knee fracture
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BAGIAN ORTOPEDI DAN TRAUMATOLOGI REFERAT
FAKULTAS KEDOKTERAN NOVEMBER 2015
UNIVERSITAS MUSLIM INDONESIA
KNEE FRACTURE
Di susun oleh :
Amalia Dwi Ananda110 210 0099
Pembimbing :
d! Al"a #an$a
Supervisor :
D! d! M$%! Sa&'i( S)!OT
DIBAWAKAN DALAM RANGKA TUGAS KPANITRAAN KLINIK
BAGIAN !RT!PDI DAN TRAUMAT!L!GI
"AKULTAS KD!KTRAN
UNI#RSITAS MUSLIM IND!NSIA
$%&'
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(ALAMAN PNGSA(AN
*an+ ,-'anda 'an+an di,awa% ini m-n.a'a&an ,a%wa /
N)m) : Am)li) D*i An)n+) K, S)nr)ng
S-)mbu. : &&%$&%%%//
0u+ul :Knee Fracture
T-la% m-n.-l-ai&an '$+a dalam an+&a &-)ani'-aan &lini& )ada ,a+ian
O')-di dan Ta$ma'l+i Fa&$l'a K-d&'-an Uni-i'a M$lim
Indn-ia!
Ma&aa( N-m,- 2015
Resi+en Pembimbing Supervisor
d! Al"a #an$a D! d! M$%! Sa&'i( S)!OT
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DA"TAR ISI
3alaman #$d$l!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!iL-m,a P-n+-a%an!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!ii
Da"'a Ii!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!iii
A! P-nda%$l$an44!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!1
B! Tina$an P$'a&a44444444444444444444442
1! D-"inii 444!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!2
2! E)id-mil+i444444!444444444444444!!6
6! Ana'mi !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!6
7! M-&anim- Ta$ma!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!9
5! Dia+ni4444!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!11
8! Klai"i&ai dan P-na'ala&anaan knee fracture!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!17! P-na'ala&anaan "a&'$ -:aa $m$m!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!19
;! Km)li&ai444!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!26
9! P+ni4!444!444!444!!!4444444444!427
Da"'a P$'a&a!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!25
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BAB I
PNDA(ULUAN
S-ndi l$'$' adala% -ndi .an+ )alin+ dminan di+$na&an -'-la% -ndi ,a%$!
S-ndi l$'$' $+a m-$)a&an -ndi '-,-a .an+ m-n)an+ '$,$%! S-ndi l$'$'
'-dii dai 'i+a )-'-m$an '$lan+ .ai'$ )a'-lla
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BAB II
TIN0AUAN PUSTAKA
&, De1inisi
Fa&'$ adala% '-)$'$n.a &n'in$i'a ain+an '$lan+( '$lan+ awan
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K-adian "a&'$ di'al "-m$ ,-$mla% -,an.a& '$$% )--n dian'aa
-m$a &-adian "a&'$ )ada "-m$! 50@ "a&'$ -&'aa'i&$l-$)a&ndil- dan
50@ m-$)a&an 'am,a%an in'aa'i&$l-!5
$, pi+emiologi
K-adian "a&'$ di'al "-m$ m-$)a&an @ dai -m$a "a&'$ "-m$! Palin+
-in+ '-adi )ada $ia m$da a&i,a' 'a$ma -n-+i 'in++i( -)-'i &-:-la&aan
m' a'a$ '-a'$% dai &-'in++ian( dan .an+ &-d$a adala% )ada )ai-n '$a a&i,a'
'-a'$%! S-dan+&an $n'$& "a&'$ )la'-a$ 'i,ia m-$)a&an 1@ &-adian dai
-m$a "a&'$ dan ;@ "a&'$ ini '-adi )ada $ia m$da! S-&i'a 55@?0@ "a&'$
)la'-a$ la'-al 'i,ia( 10@?25@ )la'-a$( dan 10@?60@ )ada ,i&ndil-! Un'$&
"a&'$ )a'-lla( ini m-$)a&an &-adiaann.a 1@ dai -m$a -ni "a&'$!
P-,andin+an la&i?la&i dan wani'a adala% 2/1( dan )alin+ -in+ '-adi )ada
&-lm)& $ia 20?50 'a%$n( -'a an+a' aan+ '-adi ,ila'-al!7
2, An)-omi
Ana'mi -ndi l$'$' '-dii a'a )&imal 'i,ia( di'al "-m$( dan )a'-lla!
Di'al "-m$ '-$$n a'a &ndil$ m-dial dan la'-al( -)i&ndil$ m-dial dan
la'-al( "a:i- )a'-llai( dan "a in'-&ndil-! Kndil$ m-dial l-,i% ,-a dan
-di&i' m-l$a di,andin+&an &ndil$ la'-al! K-d$a &ndil$ di'$'$)i l-%
&a'ila+ a'i&$la! Fa:i- )a'-llai ,-ada di da-a% d-)an di'al "-m$ dian'aa
m-dial dan la'-al &ndil$ "-m$! P-m$&aann.a $+a di'$'$)i l-% &a'ila+
a'i&$l- dan m-$)a&an ii m-l-&a'n.a )a'-lla! S-,-la% la'-al "a:i- )a'-llai
,iaan.a l-,i% m-nnl di,andin+&an d-n+an ii m-dial $n'$& m-m$da%&an
)-a,aan )a'-lla )ada "-m$!
8
Gam,a 1! Di'al "-m$ a)-& an'-i dan )'-i!
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E)i&ndil$ ,-)-an dalam ii $n'$& m-l-&a'n.a '$&'$ )-n'in+! Ba+ian
dalam dan )-m$&aan li+am-n'$m &la'-al m-dial m-l-&a' )ada -)i&ndil$
m-dial! Ba'a )&imal -)i&ndil$ m-dial l-,i% ,-a dan ,-)-an -,a+ai ii
m-l-&a'n.a add$:' ma+n$! Ba+ian la'-al a'a$ li+am-n'$m :lla'-al "i,$la
m-l-&a' )ada -)i&ndil$ la'-al! Ba+ian ,awa% dai ,a+ian i'$ adala% m-l-&a'n.a
'' ))li'-a .ai'$ )ada -&a' an'aa &ndil$ la'-al dan -)i&ndil$! S-,-la%
m-dial dan la'-al )$n:a& '' +a':n-mi$ ,-aal dai ,a+ian m-dial dan
la'-al &ndil$ )'-i "-m$! Fa in'-&ndil- adala% ii m-l-&a'n.a
li+am-n'$m :$:ia'$m! S-,-la% d-)an li+am-n'$m :$:ia'$m m-l-&a' )ada ,a+ian
)'-la'-al dai "a( dan li+am-n'$m :$:ia'$m )'-i ,-ada )ada ,a+ian
an'-m-dial dai "a in'-&ndil-!8
P-m$&aan 'i,ia )&imal '-dii a'a )la'-a$ m-dial dan la'-al -'a
in'-&ndil- -min-n! Pla'-a$ m-dial l-,i% ,-a dan l-,i% m-l$a &- ii
,-la&an+ i&a di,andin+&an d-n+an )la'-a$ la'-al! P-m$&aan m-dial )la'-a$
,-,-n'$& l-,i% da'a! S-m-n'aa la'-al 'i,ial )la'-$ l-,i% &n-&! K-d$a 'i,ial
)la'-a$ di'$'$)i l-% &a'ila+ a'i&$l-! Eminence intercondylar adala% '-m)a'
m-l-&a'n.a m-ni&$ dan li+am-n'$m :$:ia'$m! 8
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Gam,a 2!
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di,awa% )la'-a$ 'i,ial -)anan+ +ai )'-m-dial 'i,ia! Li+am-n'$m :$:ia'$m
la'-al l-,i% '-)ia% dai ii la'-al l$'$'! Ini ,-alan dai -)i&ndil$ la'-al
:a)$' "i,$la! 8
Li+am-n'$m :$:ia'$m an'-i m-n:-+a% )-+--an ii d-)an 'i,ia
'-%ada) "-m$! Li+am-n ini ,-alan dai d-)an eminence tibia &- )'-la'-al
femoral notch! Li+am-n'$m :$:ia'$m )'-i m-n:-+a% )-+--an ,-la&an+
'i,ia '-%ada) "-m$ dan m-n:-+a% %i)--&'-ni l$'$'! Li+am-n ini ,-alan dai
ii )'-i intercondylar eminencedan 'i,ia )&imal )ada +ai '-n+a%n.a
m-n$$ ii an'-m-dial dai intercondylar notch femoral!8
Un'$& m-na+a dinami l$'$' '-da)a' '' dan '-ndn .an+ m-l-wa'i -ndi
l$'$'! O''?'' '--,$' '-,a+i $n'$& "$n+i -&'-ni dan "l-&i! O'' .an+
,-"$n+i $n'$& -&'-ni adala% $adi:-) "-mi dan '-n "a:ia la'a! O''
$adi:-) '-$$n a'a -m)a' ''( .an+ m-l-&a' )ada )a'-lla dan '-nd )a'-lla(
&-m$dian ma$& m-n$$ &- '$,-:l- 'i,ia an'-i! O'' .an+ m-n.$$n
$adi:-) "-mi adala% -&'$ "-mi( a'$ la'-ali( a'$ m-diali( dan
a'$ in'-m-dial! O''?'' '--,$' di)-aa"i l-% n-$ "-mi! T-n
"a:ia la'a ,-aal dai '-)i )an++$l &-m$dian ma$& m-n$$ Gerdys tubercle
)ada )imal an'-i la'-al 'i,ia dan di)-aa"i l-% n-$ +l$'-al $)-i!8
Gambar 4. (a)Km)a'-m-n an'-i
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semitendinosus, biceps femoris, sartorius dan gracillis. Otot hamstring berasal dari
ischium dan menuju posteromedial tibia proksimal. Mereka menerima innervasidari nervus sciatic menuju percabangan nervus sciatic pada daerah tibia kecuali
dua bagian otot bisep, dimana mendapat persarafan dari nervus sciatic cabang
peroneus. Sartorius berasal dari anterosuperior spina iliaka dan gracillis berasal
dari pubis. Sartorius dipersarafi oleh nervus femoralis dan gracillis oleh nervus
obturatur. 8
Otot yang lain yang juga berperan dalam fleksi lutut adalah otot
gastrocnemius dan popliteus, dimana berasal dari aspek posterior kondilus
femoral ke calcaneusdan proksimal tibia.8
M-ni&$ adala% d$a &a'ila+ d-n+an ,-n'$& -)-'i ,$lan a,i' .an+ ,-ada
)ada )-m$&aan )&imal 'i,ia! S'$&'$ ini m-m$n+&in&an d$a "$n+i l$'$'!
K-d$an.a m-nin+&a'&an a-a weight-bearing, m-n$$n&an '- '-%ada)
&a'ila+ a'i&$l-( dan $+a m-m,-i&an 'a,ili'a )ada l$'$' d-n+an m-m,$a'
)-m$&aan )&imal 'i,ia ,-,-n'$& -)-'i man+&$&! 8
Gam,a 5! Ti,ia 'am)a& $)-i!
Pada "a ))li'-a '-da)a' a'-i dan -na ))li'-al .an+ ,-aal dai a'-i
"-mali( dan di'$'$)i l-% '-ndn add$:' ma+n$ m-n$$ &-,-la&an+
m-l-wa'i li+am-n'$m :$:ia'$m )'-i &-m$dian ,-:a,an+ &- m$&$l$
))li'-a! >a,an+?:a,an+n.a '-dii a'a a'-i genicular superior lateral( a'-i
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genicular superior medial( a'-i genicular inferior lateral( a'-i genicular
inferior medial( a'-i an'-i dan )'-i 'i,ia!8
Gam,a 8!
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,= Pada -na'a +-n++am d-n+an &-:-)a'an -nda% 'ida& da)a'
m-n.-,a,&an +an++$an )ada '$lan+ ma$)$n &-$a&an ain+an
-)-'i .an+ di-,a,&an l-% -n-+. 'in++i
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'$lan+( +a,$n+an dai )- -a,)i '$lan+ dan )-m,-n'$&an '$lan+
,a$ -$ai d-n+an %$&$m l""! K-'i&a '-)aan l-% '- -'a )-
d-"mai .an+ ,-$lan+ dan m-manan+( -a,)i 'im,$l l-,i% :-)a'
dai)ada )-n++an'ian( -%in++a m-nin++al&an da-a% .an+ &n+ dan
m-n.-,a,&an "a&'$! Maala% .an+ ama 'im,$l )ada an+ .an+ -dan+
dalam )-n+,a'an -%in++a m-n++an++$ &--im,an+an )- -a,)i
dan )-n++an'ian '$lan+ ,a$!
6! Fa&'$ Pa'l+i/
Fa&'$ da)a' '-adi d-n+an '- .an+ nmal i&a '$lan+ m-l-ma%
a&i,a' )-$,a%an )ada '$&'$n.a
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Pai-n .an+ da'an+ ,iaan.a m-n+-l$% aa n.-i( ,-n+&a& dan &-lainan
,-n'$&( $+a '-da)a' iwa.a' :-d-a( dii&$'i d-n+an &-'ida&mam)$an
m-n++$na&an '$n+&ai .an+ m-n+alami :-d-a( "a&'$ 'ida& -lal$ dai
'-m)a' .an+ :-d-a $a'$ )$&$lan da)a' m-n.-,-,&an "a&'$ )ada &ndil$
"-m$( )a'-lla a'a$ 'i,ia! Um$ )ai-n dan m-&anim- :-d-a i'$ )-n'in+(
&ala$ "a&'$ '-adi a&i,a' :-d-a .an+ in+an :$i+aila% l-i )a'l+i& n.-i(
m-ma dan )-m,-n+&a&an adala% +-ala .an+ -in+ di'-m$&an( '-'a)i +-ala
i'$ 'ida& m-m,-da&an "a&'$ dai :-d-a ain+an l$na&( d-"mi'a a$%
l-,i% m-nd$&$n+!
Tanda H 'anda l&al /
a= "ook
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m-$)a&an )a'&an $n'$& )-n+,a'an -lan$'n.a! P$lai dai a'-i
dali )-di dan a'-i 'i,iali )'-i -'a )-m-i&aan >RT
-d-a .an+ )aa% -in+ m-n.-,a,&an :-d-a )ada l-,i%
dai a'$ l--l! #adi( )ada "a&'$ :al:an-$m a'a$ "-m$ )-n'in+ dila&$&an
"' ?a. )-li dan )in-!
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-! wo occasions? B-,-a)a "a&'$ .an+ an+a' $li' $n'$& did-'-&i -+-a
-'-la% :-d-a( 'a)i )-m-i&aan ?a. .an+ lain a'$ a'a$ d$a min++$
&-m$dian da)a' m-n$n$&&an adan.a l-i! >n'% $m$m adala%
undisplaced "a&'$ $$n+ di'al &lai&$la( :a)%id( n-:& "-m$ dan
mal-l$ la'-ali dan $+a "a&'$ '- dan :-d-a "i-al .an+ 'ida&
,-)inda% dimana)$n '-adi!
&omputed tomographydan magnetic resonance imaging
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2! Ti)- B/ Uni&ndil-
a! Ti)- B1/ Kndil$ la'-al( a+i'al
,! Ti)- B2/ Kndil$ m-dial( a+i'al:! Ti)- B6/ Knal
6! Ti)- > / Bi&ndil-
a Ti)- >1/ "a&'$ T a'a$ * $)a&ndil- nn&min$'i"
, Ti)- >2/ Fa&'$ &min$'i" $)a&ndil-
: Ti)- >6/ Fa&'$ &min$'i" $)a&ndil- dan in'-&ndil-
Ta'ala&ana 7(5
1). Nn)-ai:d-n+an m-n++$na&ana long leg casta'a$skeletal traction(
'-'a)i :aa ini $li' di,$&'i&an ,-%ail! >aa ini ,iaa m-n+a&i,a'&an
mal$nin dan nn?$nin! Mana-m-n non-operati%e,iaan.a dila&$&an
)ada "a&'$ d-n+an )-$,a%an '$lan+ .an+ minimal( a'a$ )ada )ai-n
$ia '$a( )ai-n d-n+an m,iliai .an+ &$an+( a'a$ )ai-n .an+ 'ida&
,ia di,-i&an ana'-i! 7(5
2=! O)-ai 7(5
) Plate +)n screw da)a' di+$na&an )ada "a&'$ -,a+ian -ndi a'a$
$ni&ndil-( &-m$dian dii&$'i d-n+an m,iliai awal m-n++$na&an
cast*brace!
b Intramedullary devce !I" nals)id-al $n'$& "a&'$ -&'aa'i&$l-
dan ,i&ndil-( &%$$n.a )ada $ia m$da d-n+an &$ali'a '$lan+
.an+ ,ai&( '-'a)i &$an+ m-m$a&an )ada "a&'$ 'i)- >6 dimana
'-da)a' ,-n'$an )ada -ndi .an+ i+ni"i&an! Fi&ai '-,$&a dan
-&n'$&i $+a di)-l$&an!
c "i.s)si e.s-ern) -in+ dila&$&an )ada &-$a&an .an+ ,-a'(
"a&'$ 'i)- >6( dan "a&'$ '-,$&a!
Mana-m-n )'?)-ai 7
1=! Ta$ma )ada -&'-mi'a )alin+ -in+ m-n++$na&an ala' +-a&an )ai"
-aa' -'-la% )-ai i&a &$li' dan ain+an l$na& ,ia 'l-ani!
2=! Fii'-a)i $n'$& m-m)-,ai&i +-a&an a&'i" )ai-n aa' ,-la%a+a( dan
dian$&an $n'$& 'ida& m-n++$na&an -&'-mi'a aa' ,-)ia&!
25, P-n.-m,$%an )ada $ia '$a ,ia aa '-'$nda 12 min++$!
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,! Fa&'$ )a'-lla 9
Gam,a ;!
Fa&'$
Pa'-lla
Klai"i&ai Sa$nd- ;
+ ondisplaced
2! Tan-al
6! V-'i&al7! S'-lla'a
5! K$'$, in"-iC $)-i
8! Kmin$'i"
Ta'ala&ana 7(5
&5, Nn?)-ai / Ta'ala&ana ini ::& $n'$& "a&'$ non-displaced)a'-lla
d-n+an "$n+i -&'-n ,ai&! #i&a '-da)a' %-maa'%i( dian$&an
$n'$& a)iai( -,-l$m im,iliai d-n+an ilind- a'a$ brace
dil-)a&an! La'i%an $adi:-) dian$&an -'-la% maa i'ia%a'! Brace
da)a' dil-)a&an -'ala% 7?8 min++$! 7(5
2=! O)-ai /7(5
), #$en Reduct%n and Internal F&at%n6!RI"5 / M-'d- ini '-la%
m-n++$na&an cerclage wire, tension band wire( dan two.irschner
wires( a'a$ lag screw fi/ation! Pada &a$ '--,$' a)a,ila '-da)a'
"a&'$ &min$'i"( )-n+-l$aan "a+m-n &-:il da)a' dila&$&an!
Im,iliai dian$&an am)ai )-n.-m,$%an l$&a dim$lai( '-'a)i
m,iliai dini da)a' dila&$&an dalam ,-,-a)a %ai! Indi&ai
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dila&$&an ini adala% a)a,ila )ai-n &-%ilan+an "$n+i -&'-ni a&'i"(
2mm )-$,a%an )ii -ndi( 6mm )-minda%an "a+m-n( a'a$
"a&'$ '-,$&a! Pada )ai-n d-n+an "a&'$ &min$'i" ,-a' a'a$
ma+inal( im,iliai dila&$&an -lama 6?8 min++$!
,! P)-elle.-omi p)rsi)l/ Un'$& m-m)-,ai&i "$n+i -&'-n da)a'
dila&$&an in'-nal "i&ai! R--&i &$'$, in"-i adala% a'$?a'$n.a
indi&ai a)a,ila '-adi "a&'$ &min$'i" .an+ )aa%! R-&n'$&i
ana'mi nmal )a'-lla adala% '$$an )ada &a$ "a&'$ )a'-lla!
:! P)-elle.-omi -o-)l / Pa'-ll-&'mi ''al dila&$&an )ada "a&'$
&min$'i" ,-a'( '-'a)i aan+ dila&$&an! P-,ai&an -'ina&$l-m-dial dan la'-al .an+ $a& )ada aa' )a'-ll-&'mi an+a' )-n'in+!
Bai& )a'-ll-&'mi ''al ma$)$n )aial( -ndi l$'$' %a$
diim,iliai d-n+an cast)ada )ii "l-&i 10 d-aa' -lama 6?8
min++$!
:! Fa&'$ )&imal 'i,ia
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Gambar 9. Fraktur Plateau Tibia 7
Klasifikasi Schatzker
8
1! Ti)- I/Fa&'$ la'-al )la'-a$(split fracture
2! Ti)- II/ Fa&'$ la'-al )la'-a$(split depression fracture
6! Ti)- III/ Fa&'$ )la'-$ la'-al( "a&'$ d-)-i
7! Ti)- IV/ Fa&'$ m-dial )la'-a$
5! Ti)- V/ Fa&'$ )la'-a$ ,i&ndil-
8! Ti)- VI/ Fa&'$ )la'-a$ d-n+an di-'ai diiai m-'a"ii dan dia"ii
Ta'ala&ana 7(5
1=! Nn)-ai 7(5
Tr).si +)n mobilis)si +ini / Indi&ai $n'$& "a&'$ nondisplaced a'a$
d-n+an displacedminimal -'a )ada )ai-n '-)i! Ini dian$&an
l-% A)l-. )ada 'a%$n 1950( dimana dila)&an %ail .an+ ,ai& )ada
;@ )ai-n! Indi&ai &n-a'i" adala% )ada "a&'$ d-)-i &$an+ dai
7 :m! P-n+,a'an &n-a'i" )ada m,iliai dini $n'$& 'a&i( dii&$'i
d-n+an )-n++$naan cast* brace-lama 8 min++$! Fa&'$ d-)-i d-n+an
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7?; mm %a$ di)i&i&an $n'$& -l-ai( bone grafting( dan "i&ai
in'-nal( -$ai $ia dan a&'i"i'a )ai-n! A)a,ila a$Cal+$ 15( a'a$
'-da)a' d-)-i ; mm( indi&ai dila&$&an "i&ai in'-na!
2=! O)-ai 7(5
a Art'r%sc%$y dila&$&an $n'$& m-n+-al$ai )-m$&aan -ndi(
m-ni&$ dan li+am-n'$m :$:ia'$m! Ini $+a da)a' dila&$&an $n'$&
)-nan+anan %-ma'%i dan d-,i( $n'$& )-d$ m-ni&$( dan
$n'$& arthroscopic-assisted reduction and fi/ation!
, #$en Reduct%n and Internal F&at%n 6!RI"5, Fi&ai "a&'$
da)a' m-n++$na&an plate dan screw( a'a$ %an.a m-n++$na&an
screw! P-mili%an im)lan ini ,-%$,$n+an d-n+an ,-n'$& "a&'$(
d-aa' )-$,a%an "a+m-n( dan &-mam)$an a%li ,-da% d-n+an
)-d$ )-ai!
: "i.s)si .s-ern)l da)a' di+$na&an )ada "a&'$ -+m-n'al dan
,i&ndil-( a'a$ &a$ dimana &$li' dan ain+an l$na& '-&-na
'a$ma )aa%! S-)-'i &-$a&an )ada 'a$ma high energy( .an+
-in+ )ada ,-n'$an a'a$ &-$a&an ain+an l$na& .an+ l$a!
M)n)7emen pos- oper)si
P-+-a&an awal da)a' dila&$&an -'-la% )-ai dan l$'$' m-n++$na&an
cast*brace -lama ; min++$( 'ida& m-la&$&an )ia&an -lama 8 min++$!
ala$)$n )-m$&aan -ndi 'ida& da)a' ,-'$l?,-'$l di-&n'$&i(
)-n.$$nan &-m,ali -ndi l$'$' adala% .an+ '-)-n'in+ $n'$& ,-da%
-&n'$&i -lan$'n.a!5
8, Pen)-)l).s)n))n 1r).-ur se9)r) umum
Dai -m$a )-nan+anan &-:-la&aan( a'ai .& m-$)a&an lan+&a% awal dan
"a&'$ di,idai -,-l$m di)inda%&an! Bidai "a&'$ d-n+an m-'d- T%ma?'i)-
splint $n'$& m-n+$an+i )-daa%an dan aa n.-i! B-i&an an'i,i'i& dan
anal+-'i& in'a-na!2
Pini)?)ini) 'inda&anC)-nan+anan "a&'$ m-li)$'i -d$&i( im,iliai( dan
)-n+-m,alian "$n+i dan &-&$a'an nmal d-n+an -%a,ili'ai/10
a Re+u.si
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R-d$&i "a&'$
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)-n.a'$an! Saaann.a adala% m-m)-'a%an&an -d$&i di '-m)a'n.a am)ai
'-adi )-n.-m,$%an! M-'d- $n'$& m-m)-'a%an&an im,iliai adala%
d-n+an ala'?ala' -&'-nal
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m-$)a&an )-n+,a'an -m-n'aa -,-l$m dila&$&an '-a)i d-"ini'i"
$n'$& m-n+$an+i )am- ''! Ta&i '$lan+ ,-im,an+ d-n+an
,a+ian P-an )ada -ndi l$'$'! Indi&ai 'a&i '-$'ama "a&'$
.an+ ,-i"a' &m$ni'i" dan -+m-n'al! M-n++$na&an :a' ,a:in+
.an+ di)aan+ -'-la% '-adi $nin "a&'$ -:aa &lini!
:= P-m,-ian ,a'?,a'an
P-m,-ian ,a'?,a'an dalam ,idan+ ')-di m-li)$'i/
1=! O,a'?,a' an'i?,a&'-i
2=! O,a'?,a' an'i in"lamai
6=! Anal+-'i& dan -da'i"
7=! Vi'amin
5=! In-&i l&al!2! T-a)i O)-a'i" 10(11
a=! P-maan+an plate dan screw '-$'ama )ada "a&'$ )&imal dan
di'al "-m$!
,=! M-m)-+$na&an K?nail( AO?nail( a'a$ -ni?-ni lain ,ai& d-n+an
)-ai '-'$'$) a'a$)$n '-,$&a!
:=! Fi&ai -&'-na '-$'ama )ada "a&'$ -+m-n'al( "a&'$ &m$ni'i"!
In"-:'-d )-$da'i a'a$ "a&'$ '-,$&a d-n+an &-$a&an
ain+an l$na& .an+ %-,a'!
Indi&ai 0pen 'eduction and 1nternal #i/ation
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, O'-a'%i'i/ K-adian a'a$ inid-nin.a ,-ma:am?ma:am dan
,-+an'$n+ dai d-aa' ,-n'$an dan &-mam)$an -d$&i! G-ala
da)a' 'im,$l -'-la% a'$ a'a$ d$a d-&ad- -'-la% 'a$ma!
K--l$$%an '-+an'$n+ )ada $ia( dan +a.a %id$) dai )ai-n!
: Si'-mi& / -m,li l-ma&( -m,li )a$
6! "ate/2(7
a $alunion / Bila '$lan+ -m,$% d-n+an "$n+i ana'mi a,nmal
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-lain "a&' ,il+i .an+ $+a m-$)a&an $a'$ "a&' .an+ an+a' --nial
dalam )-n.-m,$%an "a&'$!11
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DA"TAR PUSTAKA
1! Kottmeier, S. Am-i:an A:ad-m. " O'%)a-di: S$+-n! Di'al F-m$
%al- M!'ockwood 7 Green8s #ractures in 5dults, 9th Edition!
UK/ Li))in:'' illiam il&in! 2008! )! 1;8;?8!
7! Kal( K-nn-'% #! $:&-man( #-)% D! andbook of #ractures, ;thEdition! USA/ Li))in:'' illiam il&in! 2008!)! 720?;( 769?75(
755?86
5! K--,-( G! .ey opic in 0rthopaedic rauma 6urgery! Lndn/ Bi
S:i-n'i"i:! 2000! P! 78?;( 178?( 2;?9
8! i--l( S!Essentials of 0rthopaedic 6urgery, n:i- O'%)a-di: Ana'm.( 2 nd Ed! El-i-
Sa$nd-( 2010! 3al/ 251( 288?;( 2;8?622!
;! M'"i( SB! #racture &lassification in &linical =ractice Lndn/
S)in+-! 2008! 56?80!
9! Mill- MD( T%m)n SR( 3a' #A! 'e%iew of 0rthopaedics >thEdition!
P%ilad-l)%ia Sa$nd- El-i-! 2012! )! 615?8!
10! Raad( >! =engantar 1lmu Bedah 0rtopedi P-n-,i' PT *ai"
a'am)n-( #a&a'a( 2009! 3al ;2?;5( 92?97( 655?681( 687
11! A)l-. GA( Slmn L! Buku 5ar 0rtopedi 3an #raktur 6istem 5pley
Edisi ke-9! #a&a'a( 1995! id.a M-di&a!
http://orthoinfo.aaos.org/topic.cfm?topic=a00364http://orthoinfo.aaos.org/topic.cfm?topic=a00364
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