REFERAT FRACTUR CLAVICULA

CHAPTER I

INTRODUCTION

A.  Background

Fracture is a bone fracture, usually accompanied by injury in the surrounding tissue. Bone is a support tool and as a protector on the body. Without bones the body will not stand upright. Bone function can be classified as both a mechanical and a physiological aspect. From a mechanical aspect, the bones build the skeleton of the body and provide a strong support for the body. While from the physiological aspects of bone protect the internal organs such as heart, lungs and others. Bone also produces red blood cells, white blood cells and plasma. In addition, bone as a storage of calcium, phosphate, and magnesium salts. However, because the bones are relatively fragile, in certain circumstances the bones may break, causing disruption of bone function, especially in movement.

Clavicula is one of the bones that often experience fracture in case of injury to the shoulder because of its superficial location. In this bone, there can be many pathological processes similar to that in other bones, ie there may be congenital abnormalities, trauma (fracture), inflammation, neoplasia, bone metabolic abnormalities and others. Fracture of the clavicula may be caused by a low-strength or high-strength impact or compression that may result in a closed fracture or multiple trauma (Trurnble TE, et al, 2006).

Clavicula is the first bone to develop during the fetus, formed through 2 primary ossification centers or the medial and lateral clavicula, which occurs during the 5th and 6th weeks of the intrauterine period. Then the secondary ossification of the epifise medial clavicula takes place at the age of 18 years to 20 years. And the last epifise united at the age of 25 years to 26 years (Housner JA, Kuhn JE, 2003).

B.  Problem Formulation

1.      What is the concept of medical fracture of the clavicle?

2.      How is the concept of emergency nursing care fracture klavikula fracture?

C.  Purpose of Writing

1.      To know the basic concept of medical fracture of clavicle.

2.      To know the concept of nursing care fraktur klavikula fracture.

CHAPTER II

DISCUSSION

A.  Understanding

There are several notions of fracture, as experts have suggested through various literatures (Musliha, 2010):

1.    According to FKUI (2000), fracture is the breakdown and disconnection of bone continuity.

2.    Boenges, ME., Moorhouse, MF and Geissler, AC (2000), fracture is the separation or fracture of the bone.

3.    Back and Marassarin (1993) argue that the fracture is a separation of normal bone continuity that occurs due to excessive bone stress.

4.    Smeltzer S.C & Bare B.G (2001) fracture is the breakdown of bone continuity and determined by type and extent.

Understanding fractures on the limbs, adjusted according to anatomy, such as Klavikula (Kolar bone). From the above understanding, clavicle fracture is a disorder of bone integrity characterized by the breakdown or discontinuity of bone tissue due to excessive pressure that occurs in the bone Klavikula.

Clavicle fracture is a fracture of the clavicle or clavicle. This is often caused by falling with the arm position rotated / attracted (outstrechedhead), the position of falling to the shoulder or a direct hit to the clavicle.

Fracture of the clavicle (collar bone) is an injury that often occurs due to a fall or a direct hit to the shoulder. More than 80% of these fractures occur in the middle or proximal third of the clavicle. Bone is a support tool and as a protector on the body. Without bones the body will not stand upright.

B.  Etiology

In general, according to Lewis (2000) argues that bones are relatively fragile but have enough strength and spring force to withstand pressure. Fractures can be caused by several things:

1.    Fraktur due to trauma event.

2.    Fracture due to fatigue or pressure.

3.    Pathologic fractures due to weakness in bone.

The rash is also called the clavicle, is the bone of the upper chest that is between the breastbone (sternum) and the shoulder blade (scapula). It is easy to feel the clavicle, because unlike other bones wrapped with muscle but this bone is only covered by the skin covering most of the clavicle.

Clavicle fractures are very common. Fractures may occur in infants (usually at birth), children and adolescents (because the clavicle does not fully harden or expand until the end of the teen), athletes (due to risk of being hit or fall) or caused by accidents and falls.

According to the history of fractures in the clavicle is a frequent injury resulting from falling with the outstreched arm position where trauma is continued from the wrist to the clavicle, but it has recently been revealed that in fact the general mechanism of clavicle fractures is a direct blow to the shoulder or to a hard pressure to the shoulder due to a fall or hit by a hard object. This data is compiled by Nowak et a, l Nordqvist and Peterson. Clavicle fractures due to fall with the outstreched hand position only 6% occur in the case, while others are due to shoulder trauma. This case of fractures found around 70% is the result of trauma from traffic accidents. Clavicle fracture cases are among the most common cases. In children about 10-16% of all incidence of fractures, while in adults about 2.6-5%.

C.  Incidents

In adults the incidence of clavicular fractures is about 40 cases out of 100,000 people, with the ratio of female males being 2: 1. The most common midclavicula fractures are about 85% of all clavicula fractures, while the distal fracture is about 10% and the proximal part about 5% (Hahn B, 2007).

Approximately 2% to 5% of all types of fractures are clavicula fractures. According to the American Academy of Orthopedic Surgeon, the frequency of clavicula fractures is about 1 case out of 1000 people in one year. Fracture of the clavicula is also a case of trauma in obstetric cases with a prevalence of 1 case of 213 cases of live child birth (Trurnble TE, et al, 2006).

D.  Pathophysiology

Clavicular fractures are most often caused by compression or compression mechanisms, most often because of a force that exceeds the bone strength in which the direction of the lateral shoulder is due to a fall, a sports accident, or a motor vehicle accident. (Rasjad C., 2009)

In the middle of the bone the clavicula is not reinforced by muscles or ligaments as in the distal and proximal regions of the clavicula. The central clavicula is also a transition point between the lateral and medial sections. This explains why this area is most commonly fractured compared to distal or proximal regions. (Rasjad C., 2009)

Figure 1. Fracture of Clavicula

E.  Clinical Features

Clinical features of clavicle fractures are usually the patient coming with a complaint of falling or trauma. The patient feels the shoulder pain and is aggravated with every arm movement. On the physical examination the patient will feel tender on the fracture area and sometimes there is crepitation on every movement. Can also be seen skin protruding from the insistence of fracture fragments. Local swelling will be seen with localized discoloration of the skin as a result of trauma and circulatory disturbance following the fracture. To clarify and confirm the diagnosis can be done investigation.

F.   Classification

The location of fractures in the clavicle is classified according to Dr. FL All in 1967 and modified by Neer in 1968, which divided the clavicle fractures into 3 groups:

1.    Group 1: fractures in the middle third of the clavicle bone (incidence is 75-80%).

a.    In this area the bones are weak and thin.

b.    Generally occurs in young patients.

2.    Group 2: clavicle fractures in the distal third (15-25%). Divided into 3 types based on the location of the coracoclavicular ligament ie, conoid and trapezoid

a.    Type 1.

Fractures are common in the distal regions without bone displacement or lacament coracoclevicular disorders.

b.    Type 2A.

Fractures are unstable and bone displacement occurs, and the coracoclavicular ligament is still attached to the fragment.

c.    Type 2 B.

There is a ligament disruption. One of them is torn or both.

d.   Type 3.

Fractures that are distal to the clavicle involving the AC joint.

e.    Type 4.

The ligaments remain to stick to the perioteum pata, while the proximal fragments move upwards.

f.     Type 5.

The fractures of the calvula are split into fragments.

3.    Group 3: clavicle fractures in one-third proximal (5%). This is usually associated with neurovascular injury.

Figure 2. Classification of Clavicular Fracture

G. Investigations

1.    Laboratory:

In laboratory test fracture that need to be known: Hb, hematocrit is often low due to bleeding, the rate of sedimentation of blood (LED) increases when soft tissue damage is very wide. In the healing period Ca and P bind in the blood.

3.    Radiology:

X-Ray can be seen picture fraktur, deformitas and metalikment.Venogram / anterogram describes the current vascularization. CT scan to detect complex fracture structures. X-ray examination to determine the location, extent and type of fracture.

4.    Bone scan, CT-scan / MRI:

Shows the frakur and identifies soft tissue damage.

H.  Management

Management of clavicular fracture there are two options that is with surgery or operative treatment and non-surgical or nonoperative treatment. The purpose of this handling is to place the ends of fractures so that each other is close together and to keep them in order properly so that no deformity and healing bone processes that are fractured more quickly. The healing process of clavicula fracture takes a long time. Nonoperative handling is done by cross-installation for 6 weeks. During this time the patient should limit the movement of the shoulders, elbows and hands. Once healed, the fractured bone is usually strong and back to function. In some fractures, a spacer is performed to limit movement. or mobilization of the bones to speed the healing process. The rest of the bones must really not be moved (immobilized).

Immobilization can be done through:

1.    Pembidaian: hard objects placed in the area around the bone

Installation of a cast is a strong material that is wrapped around a broken bone. Modified shoulder spikes (clavicle gypsum) or an eight-point bandage or clavicle strap can be used to reduce this fracture, pull the shoulders back, and maintain in this position. When a clavicle strap is used, the armpits should be adequately padded to prevent compression injury to the brachial plexus and the axillary artery.

Figure 3. Installation of the cas

2.    Withdrawal (traction): use the load to hold a limb in its place.

3.    Fikasasi:

a.    Internal fixation: performed surgery to place the plate (plate) or logs on bone fragments or often called open reduction with internal fixation (ORIF).

b.    External fixation: Immobilization of the arm or leg can cause the muscles to become weak and shrink. Therefore most patients need to undergo physical therapy

Surgical action may be taken in the following cases:

1.    Open fracture.

2.    There are neurovascular injuries.

3.    Comminuted fracture.

4.    The bone retracts because the fracture fragment overlaps.

5.    Pain due to failure of connection (nonunion).

6.    Cosmetic problems, because the position of union bone is inappropriate (malunion).

Administration of drugs in cases of fractures can be done to reduce pain. Drugs that can be used are anti-inflammatory analgesic drug categories such as acetaminophen and codeine may also be class of NSAIDs such as ibuprofen.

I.     Complications

Clavicle fracture complications include nerve trauma in the brachial plexus, venous injury or subclavian arteria due to bone fracture, and malunion (union aberrations). Malunion is a cosmetic problem when the patient wears a suit with a low neck.

1.    Acute complications:

a.    Injury to the blood vessels

b.    Pneumouthorax

c.    Haemothorax

2.    Slow complications:

a.    Mal union: normal walking bone healing process occurs in the proper time, but not in its original or abnormal form.

b.    Non union: bone grafting failure after 4 to 6 months

J. Prognosis

The short-term and long-term prognosis depends a lot on the severity of the trauma experienced, how appropriate treatment and patient age. In children the prognosis is very good because the healing process is very fast, while in adults the prognosis depends on the handling, if handling is good then the complications can be minimized. Clavicular fractures with multiple trauma provide a worse prognosis than pure fracture of pure clavicula (Trurnble TE, et al, 2006).

CHAPTER III

CLOSING

A.  Conclusion

Clavicle fracture is a fracture of the clavicle or clavicle. This is often caused by falling with the arm position rotated / attracted (outstrechedhead), the position of falling to the shoulder or a direct hit to the clavicle. Clinical features of clavicle fractures are usually the patient coming with a complaint of falling or trauma. The patient feels the shoulder pain and is aggravated with every arm movement. On the physical examination the patient will feel tender on the fracture area and sometimes there is crepitation on every movement. Management of clavicular fracture there are two options that is with surgery or operative treatment and non-surgical or nonoperative treatment.

B.  Suggestions

It is expected to further enhance the knowledge and skills in applying emergency nursing care to clients especially on clients with clavicle fractures.

BIBLIOGRAPHY

Dongoes, Marilynn E. 2000. Nursing Care Plan Issue 3 Jakarta: EGC

Krisanty. Paula, et al. 2010. Emergency Nursing Care Paula Krisanty. Jakarta: EGC

Musliha, 2010. Nursing Emergency, Nuha Medika, Yogyakarta

Price, S.A., et al. Pathophysiology Clinical Concepts of Disease Processes, 6th Edition, Volume 2, 2006, EGC, Jakarta

Rasjad C. Trauma. In: Introduction to Orthopedic Surgery. 6th ed. Jakarta: Yarsif Watampone, 2009, p. 355-356.

Suzanne, Smeltzer C and Brenda G. Bare. 2002. Fundamentals of Nursing. Jakarta: EGC

Trurnble TE, Budoff JE, Cornwall R, editors. Hand, Elbow and Shoulder: Core Knowledge in orthopaedics. I "ed. Philadelphia: Mosby Elsevier; 2006. p.623-7.