fraktur tertutup kominutif humerus
TRANSCRIPT
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PORTOFOLIO
FRAKTUR TERTUTUP KOMINUTIF HUMERUS DEXTRDENGAN PALSI NERVUS RADIALIS
Oleh:
dr. Medisiana S. S
Dokter Pembimbi!:
dr. H. Muhammad Adijayansyah, Sp. OT
Dokter Pe"#m$i!:
dr. Hesti Sasmila Wardani
%AGIAN&SMF ILMU %EDAH ORTOPEDI
RSUD %AN'AR%ARU
%AN'AR%ARU
M#ret( )*+,
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I"etit#-
Nama penderita Tn. A!
!enis "elamin laki- laki #mur $$ tahun
Alamat %anau Sala&
Pe&erjaan '
A(ama Islam Status per&a)inan *lm
meni&ah
Su&u +anjar
Tan((al MRS - $/ Tan((al peri&sa $0 $/
N1. Re( $$234-
A#me-i-
KU : N.eri le!# k## #t#-
RPS :P#-ie "#t#! ke IGD%#/#rb#r0 r0/0k# "#ri RS D#"e!# "i#!o-i- 1r#kt0r h0mer0- "e2tr#3 4 /#m -ebel0mRS $#-ie me!#l#mi ke5el#klit#-3 P#-ie me!e"#r#i motor3 P#-ie me!!0#k# helmme!e"#r#i motor "e!# #m0 ti"#k i!#t ber#$# km&/#mbert#br#k# "e!# -e$e"# m
#r#h berl#6##3 P#-ie ter/#t0hk##( kem0"i# ter-eret 7Mek#i-me ter/#t0h ti"#k "Setel#h ke5el#k## $#-ie -#"ti"#k #"# kel0#r "#r#h "#ri m0l0t( "# hi"0!3 Ti"#k #"# mm0t#h3 H#.# ter#-# be!k#k "
$#"# le!# k## #t#-3 L#l0"ib#6# ke RS D##0 S#l#kme"#$#tk# $ertolo!#3 Di RS#l#k $#-ie "i beb#t "# "i bi"#
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•"# tampa& sa&it sedan( Nadi -05m•"esadaran 6M Suhu 24./7 6•86S 9:;/M4 "L d*n
• Te&anan darah /0hial de5tra • Look • Terpasan( *idai, Lu&a ?'@, pus ?'@, *en(&a& ?@, hemat1m ?'@, de=1rmitas ?@
• Feel • Suhu sama den(an daerah se&itar, nyeri te&an ?@, &repitasi ?@, >apillary reBll time C$
deti&, pulsasi arteri ?@,Sensi*ilitas hip1estesi sepanja( distri*usi radial nerve, pulsasi darteri radialis tera*a
• Move • 8era&an a&ti= dan pasi= dari sendi punda& dan si&u tida& dapat dieDaluasi &arena nyeri
• Special Test • 9&stensi jari jemp1l ?'@, e&stensi per(elan(an tan(an ?'@, OK sign ?@, a*du&si dan addu
di(iti ?@
Status L1&alis
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P9M9RI"SAAN P9N#N!AN8
'ei- Pemerik-## H#-il Nil#i Norm#l
Hb 13,4 12 – 18 gr/dl
Leukosit 10400 4000-10000/mm3
Trombosit 196000 100000 – 400000/mm3
Hematokrit 36% 36 – %
L!" 14 0 – 20 mm/#am
$T 10 2- 6 me&it
'T 12 1 – 3 me&it
Hitu&g (e&is
'aso)il
!osi&o*+il
'ata&g
egme&
Lim)osit
o&osit
0
1
2
.4
20
3
0 – 1%
1 – 4%
2 – 6%
3 – 80%
1 – 0%
2 – 8%
Hbsg &egati) egatie
" 100 11 mg/100 ml
T 42 Lk sd 3./L5 r sd 31 /L
T 30 Lk sd 43 /L5 r sd 32 /L
reum 41 1-0 mg/100 ml
rotei& total 6 6 – 82 gr/100 ml
7reati&i& 12 am*ai 14 mg/100 ml
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• Fra&tur &1minuti= tertutup 2 medial humerus &a•
Radial nerve palsy &anan
%ia(n1si
s
• I;F% RL $0 tpm• Tramad1l %rip ampul• Inje&si "et1r1la> 20 m(- jamiD• Inje&si Ranitidin $/ m($ jamiD• Inje&si de5ametas1n : m($jamiD• Inje&si me>1*alamin ampul$: jamiD• Inje&si 1ndan>entr1n : m( apa*ila muntah• Pr1 ORIF E e&spl1rasi nerDus tan((al $ %esem*
Terapi
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P9M+AHASAN Status l1&alistanda tanda =ra&tur
Pemeri&saan penunjan(L9% G, R1nt(en
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hialis ?%@L11& len(anterpasan( tertutupper*an, lu&amerem*es ?'@Feel nyeri te&an ?@M1Dement ROMlimited
"es 6M86S 9:;/M4Status l1&alis ar*ra>hialis ?%@L11& len(anterpasan( tertutupper*an, lu&amerem*es ?'@Feel nyeri te&an ?@M1Dement ROMlimited
86S 9:;/M4Status l1&alis ar*ra>hialis ?%@L11& len(anterpasan( tertutupper*an, lu&amerem*es ?'@, lu&a*ai&, nanah ?'@Feel nyeri te&an?@M1Dement ROM
limited
8
St*L1tepem*aFe?M
lim
A ' Closed fracture 1/3edial !ueruscoinutive displaced"d#$ %ulnus eksoriatuultiple
' Closed fracture 1/3edial !ueruscoinutive displaced"d#$ %ulnus eksoriatuultiple
' Closed fracture 1/3edial !ueruscoinutivedisplaced "d#$ %ulnus eksoriatuultiple$ susp radial nervein&ury
' 'ost OR(F ecClosed fracture 1/3edial !ueruscoinutivedisplaced "d#$ Radial nerve palsy
' 'ost OR(F ecClosed fracture 1/3edial !ueruscoinutivedisplaced "d#$ Radial nerve palsy
$ 'ost OR(F ecClosed fracture1/3 edial!ueruscoinutivedisplaced "d#$ Radial nerve palsy
$ 'C1/!ucodi$ R pa
P Pr1 r1nt(en humerus
APlatI;F% RL $0 tpmtramad1l dripInj. "et1r1la> 25 20 m(Inj. Ranitidin $5 ampInj. Ondan>entr1n &pmuntah
I;F% RL $0 tpm
neur1san*e drip amp&1l= Inj. "et1r1la> 25 20 m(Inj. Ranitidin $5 ampInj. Ondan>entr1n &pmuntahInj de5ametas1n
I;F% RL $0 tpm
neur1san*e drip amp&1l= Inj. "et1r1la> 25 20m(Inj. Ranitidin $5ampInj. Ondan>entr1n &p
I;F% RL 0 tpm
neur1*i1n dripInj 6e=tria51ne $5(rInj. "et1r1la> 2520m(Inj. %e5ametas1n5: m(
I;F% RL 0 tpm
neur1*i1n dripInj 6e=tria51ne $5(rInj. "et1r1la> 2520m(Inj. %e5ametas1n5: m(
I;F% RL 0 tpm
neur1*i1n dripInj 6e=tria51ne $5(rInj. "et1r1la> 2520m(Inj. %e5ametas1n5: m(
Pa
dpR"1Ode
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T9RIMA
"ASIH