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1. klasifikasi Winquist - Type I: Patahan minimal atau tidak ada patahan pada daerah fraktur. - Type II: Patahan lebih besar dari tipe 1. Paling tidak terjadi kontak antar tulang lebih besar dari 50%. Butterfly Fragment - comminution involves a fragment larger than that in type I but has at least 50% of the circumference of the cortices of two major frx fragments intact; - broad cortical contact following frx reduction & nailing prevents shortening & malrotation, simple IM nailing suffices for most type II frx; - Type III: kontak patahan antar tulang kurang dari 50% - injuries, between 50 and 100% of the circumference of two major frx fragments is comminuted; - such large butterfly fragments compromises frx fixation since broad cortical abutment of major frx fragments is impossible; - simple intramedullary nails are insufficient for type III frx and must be supplemented with interlocking screws, cerclage wires, or post operative traction or bracing; - Type IV: tidak ada kontak tulang sama sekali - all cortical contact is lost in type IV injuries; - cortex is circumferentially comminuted over a segment of bone; - even w/ intramedullary nailing, there is no contact between proximal and distal fragments; all inherent stability of fractue is lost 2. Apa indikasi dilakukannya ORIF ? - Fraktur mencakup area metaphyseal dan diaphyseal - kontraindikasi dilakukan intramedullary nailing (biasa krna medula terlalu kecil atau sempit) - Complex shaft fracture pada pasien muda disertai open growth plates 3. Management lain untuk penanganan Femur Shaft Fracture? Intramedullary nailing. 4. Indikasi dilakukan Intramedullary Nailing? - Dapat dilakukan pada fraktur terbuka Gustillo tipe I, II, IIIa. - Fraktur mencakup area metafisis. asal pecahan maupun patahan bersifat stabil dan bukan berbentuk pecahan. - Dapat dilakukan pada pasien yang memiliki komplikasi post op. contoh pada pasien multiple organ failure, Acute Respiratory Distress Syndrome, dan juga hemodynamic yang tidak stabil

5. Klasifikasi Gustillo? Ini kalau ditanya yang klasifikasi open fraktur di Femoral Shaft The Gustillo Anderson classification of open injuries I.The wound is less than 1cm long. It is usually a moderately clean puncture, through which a spike of bone has pierced the skin. There is little soft-tissue damage and no sign of crushing injury. The fracture is usually simple, transverse, or short oblique, with little comminution. II.The laceration is more than 1 cm long, and there is no extensive softtissue damage, flap, or avulsion. There is slight or moderate crushing injury, moderate comminution of the fracture, and moderate contamination. III.These are characterized by extensive damage to soft-tissues, including muscles, skin, and neurovascular structures, and a high degree of contamination. The fracture is often caused by high velocity trauma, resulting in a great deal of comminution and instability. III A – Soft tissue coverage of the fractured bone is adequate III B – Extensive injury to, or loss of soft tissue, with periosteal stripping and exposure of bone, massive contamination, and severe comminution of the fracture. After debridement and irrigation a local or free flap is needed for coverage. III C – Any open fracture that is associated with an arterial injury that must be repaired, regardless of the degree of soft tissue injury. (Gustillo) There is some degree of inter-observer discrepancy when applying the Gustillo-Anderson classification. As demonstrated in tibial fractures where the average agreement was only 60%, however this has not been formally studied in femoral shaft fractures to date 6. Cedera saraf pada femoral shaft? Jarang

7. Definisi Malunion, Delayed Union, non Union? A. Malunion adalah tulang yang sembuh pada saatnya dalam keadaan tersebut, namun terdapat kelainan bentuk pada tulang. Kelainan itu antara lain: pembentukan sudut, pemendekan tulang, keterbatasan dan kelainan gerak. B. Delayed union adalah keadaan patah tulang yang tidak sembuh setelah selang waktu 3-5 bulan. Penyebabnya tidak segera mendapat pengobatan, begitu terkena patah tulang. Gejala delayed union: * Nyeri ketika bergerak. * Nyeri ketika berjalan dan beraktifitas walaupun tidak berat. * Pembengkakan pada tulang yang patah. * Kelainan bentuk pada tempat terjadinya fraktur/patah tulang. C. Non-union adalah suatu keadaan dimana patah tulang tidak sembuh setelah 6-8 bulan dan tidak didapatkan konsolidasi, sehingga terjadi pseudoarthrosis atau sendi palsu. Pseudoarthrosis bisa terjadi tanpa atau dengan infeksi. Pasien mungkin tidak merasakan nyeri, namun terjadi gerakan abnormal dari patah tulang yang membentuk sendi palsu. Tindakan ke operatif. 8. Prinsip Management Fraktur? Recognition, Reduction, Retained, Rehabilitation 9. Test Fulcrum http://www.physio-pedia.com/Fulcrum_Test Purpose

A stress fracture is a partial or a complete fracture that is a result of the repetitive application of stress to the bone. This application of excessive load to the bone will result in an imbalance between bone formation and bone resorption. 10% of all sport related injuries are stress fractures.[1] Between 2.8 and 7% of all sport related stress fractures involve the femur. [1,2]. Although, Johnson et al. found in his study of running athletes that 20% of all the sports-related stress fractures involved the femur. [5]

In the general population there are two main groups that are more susceptible to stress fractures of the femur: Military trainees and athletes (especially runners). [3]Stress fractures of the femur can occur at the neck (highest incidence), the femurshaft and the condyle. [2] It mostly occurs in the proximal third of the femur.[1] Femoral shaft stress fractures are not easy to diagnose. There are only few clinical signs, but they don’t allow to differentiate a stress fracture from another injury. One of this clinical signs is anterior thigh and hip pain, but this is generally vague and the location of the pain might not correlate with the location of the stress fracture.[1,2] A femoral stress fracture is also difficult to palpate due to the muscles covering the femoral shaft. [3] Instead there are two clinical tests that can differentiate and diagnose a stress fracture of the femur. This two are the Hop test and the Fulcrum test as described by Johnson et al. [1] The hop test and fulcrum test are positive during the physical examination. [1] For further information on the purpose and technique of the hop-test see also: ‘Hop test’. The technique of the fulcrum test is explained further below. If these clinical tests are positive, the diagnosis must still be confirmed by a bone scan or a Magnetic Resonance Imaging scan. [1,4] Technique

The technique of this test is the fulcrum test as described by Johnson et al. [5] The patient is seated on the examination table with his lower legs dangling. The examiner places one of his arms under the symptomatic thigh. The palm of the hand is facing up and touching the patient’s leg This arm will serve as a fulcrum. At one side of the fulcrum, the force is created by the patient’s body weight. The patient is sitting, so the force si created by the upper body weight. At the other side of the fulcrum, the force is created by the weight of the lower leg and pressure by the examiner’s hand. The arm is then moved slowly towards the proximal thigh while the examiner applies with his other hand a pressure to the dorsum of the knee. When the arm as fulcrum is located under the stress fracture, the pressure on the dorsum of the knee produces an increased discomfort which is described by the patient as a sharp pain and is usually accompanied by apprehension. These tests are very sensitive and were also used during follow up to determine the eligibility of the patient for transfer to the next phase of the treatment. [1,2,3,5] 10. Pemeriksaan fisik terhadap fraktur? Look Feel Move (bab 23 Appley) Related Link : http://www.rcsed.ac.uk/fellows/lvanrensburg/Femoral.htm