Download - 156743728-d-i-s-l-o-k-a-s-i.ppt
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D I S L O K A S ID I S L O K A S I( Luksasio )( Luksasio )
Dr. A. Artanto Dibyosubroto, SpOT, Dr. A. Artanto Dibyosubroto, SpOT, FICSFICS
Bagian Bedah Orthopaedi & Bagian Bedah Orthopaedi & TraumatologiTraumatologi
RS Daerah KudusRS Daerah Kudus
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• Definisi :
Kehilangan hubungan yang normal antara 2 permukaan sendi secara komplit
Subluksasi Subluksasi tidak komplit
Fraktur dislokasiFraktur dislokasi Disertai fraktur dari tulang persendian
tersebut
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Penyebab : Trauma Infeksi : Sinovitis dengan kapsul sendi joint laxity Muscle Imbalance :
Polio : Otot-otot normal kontraksi otot yang normal
Cerebral palsy : keseimbangan antara otot-otot spastik dengan otot–otot normal. Kongenital : CDH
Gangguan plate acetabulum jadi dangkal
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Pemeriksaan Fisik : Anamnesa : Riwayat trauma Inspeksi : Swelling
Deformitas Gerakan abnormal Nyeri setempat
Rontgen : Akan lebih jelasProyeksi AP – Lateral
Terapi : Kasus akut Dini lanjut Reposisi tertutup gagal
reposisi terbuka
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Dislokasi Hip JointDislokasi Hip Joint Sendi paling stabil ( ball and socket ) Trauma berat KLL, jatuh
Ada 3 type : Dislokasi Hip PosteriorDislokasi Hip Posterior ( dashboard injury )
Paling sering Hip : - Flexi – Adduksi – Internal rotasi Shortening Spasme ototRontgen : …
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Terapi
Reposisi tertutup
Gagal / + fraktur reposisi terbuka Komplikasi :
AVN Lesi N. Schiatic Post traumatic degenerativa joint dislokasi
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Dislokasi Hip AnteriorDislokasi Hip Anterior
Jarang terjadi Hip :
Fleksi –abduksi - eksternal rotasi
Shortening
Terapi : Reposisi tertutupReposisi tertutup bila gagal / + fraktur : reposisi terbuka
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Reposisi tertutup : Allis Maneuver
bila gagal / + fraktur reposisi terbuka
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Dislokasi CentralDislokasi Central
- Disertai fraktur acetabulum
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Terapi Konservatif :
Traksi
Operatif :
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Dislokasi Shoulder JointDislokasi Shoulder Joint Sering terjadi
Cavitas glenoidalis dangkal
caput humerus besar
Dislokasi Anterior Subcoracoid Subglenoid
Subclavicular
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Gambaran klinis :
Rontgen ::
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Terapi :Terapi :
Reposisi tertutup
Ada 3 cara : Stimson maneuver Milch maneuver Hippocratic maneuver
Post reposisi :
imobilisasi dlm posisi : adduksi–internal rotasi dengan sling selama 3 mgg.
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Komplikasi :Komplikasi : Recurrent dislocation operatif
Gangguan N. Axillaris
Ruptur rotator cuff
Interposisi caput longus dari tendon biceps
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Dislokasi PosteriorDislokasi Posterior
Jarang
Gambaran klinis :Gambaran klinis : Adduksi – Internal rotasiAdduksi – Internal rotasi Ant. Fullness of shoulder lostAnt. Fullness of shoulder lost Coracoid process prominentCoracoid process prominent Humeral head prominentHumeral head prominent
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Rontgen :
Terapi :
Reposisi tertutup
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Dislokasi Elbow JointDislokasi Elbow Joint
PosteriorPosterior
AnteriorAnterior
LateralLateral
MedialMedial
DivergenDivergen
sering sering disertai disertai dng fraktur dng fraktur
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Terapi :Reposisi tertutup
gagal / + fraktur Reposisi terbuka
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Dislokasi Knee Dislokasi Knee Joint :Joint :
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Dislokasi Subtalar Joint & TalusDislokasi Subtalar Joint & Talus
( ankle joint ):
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T R A K S IT R A K S I
Dr. A. Artanto Dibyosubroto, SpOT, Dr. A. Artanto Dibyosubroto, SpOT, FICSFICS
Bagian Bedah Orthopaedi & Bagian Bedah Orthopaedi & TraumatologiTraumatologi
RS Daerah KudusRS Daerah Kudus
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T r a k s i :T r a k s i :
Upaya pengobatan atau rehabilitasi Upaya pengobatan atau rehabilitasi pasca kelainan / cedera sistem pasca kelainan / cedera sistem muskuloskeletal dengan menggunakan muskuloskeletal dengan menggunakan traksi ( tarikan ) padanya secara terus traksi ( tarikan ) padanya secara terus menerus.menerus.
Pada Tulang ( traksi skeletal ) Pada kulit ( traksi kulit )
Traksi menetap ( fixed traction ) Traksi berimbang ( balanced traction )
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Tujuan : Reposisi ( fraktur, dislokasi )
Imobilisasi ( setelah reposisi )
Contraction deformitas : Kontraktur
Mengurangi rasa nyeri : fraktur, coxitis / gonitis TBC
Mencegah deformitas
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Prinsip :Prinsip : Ada traksi dan kontra traksi Kontra traksi : gravitasi / BB Pasien Traksi - kontra traksi mengikuti hukum alam Traksi – kontra traksi tidak menimbulkan komplikasi
Komplikasi tarikan :Komplikasi tarikan : Spasme pembuluh darah Kelumpuhan saraf Iskemi kulit
Komplikasi atas traksi :Komplikasi atas traksi : Infeksi tusukan pin Alergi plester
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Skin traction :Skin traction : Plester ( adhesive tape ) Karet busa ( joint rubber )
Tekanan negatif dalam busa karet Beban traksi : max. 5 kg bila nekrosis kulit
Kontra indikasi :Kontra indikasi : Abrasi kulit Lacerasi kulit Infeksi kulit Gangguan sirkulasi
kulit
Komplikasi :Komplikasi : Alergi Abrasi /
ekskoriasi Decubitus Parese N.
Peroneus
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Skeletal Skeletal TractionTraction
Alat yang dipakai :
Steinmann Pin
Denham Pin
Kirschner wire
Screw
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Lokasi Pemasangan:Lokasi Pemasangan:
Tuberositas tibia Supracondyler femur Trochanter mayor Calcaneus Olecranon Metacarpal
Komplikasi :Komplikasi : Infeksi ( Pin trac inf. ) Over traction Distraksi fragmen fraktur Kerusakan ligamentum bl.lama Kesalahan penempatan pin Merusak Epiphyseal plate (pada anak) Spasme vaskuler – parese saraf
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Traksi menetapTraksi menetap
(fixed traction)(fixed traction)
Digunakan pada Digunakan pada transportasi / transportasi / evakuasi pasien evakuasi pasien dengan frakturdengan fraktur
Traksi berimbangTraksi berimbang
(balanced traction)(balanced traction)
Adalah Adalah keseimbangan keseimbangan dinamik antara traksi dinamik antara traksi
dengan kontra dengan kontra traksitraksi
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Traksi berimbang Traksi berimbang dengan dengan bidai bidai ThomasThomas
Traksi berimbang Traksi berimbang dengan bidai dengan bidai BohlerBohler
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Traksi berimbang Traksi berimbang dengan traksi dengan traksi kulitkulit
Bryant tractionBryant traction
Buck extension Buck extension tractiontraction
Hamilton Russel Hamilton Russel tractiontraction
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