Refrat Orthopedi Fraktur collum remur

Shaktana Kusumaningrat 01.206.5291

INTRODUCTION
Bones have many functions:

as forming the framework of the body

where muscles attach protective organs

as the hemopoetik

DEFINITION
A fracture is the breaking of continuity of bone or cartilage which is

generally caused by the i.nvoluntary

While the collum of the femur fracture is a fracture that occurs at the collum of the femur

EPIDEMIOLOGI
Most of the fractures in the elderly caused by an accident in the house. It happened in women three times greater than that osteoporosis is a major predisposing factor More than 250,000 hip fractures occur in the United States each year (50% including collum fracture of the femur), and this number is

expected to double by the year 2040. 8o% occur in women, and the
incidence to be 2-fold every 5 to 6 years in women aged over 30 years Volpin et al reported as much as 4.7% in 1946 on Israeli military. Zahger et al reported higher rates of femoral collum fracture in women israel military

REVIEW REFERENCES
DEFINITION

Understanding of bone fracture is the breaking of continuity and or

cartilage which is generally caused by the forced Ruda (Mansjoer, 2000). While Colum femur fracture is a fracture of the femur terjadipada Colum. Fracture of neck of femur is intracapsular fractures that occur in the proximal femur, which includes the neck of the femur is the start of the distal surface of the femoral head up to the proximal portion of intertrokanter

Etiology
Neck of femur fracture often occurs in women caused by a combination

of fragility tulangakibat aging process and post-menopausal

osteoporosis. Fractures can berupafraktur subkapital, transervikal and basalt, which is located inside the hoop kesemuannya sendipanggul or intracapsular, intertrochanter and sub trochanter fractures are located extra-capsular

Trauma

Divided into two, namely:

Direct trauma, the impact on bone. Usually people fall in a tilted position in which the major trokhanter direct hit with hard objects (road). Indirect trauma, the impact and fracture titk pedestal far apart, for example jajtuh slip bathroom in the elderly

ANATOMI
Bone of the femur is the strongest, longest, and heaviest in the body

and has a function that is essential for normal movement. This bone
consists of three parts, namely the femoral shaft or diafisis, metaphysical proximal and distal metaphysical. The femoral shaft is tubular sections with slight anterior bow, which lies between the femoral trochanter minor to condylus. The upper end of the femur has the caput, collum, and trochanter major and minor.

Section caput is more or less two thirds of the ball and articulates with the

acetabulum of os coxae shape articulatio coxae. In the center there is a small

indentation caput called the fovea capitis, where the ligament attachment of the caput. Most of the blood supply for the caput femoris delivered along this ligament and enters the bone at the fovea. Section collum, which connects the head of the femur shaft, running down, rear, lateral, and makes an angle of approximately 125 degrees (in females slightly smaller) to the long axis of the femur shaft. The magnitude of this angle needs to be remembered because it can

be changed by the disease.

Caput femoris artery receives blood supply from three sources: (1)

intraoseosa flowing vessels in the neck, which would be damaged if the

neck is fractured and moving, (2) vessels in the retinaculum that curved from the capsule to the neck, which can be damaged by fractures or pressure by effusion, and (3) vessels in the ligamentum teres, which has not been developed in the early years of life and even later in life only to give a little blood supply

DESCRIPTION CLINIC
Clinical manifestations of fracture is obtained a history of trauma, loss

of function, signs of inflammation and severe form of acute pain, local

swelling, redness / discoloration, and heat at the fracture area. In addition it was also marked by deformity, may be angulation, rotation, or shortening, and crepitus. If the fracture occurs in the extremities or joints, the LGS will be encountered limitations (range of motion). Pseudoartrosis and abnormal movements.

INVESTIGATION SUPPORTING
Not all signs and symptoms are present in each fracture, so that the

necessary investigations. Investigations to establish the diagnosis is

examination of the X-images, which must be done with two projections of the anterior-posterior and lateral. With the X-photos can be seen the presence or absence of fracture, extensive, and the state of bone

fragments. This check is also useful to follow the process of bone

healing. Diagnosis of fracture depends on the symptoms, physical signs and xray examination of the patient. Typically patients complain of an injury to the area. When based on clinical observations suspected fracture, then treat as a fracture until proven otherwise.

CLASSIFICATION
There are two types of fractures of the femur
Intrakapsuler fracture; Through the head of the femur Just below the femur (capital fracture) Through the neck of the femur Fractures ekstrakapsuler Occurs outside the joint and capsule, through the femur

trokhanter larger / smaller / on the introkhanter

Section occurs distal to the femoral neck but not more than 2 inches below trokhanter

 Classification of fractures of the femur (in garden):

Stage I: incomplete (called berabduksi / impacted) Stage II: complete without shifting

Stage III: complete with a shift of some

Stage IV: complete with a full shift

Classification of fractures of the femur (in garden)

 Classification according to pauwel:

Type I: fractures with fracture line 30
0 0 0

Type II: fractures with fracture line 50

Type III: fractures with fracture line 70

Classification according to pauwel

HANDLING
Conservatives with an indication of the limited Operative therapy Almost all are always done because: Keep accurate and stable reduction Required the rapid mobilization in the elderly to prevent complications Type operative:

Mounting pin
Mounting plate / screw Arthroplasty; performed in patients aged above 55 years old, in the form: Excision arthroplasty (pseudoartrosis according to Girdlestone) Hermiathroplasty Arthropasty total

 Complications of a general nature; venous thrombosis, pulmonary embolism, pneumonia, decubitus Necrosis of the femoral caput avaskuler If location is more to the proximal fracture is likely to occur necrosis avaskuler greater Non-union Because of poor vascularization, the reduction being inaccurate, inadequate fixation and location of the fracture is intra-artikuler Osteoarthritis

COMPLICATIONS

Shortened limbs
Malunion Malrotation of external rotation

Koksavara

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