Dr. Iwan Budiwan Anwar Sp.

OT(K)
 Emergency
LIMB THREATENING LIFE THREATENING
Emergency
1. Open fracture
2. Dislocation
3. Unstable Pelvis
4. Acute osteomyelitis
5. Compartement syndrome
6. Lesi vascular besar
7. Traumatic amputasi
OPEN FRACTURE

Fracture with bone fragment exposed

breaching the skin, creating contact of bone
with outside environment
OPEN FRACTURE
If not properly
managed
prolonged chronic
infection
Alan Graham Appley
Once osteomyelitis,
forever osteomyelitis
Do not pass over
golden periode time
(6 hours)
Management
Diagnostic: history
taking, physical exam &
additional exam
Therapy:
Antibiotic injection
ATS injection
Emergency
debridement & fixation
DISLOCATION & FRACTURE
DISLOCATION
Cartilage gain nutrition
from synovial fluid
produced by filtered
erythrocyte diffusing to
joint space in joint
movement.
Dislocation No
Nutrition
Dislocation can also
disturb local
neurovascular structure
Dislocation will cause
Pain
Abnormal movement of joint
Joint damage early osteoarthritis
Unequal length of limb limb discrepancy
Unstable joint
Dislocation treatment
1. Emergency reduction (closed reduction)
2. Failed open reduction
3. Immobilize the joint
4. Rehabilitation
UNSTABLE PELVIS
Fracture disrupting
major blood vessel
around the pelvis
Intra and
retroperitoneal
bleeding, diff diagnosis
with Intraperitoneal
abdominal Bleeding
Haemodynamic shock
Bleeding control
EMERGENCY ORTHOPAEDIC REFERRAL

PELVIC SPLINTING Protection of clot formation

BLEEDING Major blood vessels

Fluid resucitation 2 IV lines

PAY ATTENTION before applying urin catheter

Vertical shearing
ACUTE OSTEOMYELITIS
Child, high fever,
dehidrated, very painfull
High WBC
Severe bone pain
TX: Antibiotic treatment
+ operative if needed
Fail for treatment:
SEPSIS
COMPARTMENT SYNDROME
Cellular trauma (mechanical or termal) will cause Na
pump system Na & Cl will enter intracellular with
water causing cell edema
Edema in osteomyofascial comp will disturb blood
flow and cellular oxygenation
Hypoxia cause agravation of symptom
5P
1. Pulseless
2. Palor
3. Pain
4. Parese
5. Paralyse

Late complication: volkman ischemic contracture

muscle become necrosis and non-functional
PAIN
Terutama saat dilakukan pasif extensi maka otot flexor
akan digerakkan shg daerah ischemic teregang
WHEN TO PERFORM FASCIOTOMY:
P intra comp> 30 mmHg risk of tissue necrosis

Muscle :
Tolerate 4 hrs ischemia (reversible)
> 8 hrs complete irreversible

Nerve :
< 4 hrs : neuropraxic
> 8 hrs : axonotmesis & irreversible changes
VASCULAR LESSION
Poplitea artery
Inguinalis artery
Brachialis artery
Femoralis artery

Diagnosis with
arteriografi atau Dopler,
measure distal to injury
saturation 02 level
TRAUMATIC AMPUTATION
Vascular must be anastomosed before 6 hours
if more, possibility of revascularization is
poor, and there is high risk of toxin release
from amputated part
Finger: tendon component is more than
muscle component more resiliant for
hypoxia
Forearm: muscle component is more than
tendon component more fragile for hypoxia
Amputee preservation
Clean with sterile NaCl
Put into clean plastic bag
Put into another plastic bag containing ice
Never put amputee to direct contact with ice
Amputasi zaman tanpa bius