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Asisted by:
Specialist:
dr. Ira Nong, M. Kes, Sp. OT
Introduction
• Fracture is a break in the structural continuity of bone.
• Causes Of Fractures :
Solomon L, Warwick D, Nayagam S. Apley’s System of Orthopaedics and Fractures Ninth Edition. London: Hodder. Education. 2010. P916-923
Epidemiology
• Fractures of the tibia and fibula shaft are the most common long bone fractures. There are about
26 per 100,000 population per year.
o Males have the highest incidence of 21.5/100,000/year the highest frequency between
the age of 10 and 20
o Women have a frequency of 12.3/100,000/year the highest frequency between the age
of 30 and 40
Larsen P., Elsoe R., Hansen S.H., Graven-Nielsen T., Laessoe U., Rasmussen S. Incidence and epidemiology of tibial shaft fractures. Injury. 2015;46(4):746–750.
Koval, Kenneth J., and Joseph D. Zuckerman. Handbook of Fractures, Fifth Edition. Lippincott Williams & Wilkins, 2015. P421-423.
aNATOMY
Bulcholz RW, Heckman JD, Court-Brown CM. Rockwood & Green's Fractures in. Adults, 8th Edition. USA: Maryland Composition. 2015.
ANTERIOR COMPARTMENT
Incomplete Fractures
Greenstick fracture
Buckle/torus
Monitor
Compartment Assess soft tissue or
syndrome ligament injury
- 5P
Clinical Evaluation
Handbook ok Fracture, Chapter 37: Lower Extremity Fracture and Dislocations
Radiographic Evaluation
• Radiographic evaluation must include:
• - entire tibia, ankle, knee joints
• Recommended views:
• Full length AP and lateral view of affected tibia
• Oblique view, helpful to further characterize the fracture pattern
• CT scan and MRI are not necessary
• Ix: Intraarticular fracture extension
• Diminished pulse/arterial injury(ABIs)=> Angiography
Bulcholz RW, Heckman JD, Court-Brown CM. Rockwood & Green's Fractures in. Adults, 8th Edition. USA: Maryland Composition. 2015. P2420-2425.
Abdul Rahman. Ortho Bullet Trauma Volume 1, 2017 page 8 and 361-366
Nayaman S. Principles of Fractures. Dalam: Solomon L, Warwick D, Nayagam S. Apley’s System of Orthopaedics and Fractures Ninth Edition. London: Hodder. Education. 2010. P916-923.
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
CLASSIFICATION OF AO/OTA
OPEN FRACTURE
“The Oestern and Tscherne “
CLOSED FRACTURE
“Oestern and Tscherne”
SHAFT TIBIA FRACTURE
TREATMENT
Bulcholz RW, Heckman JD, Court-Brown CM. Rockwood & Green's Fractures in. Adults, 8th Edition. USA: Maryland Composition. 2015. P2420-2425.
Abdul Rahman. Ortho Bullet Trauma Volume 1, 2017 page 8 and 361-366
Nayaman S. Principles of Fractures. Dalam: Solomon L, Warwick D, Nayagam S. Apley’s System of Orthopaedics and Fractures Ninth Edition. London: Hodder. Education. 2010. P916-923.
CLOSED FRACTURE
ACCEPTABLE CRITERIA
< 5° varus-valgus angulation
< 10° degrees anterior/posterior angulation
> 50% cortical apposition
No
Yes < 1 cm shortening
< 10° rotation malalignment
Cast
External fixation Internal fixation
Elevated 24-48 hrs
IM Nailing
Home on 3rd day
Fixation plate
Follow up after 2 weeks
Cephalosporin pada 24 - 48 hrs > grade I,II dan IIIA open fxs.
ANTIBIOTIC Aminoglycoside > group IIIB
Internal/external fixation
STABILIZATION
Bulcholz RW, Heckman JD, Court-Brown CM. Rockwood & Green's Fractures in. Adults, 8th Edition. USA:
CONCLUSION
• Tibia and fibula fractures are the most common long bone fractures that can be caused by direct or indirect
trauma. (men>>, 10-20 years old)
• Due to the thinner periosteum on the anterior tibia, susceptible to fractures
• Fractures line related to mechanism of trauma; transverse, oblique, spiral and avulsion fractures.
• A thorough history and examination should be carried out in patients with fractures (evaluate neurovascular
status and compartment syndrome) & radiological examination; AP and lateral.
• The fracture classification according to The Oestern and Tscherne is divided into 2; open and closed.
• The classification of diaphysis tibia fracture can be determined based on Gustilo-Anderson, which depends
on the size of the wound, contamination, soft tissue and bone injury.
• The general classification for tibia and fibula fractures; AO / OTA classification system is not too practical.
• General treatment; ATLS must be prioritized first in dealing with these cases.
• Management of closed tibial fractures for non-operative indication patients who meet the criteria is by
applying cast & for operative indication, internal fixation can be done; (Intramedullary nailing and plate
fixation) and external fixation.
• Management of open tibial fractures by giving antibiotics, debridement, stabilization, amputation.