wound&fracture - drdavid,spot
DESCRIPTION
Wound&Fracture - DrDavid,SpOTTRANSCRIPT
![Page 1: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/1.jpg)
WOUND & FRACTURE
Dr DAVID IDRIAL, SpOT
Spesialis Orthopaedi dan Traumatologi
FKK UMJ
14 April 2011
![Page 2: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/2.jpg)
ORTHOPAEDI……???
![Page 3: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/3.jpg)
TRAUMATOLOGI ……..???
![Page 4: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/4.jpg)
TRAIN INJURY
![Page 5: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/5.jpg)
TRAUMA:
TRAUMA TAJAM.
TRAUMA TUMPUL.
![Page 6: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/6.jpg)
KEDARURATAN ORTHOPAEDI BERTUJUAN:
MENYELAMATKAN JIWA. = LIFE-THREATENING. = LIFE-SAVING.
MENYELAMATKAN EKSTREMITAS. = LIMB-THREATENING. = LIMB-SAVING.
![Page 7: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/7.jpg)
KEADAAN YANG DAPAT MENGANCAM JIWA:
PERDARAHAN. - EKSTERNA. - INTERNA.GAGAL GINJAL.INFEKSI, SEPSIS, GAS
GANGREN.MOF (MULTIPLE ORGAN
FAILURE SYNDROME).FRAKTUR CERVIKAL.
![Page 8: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/8.jpg)
PENYEBAB KEMATIAN EKSTREMITAS:
KELAINAN VASKULER.COMPARTMENT SYNDROME.FRAKTUR TERBUKA DAN INFEKSI.CRUSHING INJURIES.DISLOKASI SENDI BESAR.
![Page 9: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/9.jpg)
PERDARAHAN DAPAT TERJADI PADA:
FRAKTUR PELVIS.FRAKTUR FEMUR BILATERAL.MULTIPLE FRAKTUR.FRAKTUR TERBUKA.TRAUMATIK AMPUTASI
PROKSIMAL.
![Page 10: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/10.jpg)
PERKIRAAN PERDARAHAN PADA FRAKTUR:
PELVIS : 1 – 5 LITER.FEMUR : 1 – 4 LITER.SPINE : 1 – 2 LITER.LEG : 0,5 – 1 LITER.ARM : 0,5 – 0,75 LITER.
![Page 11: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/11.jpg)
PADA TRAUMA EKTREMITAS PENANGANANNYA SESUAI DENGAN: ATLS YAITU:
PRIMARY SURVEY DAN RESUSITASI.
SECONDARY SURVEY.
EARLY MANAGEMENT OF EXTREMITY INJURIES.
![Page 12: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/12.jpg)
PRIMARY SURVEY DAN RESUSITASI:AIRWAY DENGAN KONTROL COLL.
VERT. CERVIKAL.BREATHING.CIRCULATION.DISABILITY (NEUROLOGIC
EVALUATION).EXPOSURE. Pembukaan
![Page 13: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/13.jpg)
SECONDARY SURVEY:NILAI PERFUSI.PERIKSA AKAN ADANYA LUKA.PERIKSA ADANYA: DEFORMITAS,
PEMBENGKAKAN, TENDERNESS, INSTABILITAS, CREPITASI.
FUNGSI NEUROMUSKULAR.GERAKAN SENDI.
![Page 14: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/14.jpg)
EARLY MANAGEMENT:
IMMOBILISASI DENGAN SPLINT ATAU TRAKSI.
PERTAHANKAN KELURUSAN EKSTREMITAS.
PERAWATAN LUKA.PERTAHANKAN PERFUSI.
![Page 15: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/15.jpg)
WOUNDS ( LUKA PADA JARINGAN LUNAK )
Types of WoundsTraumatic wounds
- epithelial wounds (surface wounds)- penetrating wounds - complicated wounds
Iatrogenic wounds (surgical wounds)BurnsUlcerous wounds
![Page 16: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/16.jpg)
Wound presentation………
![Page 17: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/17.jpg)
FRACTURE (PATAH TULANG )
DEFINITION: wheter of a bone, an epiphyseal plate, or a cartilaginous joint surface, is simply a structural break in continuity
![Page 18: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/18.jpg)
PATAH TULANG TERTUTUP
DEFINISI :Patah tulang dimana antar fragmen tulang
tidak terdapat hubungan langsung dengan
dunia luar
![Page 19: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/19.jpg)
Tanda Klasik Faktur1. Riwayat trauma2. Nyeri3. Bengkak4. Deformitas5. Rotasi 6. Angulasi7. Krepitasi8. Gangguan dalam pergerakan
![Page 20: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/20.jpg)
PATAH TULANG TERBUKA.
DEFINISI: PATAH TULANG YANG SEDANG ATAU PERNAH BERHUBUNGAN DENGAN DUNIA LUAR.
![Page 21: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/21.jpg)
TANDA KLINIS DAN DIAGNOSIS
TERDAPAT TANDA-TANDA PASTI DAN TIDAK PASTI DARI FRAKTUR.
TERDAPAT LUKA.KELUARNYA DARAH YANG TIDAK
SESUAI DENGAN BESARNYA LUKA.DITEMUKAN ADANYA FAT BUBLE.
![Page 22: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/22.jpg)
![Page 23: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/23.jpg)
![Page 24: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/24.jpg)
Klasifikasi GUSTILLO – ANDERSON 1976
Dasar klasifikasi adalah :1.Ukuran luka ( lebar cm )2.Derajat kerusakan jaringan lunak
3.Konfigurasi garis fraktur4.Derajat kontaminasi ( kotor / bersih )
![Page 25: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/25.jpg)
GRADASI PATAH TULANG TERBUKA:GRADE I: LUKA YANG KECIL, KURANG 1CM.
AKIBAT TUSUKAN FRAGMEN (PINT POINT).KERUSAKAN MINIMAL, GARIS FRAKTUR SIMPEL, DERAJAT KONTAMINASI BERSIH
GRADE II: LUKA LEBIH 1CM, DENGAN KONTUSIO/KERUSAKAN JAR.LUNAK SEDANG, TANPA KEHILANGAN OTOT DAN TULANG.GARIS FRAKTUR OBLIQUE/KOMINUTIF RINGAN, DERAJAT KONTAMINASI SEDANG
![Page 26: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/26.jpg)
GRADASI PATAH TULANG TERBUKA:
GRADE III :Luka > 1 cm, kerusakan jaringan lunak
berat, garus fraktur kominutif brat, derajat kontaminasi kotor
A : bila fraktur masih bisa ditutupi oleh jar lunak yang terluka
B : bila terdapat bone expose & periosteal stripping / terkelupas, perlu skin graft
C : bila disertai kerusakan pembuluh darah (diperlukan reparasi arteri, tanpa melihan ukuran luka )
![Page 27: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/27.jpg)
BERDASARKAN GARIS PATAH
1. KOMPLIT Mengenai seluruh korteks2. TIDAK KOMPLIT ( INCOMPLETE )
Mengenai satu sisi korteks
![Page 28: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/28.jpg)
BERDASARKAN JUMLAH GARIS PATAH
1. SIMPLE : 1 garis patah2. KOMINUTIF : lebih dari 1 garis patah yang
berhubungan3. SEGMENTAL : lebih dari 1 garis patah tidak
saling berhubungan
![Page 29: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/29.jpg)
BERDASARKAN ARAH GARIS PATAHTransverseObliqueSpiralKompresiBerbentuk V, T, Y ( sering pada permukaan sendi )
![Page 30: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/30.jpg)
BERDASARKAN LOKASITULANG PANJANG : DiafisisEpifisisBERDASARKAN DISLOKASI FRAGMEN
UndisplcedDisplaced
![Page 31: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/31.jpg)
STADIUM PENYEMBUHAN TULANG1. HEMATOMA ( penimbunan darah )2. PROLIFERASI SEL SUB PERI /
ENDOOSTEAL ( organisasi hematoma menjadi jaringan granulasi )
3. PEMBENTUKAN KALUS ( woven bone )
4. KONSOLIDASI ( lamelar bone )5. REMODELLING
![Page 32: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/32.jpg)
PEMERIKSAAN PENUNJANG:
RADIOLOGIS.
LABORATORIUM.
![Page 33: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/33.jpg)
PRINSIP PENANGANAN FRAKTUR
“ 4 R “1. RECOGNITION2. REPOSITION3. RETAIGHT ( IMOBILISASI )4. REHABILITASI
![Page 34: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/34.jpg)
PENANGANANNYA
PENANGANAN AWAL (ATLS).ANTIBIOTIKA BROAD SPEKTRUM.TETANUS PROFILAKTIS.BILA MEMUNGKINKAN, DILAKUKAN
DEBRIDEMENT.
![Page 35: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/35.jpg)
Management - First aid
![Page 36: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/36.jpg)
![Page 37: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/37.jpg)
![Page 38: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/38.jpg)
DEBRIDEMENT ( kamar operasi ):
BUANG BENDA-BENDA ASING.
BUANG JARINGAN YANG MATI.
PERTAHANKAN STRUKTUR YANG VITAL (VASKULER & SYARAF).
PERTAHANKAN JARINGAN YANG VASKULARISASI BAIK.
IRRIGASI DAN PENUTUPAN LUKA.
![Page 39: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/39.jpg)
PRINSIP PENGOBATAN FRAKTUR:
REPOSISI.
FIKSASI.
REHABILITASI.
![Page 40: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/40.jpg)
KOMPLIKASI:
PERDARAHAN.KERUSAKAN SYARAF.KERUSAKAN VASKULER.INFEKSI.DEFORMITAS
![Page 41: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/41.jpg)
KOMPLIKASI (lanjutan)
![Page 42: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/42.jpg)
DISLOKASI SENDI
DEFINISI: KELUARNYA KEPALA SENDI DARI
MANGKOK SENDI. KALAU SEBAGIAN
DISEBUT: SUB LUKSASI
![Page 43: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/43.jpg)
DISLOKASI SENDI BESAR:
SENDI PANGGUL.SENDI LUTUT.SENDI BAHU.SENDI SIKU. DLL.
![Page 44: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/44.jpg)
GEJALA KLINIS & PEMERIKSAAN PENUNJANG:
KLINIS SANGAT MUDAH MENDIAGNOSE SUATU DISLOKASI.
BILA MERAGUKAN DIBUAT FOTO.
![Page 45: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/45.jpg)
![Page 46: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/46.jpg)
PENATALAKSANAAN:
REPOSISI.
IMMOBILISASI.
REHABILITASI.
![Page 47: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/47.jpg)
KOMPLIKASI:KOMPLIKASI DINI: - GANGGUAN NEUROVASKULER. - TERTEKANNYA ORGAN VITAL.KOMPLIKASI LANJUT: - CHONDROLISIS. - AVASKULERNEKROSIS. - OSTEOARTHRITIS. - KEKAKUAN SENDI.
![Page 48: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/48.jpg)
GANGGUAN VASKULER:LESI PADA PEMBULUH DARAH ARTERI
MAUPUN VENA.DAPAT BERUPA: - PUTUS. - ROBEK. - TERTEKAN. - SUMBATAN.
![Page 49: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/49.jpg)
COMPARTMENT SYNDROME:
ADALAH MENINGKATNYA TEKANAN INTRACOMPARTMENT DAN MENIMBULKAN GEJALA LESI NEUROVASKULER.
![Page 50: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/50.jpg)
GEJALANYA: 6 PP – PAIN.P – PALE.P – PULSELESSNESS.P – PARESTHESIA.P – PARALYSE.P – POIKILLOTHERMIA.
![Page 51: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/51.jpg)
GANGGUAN VASKULER SERING DIJUMPAI PADA:
FRAKTUR ANTEBRACHI.FRAKTUR DAERAH SIKU.FRAKTUR PROKSIMAL TIBIA.FRAKTUR ANKLE.
![Page 52: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/52.jpg)
![Page 53: Wound&Fracture - DrDavid,SpOT](https://reader035.vdocument.in/reader035/viewer/2022062217/5695d2291a28ab9b02995890/html5/thumbnails/53.jpg)