conference frscture

7/28/2019 Conference Frscture

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ConferencePembimbing:

dr. Panji Sananta, M.Ked, Sp.OT

Muhammad Cholis Hidayat(0910713053)


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IDENTITAS

Nama : Ny E

Jenis Kelamin : Wanita

Usia : 27 th

No Register : 1305250xxx Alamat : Jl. Danau Sentani Dalam

Status : Menikah

Pekerjaan : Ibu rumah tangga

Agama : Islam MRS : 25 Mei 2013


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SUBJEKTIF

Keluhan Utama :

Nyeri pada dada bagian atas dan lutut kanan

Mekanisme InjuriKecelakaan sepeda motor vs mobil. Kecelakaan

terjadi siang hari (11.00 WIB). Pasien saat itu

menyetir sendirian. Sepeda motor dan mobil

datang dari arah yang sama dan ketikabertabrakan, pasien terlempar ke depan. Jatuh

tengkurap di aspal dengan lutut menyentuh

tanah duluan, lalu kaki terlindas mobil.


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Riwayat penyakit dahulu : Riwayat trauma (-)

Riwayat pengobatan : Setelah terjadi kecelakaan,

pasien tidak meminum obat apapun selain yang

diberikan Puskesmas Pujon yakni infus dan juga bidai.

Tidak meminum obat anti nyeri atau jamu apapun.

Riwayat Keluarga : HT (-) DM (-) Keganasan (-)

Review of the system: pusing (-), mual (-), muntah (-),

pingsan (+), sesak nafas () sakit di perut (-) BAK (+)

BAB (+)


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STATUS GENERALIS

Primary Survey

Airway : Paten

Breathing : Normal, Simetris, RR = 20 x/menit

Circulation : Tensi = 100/70

Nadi = 102 x/menit

Akral hangat

Disability : GCS 456, Pupil bulat isokor 3 mm

Exposure : (-)


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Secondary Survey

K/L : an -/- ict -/-

JVP (-) Pembesaran KGB (-)

Tho : simetris c/ S1 S2 single m(-), g(-)P/ v l v Wh - l - Rh - l -

v l v - l - - l -

v l v - l - - l -Abd : Flat, soefl, Bising Usus (+)

Ext : Akral Hangat, AVN Distal (+)

SECONDARY SURVEY


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Alergy: -

Medication: infus dan bidai

Past medical history: -

Last meal: -

Event at injury: Kecelakaan lalu lintas

AMPLE


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REGIO SHOULDER DEXTRA-SINISTRA

L : Swelling (+) Deformity (+)

F : Ternderness (+) AVN distal (+)

M : ROM limited

REGIO FEMORIS DEXTRA

L : Swelling (+) Deformity (+)

F : Tenderness (+) AVN distal (+)

M : ROM limited

REGIO GENU DEXTRA

L : Deformity (+) Open Wound dasar retinaculum (+)

F : Tenderness (+) AVN distal (+)

M : ROM limited

STATUS LOKALIS


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CF Clavicula (D/S) 1/3 tengah

CF Femur (D) 1/3 Tengah

CF Patella (D) Open Wound Genu (D)

CKR 456

Obs TTT & TTA

WORKING DIAGNOSIS


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Foto Thorax AP/Lat

Foto Femur D AP/Lat

Foto Genu D AP/Lat Foto Pelvis AP

Skull AP/L

DL/FH/ SE

PLANNING DIAGNOSIS


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PEMERIKSAAN PENUNJANG


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Hematologi

Hemoglobin : 12,20

Eritrosit (RBC) : 4,09

Leukosit WBC : 16,80

Hematokrit : 36,7Trombosit PLT : 250

MCV : 89,7

MCH : 29,8

MCHC : 33,2

RDW : 12,5

PDW : 12

MPV : 10,5

P LCR : 29,4

PCT : 0,26

LED : 11 mm/jam

Hitung jenis :

-Eosinofil : 0,1 %

-Basofil : 0,0 %-Neutrofil : 86,8 %

-Limfosit : 9,9 %

-Monosit : 3,2

Lain-lain : -

Retikulosit :

-Retikulosit absolut: 0,0347

-retikulosit : 0,78

HASIL LABORATORIUM


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Faal Hemostasis

PPT

-Pasien : 14 detik

-Kontrol : 11 detik-INR : 1,21

APTT

-Pasien : 27,7 detik-kontrol : 27 detik

PPT dan APTT dalam

batas normal

Elektrolit Serum

Natrium : 137

Kalium : 3,60

Klorida : 111

HASIL LABORATORIUM


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CF Clavicula (D/S) 1/3 Tengah

CF Femur (D) 1/3 Tengah Comminuted

CF Patella (D) Incomplete

Open Wound Regio Genu (D)

CKR 456 + Edema Serebri

DIAGNOSIS


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O2 NRBM 10 lpm IVFD RL 2000 cc

Injeksi :

Ketorolac 3x10 mg Ranitidin 2x1 gr

Cefazolin 3x1 gr

Tetagram 1 gr 250 iu iv i.m.

Debridement

Skin Traksi beban 5 kg + Arm Sling

ORIF + Plate Fixation

Rawat ruangan (Orthopedi, NS, TKV)

RENCANA TERAPI


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Observasi Tanda-tanda vital

Observasi AVN distal

Observasi tanda-tanda kompartemen sindrom

RENCANA MONITORING


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KIE

RENCANA EDUKASI


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TERIMA KASIH


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Winquist and Hansen classification of femoral shaft fractures.


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Type I: Minimal or no comminution

Type II: Cortices of both fragments at least

50% intact

Type III: 50% to 100% cortical comminution

Type VI: Circumferential comminution with no

cortical contact

Open versus closed injury

Location: proximal, middle, or distal

one-third

Location: isthmal, infraisthmal or

supracondylar

Pattern: spiral, oblique, or transverse

Comminuted, segmental, or butterfly

fragment

Angulation or rotational deformity

Displacement: shortening ortranslation

This is based on fracture

comminution.

It was used before routine placement

of statically locked IM nails.

Winquist and Hansen classification of femoral shaft fractures.


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Figure 32.1. Deforming muscle forces on

the femur; abductors (A), iliopsoas (B),

adductors (C), and gastrocnemius origin

(D). The medial angulating forces areresisted by the fascia lata (E). Potential

sites of vascular injury after fracture are

at the adductor hiatus and the

perforating vessels of the profundafemoris. (From Bucholz RW, Heckman JD,

eds. Rockwood and Greens Fractures

in Adults, 5th ed. Baltimore: Lippincott

Williams & Wilkins, 2002.)


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Fracture Patella Classification

Open versus

closed

Nondisplaced

versus displaced

Pattern: stellate,

comminuted,

transverse,vertical

(marginal), polar

Osteochondral


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