fraktur tertutup kominutif humerus

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    PORTOFOLIO

    FRAKTUR TERTUTUP KOMINUTIF HUMERUS DEXTR DENGAN 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"etit#-

      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#me-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 -ebel0m RS $#-ie me!#l#mi ke5el#k lit#-3 P#-ie me!e"#r#i motor3 P#-ie me!!0#k# helm me!e"#r#i motor "e!# #m0 ti"#k i!#t ber#$# km&/#m bert#br#k# "e!# -e$e"# m

    #r#h berl#6##3 P#-ie ter/#t0h k##( kem0"i# ter-eret 7 Mek#i-me ter/#t0h ti"#k " Setel#h ke5el#k## $#-ie -#" ti"#k #"# kel0#r "#r#h "#ri m0l0t( "# hi"0!3 Ti"#k #"# m m0t#h3 H#.# ter#-# be!k#k "

    $#"# le!# k## #t#-3 L#l0 "ib#6# ke RS D##0 S#l#k me"#$#tk# $ertolo!#3 Di R S#l#k $#-ie "i beb#t "# "i bi"#

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    •"#  tampa& sa&it sedan( Nadi  -05m •"esadaran  6M Suhu  24./7 6 •86S  9:;/M4  "L d*n

    • Te&anan darah  /0hial 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 d arteri 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

     'ei- 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 12 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%

    Hbsg &egati) egatie

    " 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& 12 am*ai 14 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(- jamiD • Inje&si Ranitidin $/ m($ jamiD • Inje&si de5ametas1n : m($jamiD • Inje&si me>1*alamin  ampul$: jamiD • 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&alistanda tanda =ra&tur

     Pemeri&saan penunjan(L9% G, R1nt(en

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    hialis ?%@ L11& len(an terpasan( tertutup per*an, lu&a merem*es ?'@ Feel  nyeri te&an ?@ M1Dement ROM limited 

    "es 6M 86S 9:;/M4 Status l1&alis ar *ra>hialis ?%@ L11& len(an terpasan( tertutup per*an, lu&a merem*es ?'@ Feel  nyeri te&an ?@ M1Dement ROM limited 

    86S 9:;/M4 Status l1&alis ar *ra>hialis ?%@ L11& len(an terpasan( tertutup per*an, lu&a merem*es ?'@, lu&a *ai&, nanah ?'@ Feel  nyeri te&an ?@ M1Dement ROM

    limited 

    8

    St * L1 te pe m *a Fe ? M

    lim

    A ' Closed fracture 1/3 edial !uerus coinutive displaced "d# $ %ulnus eksoriatu ultiple 

    ' Closed fracture 1/3 edial !uerus coinutive displaced "d# $ %ulnus eksoriatu ultiple 

    ' Closed fracture 1/3 edial !uerus coinutive displaced "d# $ %ulnus eksoriatu ultiple $ susp radial nerve in&ury  

    ' 'ost OR(F ec Closed fracture 1/3 edial !uerus coinutive displaced "d# $ Radial nerve palsy  

    ' 'ost OR(F ec Closed fracture 1/3 edial !uerus coinutive displaced "d# $ Radial nerve palsy  

    $ 'ost OR(F ec Closed fracture 1/3 edial !uerus coinutive displaced "d# $ Radial nerve  palsy  

    $ ' C 1/ !u co di $ R  pa

    P Pr1 r1nt(en humerus

    APlat I;F% RL $0 tpm tramad1l drip Inj. "et1r1la> 25 20 m( Inj. Ranitidin $5 amp Inj. Ondan>entr1n &p muntah

    I;F% RL $0 tpm 

    neur1san*e drip  amp&1l=  Inj. "et1r1la> 25 20 m( Inj. Ranitidin $5 amp Inj. Ondan>entr1n &p muntah Inj de5ametas1n

    I;F% RL $0 tpm 

    neur1san*e drip  amp&1l=  Inj. "et1r1la> 25 20 m( Inj. Ranitidin $5 amp Inj. Ondan>entr1n &p

    I;F% RL 0 tpm

    neur1*i1n drip Inj 6e=tria51ne $5 (r Inj. "et1r1la> 2520 m( Inj. %e5ametas1n 5: m(

    I;F% RL 0 tpm

    neur1*i1n drip Inj 6e=tria51ne $5 (r Inj. "et1r1la> 2520 m( Inj. %e5ametas1n 5: m(

    I;F% RL 0 tpm

    neur1*i1n drip Inj 6e=tria51ne $5 (r Inj. "et1r1la> 2520 m( Inj. %e5ametas1n 5: m(

    Pa

    d p R "1 O de

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     T9RIMA

    "ASIH