gerak 070805 dr agung trauma
DESCRIPTION
bbTRANSCRIPT
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LUKA &
FRAKTUR
Dr Agung Widianto, SpB
FK Universitas Islam Indonesia
Yogyakarta
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Definisi
• Terputusnya kontinuitas jaringan kulit• Hilang atau rusaknya sebagian jarigan
tubuh
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Penyebab Luka
• Trauma benda tajam• Trauma benda tumpul• Perubahan suhu• Zat kimia• Ledakan • Sengatan listrik• Gigitan hewan
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Macam Luka
Berdasarkan Bentuknya :• Luka terbuka • Luka tertutup :
- kontusio / lebam- hematoma
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Macam Luka
Berdasarkan letaknya :• Tersembunyi• Jelas
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Macam Luka
Berdasarkan jaringan yg terkena :• Luka dalam • Luka dangkal
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Macam Luka
Berdasarkan berat ringannya :• Luka ringan• Luka berat• Luka parah
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Macam Luka
Berdasarkan klinis :• Luka bersih• Luka terkontaminasi• Luka infeksi
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Luka Terbuka
• Luka lecet (vulnus excoriatum)
• Penanganan :
Rawat terbuka
Desinfektan (betadin / obat merah)
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Luka Terbuka
• Luka iris (vulnus scissum)
• Penanganan : • Desinfeksi• Jahit / haecting
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Luka Terbuka
• Luka bacok (vulnus caesum)
• Penanganan :• Desinfeksi• Debridemen• Eksplorasi• Jahit / haecting
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Luka Terbuka
• Luka robek (vulnus laceratum)
Penanganan :• Desinfeksi• Debridement• Jahit / haecting
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Luka Terbuka
• Luka tusuk (vulnus punctum)
Penanganan :• Desinfeksi• Pisau jangan
dicabut• Rujuk• Operasi
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Luka Terbuka
• Luka hancur (crush injury)
Penanganan :• Hentikan perdarahan
/ tekan• Rujuk
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Luka Terbuka• Luka tembak (vulnus sclopetorum)
Penanganan :• Hentikan perdarahan / tekan• Rujuk
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Luka Bakar (burn/combustio)
• Penanganan :
Dinginkan dengan air
Jangan diolesi dengan kecap/mentega
Olesi dengan obat luka bakar
Bila luas, rujuk ke rumah sakit
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LUKA BAKAR
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BURN SIZE / AREA
“Rule of Nines”
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Luka Bakar
Indikasi rawat inap :• Penderita syok atau terancam syok
Anak > 10%
Dewasa > 15%• Luka bakar di wajah, mata, tangan atau
kaki, perineum/ kemaluan• Luka bakar inhalasi
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Penyembuhan Luka
Tiga fase :• Fase inflamasi ( .. - hari ke 5)
Rubor, kalor, dolor, tumor, fungsiolesa• Fase proliferasi ( hari ke 5 sd minggu III)
Jar. Granulasi/kalus tulang• Remodelling jaringan (3-6 bulan)
Jaringan parut/fibrosis
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Penyembuhan Luka
• Primer :
Bila luka bersih, tidak terinfeksi dan dijahit dengan baik
• Sekunder
Luka dibiarkan terbuka, granulasi• Primer tertunda
Dibiarkan terbuka, granulasi, jahit
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Penanggulangan Luka
Sebelum mulai• Baca bismillah• Perhatikan keadaan umum• Cari kemungkinan cedera lain
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Penanggulangan Luka
• Penanganan hari pertama• Anestesi lokal atau umum• Pembilasan luka• Sterilisasi kulit sekitar luka• Pembersihan luka (debridement)
– Kotoran– Benda asing– Eksisi jar mati pinggir kulit
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Penanggulangan Luka
Amati luka pada hari ketiga• Ganti balut• Amati adakah infeksi
Amati hari ketujuh• Bila luka kering dan baik, angkat jahitan
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TRAUMAFraktur
(Patah Tulang)
Dr. Agung Widianto, SpBBag Bedah FK UII
Yogyakarta
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FRACTURE IS A BREAK
IN THE STRUCTURAL CONTINUITY OF THE BONE
FRAKTUR TERTUTUP
(SIMPLE FRACTURE) FRAKTUR TERBUKA
(COMPOUND
FRACTURE)
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Jenis patah tulang:
• Patah tulang tertutup Tulang yang patah tidak tampak dari luar.
• Patah tulang terbuka Tulang yang patah tampak/tidak dari luar karena tulang telah menembus kulit atau kulit mengalami robekan.
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Patah Tulang Terbuka
grade IIIB - IIIC
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Jenis patah tulang:
• Patah tulang avulsi. disebabkan oleh kontraksi otot yang kuat, sehingga menarik bagian tulang tempat tendon otot tersebut melekat. Paling sering terjadi pada bahu dan lutut, tetapi bisa juga terjadi pada tungkai dan tumit.
• Patah tulang patologis. Terjadi jika sebuah tumor (biasanya kanker) telah tumbuh ke dalam tulang dan menyebabkan tulang menjadi rapuh. Tulang yang rapuh bisa mengalami patah tulang meskipun dengan cedera ringan atau bahkan tanpa cedera sama sekali.
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The Mechanism of Fracture
• SINGLE TRAUMATIC INCIDENCE
• REPETITIVE STRESS
• ABNORMAL WEAKENING OF BONE
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Jenis dan beratnya patah tulang dipengaruhi oleh:
- Arah, kecepatan dan kekuatan dari tenaga yang melawan tulang - Usia penderita - Kelenturan tulang - Jenis tulang
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Fraktur Akibat Kejadian Trauma
• DIRECT FORCE / LANGSUNG• INDIRECT FORCE / TIDAK LANGSUNG
TWISTING/PUNTIRAN – SPIRAL BENDING/TEKUKAN – TRANSVERSE BENDING COMPRESSING - TEKANAN COMBINATION OF TWISTING, BENDING AND
COMPRESSING PULLING/TARIKAN
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Macam Fraktur
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Macam Fraktur
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PENYEMBUHAN FRAKTUR
1. Std. Destruksi / Hematom 2. Std. Inflamasi & Proliferasi sel3. Std. Pembentukan kalus4. Std. Konsolidasi5. Std. Remodelling
1 2 3 4 5
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Fraktur Union Konsolidasi Remodelling
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Faktor Penyebab Non-Union Fracture
• Motion / pergerakan• Infection / infeksi• Gap / celah• Others (Metabolik, Umur, Keadaan umum)• Gangguan vaskularisasi
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NON UNION
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Clinical features of Fractures
• PAIN AND TENDERNESS• LOSS OF FUNCTION• DEFORMITY• ABNORMAL MOBILITY
AND CREPITUS• NEUROVASCULAR
INJURY
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Treatment of Fracture
• EMERGENCY CARE• DEFINITIVE TREATMENT • REHABILITATION
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Definitive Treatment of Fracture
• CLOSED TREATMENT
• OPEN REDUCTION INTERNAL FIXATION
• OPEN REDUCTION EXTERNAL FIXATION
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Types of Immobilization
• PLASTER OF PARIS• FIBERGLASS CAST• SKIN TRACTION • SKELETAL TRACTION
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CARA GIP
Stockingette Padding
PLESTER SLAB
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Bryant ‘s / Gallow’straction
Buck Extension
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Indication for Operative Treatment
• FAILURE OF CLOSED METHODS• CONTRA - INDICATION OF CLOSED
METHODS• FRACTURE AND DISPLACED
ARTICULAR SURFACES
Fracture and dislocation
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61ORIF (OPEN REDUCTION AND INTERNAL FIXATION)
Plate - screw Fixasi External
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ORIF
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Dislocation
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Pada fraktur yang
dinilai:
aposisi dan panjang
angulasi
displacement
rotasi
Pada dislokasi:• jauhnya terlepas• subluksasi/luksasi• adanya fraktur?
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Posterior Dislocation of The Hip
CLINICAL SIGNS:
• SHORTENED/
FLEXION
• INTERNAL
ROTATION
• ADDUCTION
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Method of Closed Reduction
• GRAVITY METHOD OF STIMSON
• ALLIS’ MANOUVER
• BIGELOW’S MANOUVER
• HIPPOCRATIC TECHNIQUE
Posterior dislocation of the hip
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PENATALAKSANAAN TRAUMA SENDI
Metode Stimson
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Complication …
• EARLY:
Sciatic nerve paresis
Irreducible posterior dislocation (3-
16%)
Knee ligament injury
Recurrent dislocation
Posterior dislocation of the hip
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Anterior shoulder dislocation
• Elbow flexion
• Shoulder abduction
• Endorotation
badge area
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Methods of Close reduction
Stimson gravitation
- analgesic
- sedatives
- weight load 2 kg
- 5-10 minutes
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Hippocratic Methods
Methods of Close reduction
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Methods of Close reduction
Traction and Counter traction methods
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Compartment Syndrome
Crush Injury
with Compartment Syndrome
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Etiologi of Compartment Syndrome
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Mechanism• compartment size:
– tight dressing– tight external support
• compartment contents:–bleeding– capillary permeability: post ischemic
swelling, exercise, trauma, burns, intra-arterial drug
– capillary pressure: venous obstruction, muscle hypertrophy
Compartment syndrome
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Symptoms and Signs
• Clinical Features: 5P–pain–pallor–pulselessness–paralysis–paresthesia
Compartment syndrome
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Management
• Remove circumferential bandages• supplemental oxygen administration• split the plaster bandage• fasciotomy • Wounds should be left open • May require delayed closure or skin grafting
Compartment syndrome
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Incision of Compartment Syndrome
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ACUTE COMPARTMENT SYNDROME
Surgical treatment : decompression / fasciotomy in the lower leg
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ACUTE COMPARTMENT SYNDROME
Post fasciotomy
� Leave the wound OPEN
Wound complications in 51% of cases with PRIMARY / DELAYED closure only 5% in split skin graft patients
Skin graft performed after 1 – 3 weeks
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Selamat
Belajar