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
