moderate soft tissue
damage
Outside-in
mechanism
Higher energy injury
Some necrotic
muscle, some
periosteal stripping
Type IIIA Open Fractures
High energy
Outside-in injury
Extensive muscle
devitalization
Bone coverage with
existing soft tissue
not problematic
After operation
Expose bone (-)
Type IIIB Open Fractures
High energy
Outside in injury
Extensive muscle
devitalization
Requires a local flap
or free flap for bone
coverage and soft
tissue closure
Periosteal stripping
After operation
Exposed bone(+)
Type IIIC Open Fractures
High energy
Increased risk of
amputation and
infection
Major vascular injury
requiring repair
Table 1. The Gustilo Anderson Classification of Soft-Tissue
Injury in Open Fracture (1976)
Type I Type II Type III
Va s c u l a r Va s c u l a r i n j u r y
Injury Not significant Not significant requiring repair for
limb salvage