Langkah Langkah Praktis Menangani Kasus Kegawatan Dalam Orthopaedi

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Text of Langkah Langkah Praktis Menangani Kasus Kegawatan Dalam Orthopaedi

  • Langkah langkah praktis menangani kasus kegawatan dalam orthopaedi bagi dokter umumSUNARYO

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  • CVSUNARYO, dr., SpOT., SH., MH.Kes.Fellow International College Surgeon

    Lahir di Solo, 1 Agustus 1956Status : Menikah. Istri : Dr. Hj. Rina Dewi Hafil Anak : 1. Ayu Puspita Sari (Mhs.FK Undip). 2. M. Nadhil Sunaryo Putra (Mhs.FK Undip).

    Riwayat Pendidikan : 1. SD s/d SMA di Jakarta. 2. Dokter : FK UKI Jakarta (1984).3. SpOT : FK UI Jakarta (1999). 4. SH : Univ. Langlangbuana Bandung (2009).5. MH.Kes. : Unika Soegiyapranata Semarang (2007). 6. Lulus Advokat Peradi : (2010).

    Riwayat Pekerjaan : 1. Asisten Bagian Bedah FK UKI/RS PGI Cikini (1985-1987). 2. Staf Bagian Bedah RSU Dr. Abdoel Moeloek Bandar Lampung (1988).3. Kepala Puskesmas Kec. Padang Cermin Lampung Selatan (1989-1990).4. Kepala Puskesmas Kec. Kedondong Lampung Selatan (1991-1992).5. Dokter SpOT dan Kepala Instalasi Bedah Sentral RSUD Kota Tasikmalaya (sekarang)

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  • Riwayat Organisasi Ketua MKEK IDI Cabang Tasikmalaya (2010-2016).Ketua Komite Medik RSUD Kota Tasikmalaya (2010-2013).Ketua Komite Medik RSU Jasa Kartini Tasikmalaya (2010-2013).Ketua IDI Cabang Tasikmalaya (2004-2007, 2007-2010). Wkl Ketua I IDI Wilayah Jawa Barat : Bidang Organisasi dan Pembinaan Wilayah (2010-2013).Wkl Ketua II Ikatan Sarjana Hukum Indonesia Cab. Priangan Timur (2010-2013)Wkl Ketua Komite Medik RSJK Tasikmalaya (2006-2009).Wkl Ketua Komite Medik RSUD Tasikmalaya (2006-2009).

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  • *PendahuluanRuang lingkup orthopaedi dan traumatologiKelainan bawaanInfeksiInflamasiTumorTrauma extremitas dan tulang belakangKelainan metabolikCedera olah ragaDegeneratifRehabilitasi*

  • Kasus kasus emergensi dalam trauma orthopaediA. Fraktur terbukaB. DislokasiC. Fraktur dan dislokasiD. Fraktur dengan dislokasiE. Fraktur dengan gangguan NVD F. Fratur Teramputasi

  • A. Fraktur TerbukaFraktur : Terputusnya kontinuitas (discontinuitas) jaringan tulang, tulang rawan dan tulang rawan epiphysis.Fraktur Terbuka : apabila terdapat hubungan antara fragment tulang dengan dunia luar**

  • Principles of management of open fractures

    **1. Classification of open fractures2. Principles of surgical care for open fractures3. Dbridement4. Fixation of open fractures5. Soft-tissue care6. Primary amputation7. Modifiable risk factores

  • Fraktur TerbukaIn 1895, Stanley Boyd said The most important divisions of fractures - simple, compound and complicated - are based upon the condition of the soft parts.

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  • Dr. Ramon GustiloSeorang Professor Orthopaedi dari University of Minessota AS,Kelahiran Philipina mengelompokan fraktur terbuka berdasarkan kondidi jaringan lunaknya.Gustilo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures. A new classification of type III open fractures. J.Traum Aug;24(8):742-6)

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  • 1. Open fracture classification (Wound-severity classification) Gustilo and Anderson. (JBJS 1976) **

  • Ramon Gustilo classification of open fracture**

  • Grade I: fraktur dengan luka terbuka kurang dari 1 Cm, luka bersih, grs fr simple**

  • Grade II : Frakrur terbuka dengan luka > 1Cm, contaminated, grs fr simple**

  • Grade III : Fraktur terbuka, kerusakan jar lunak yg luas, kotor, grs fraktur segmental/komminutif **

  • Ramon Gustilo Grade III**

  • Ramon Gustilo Grade III**

  • Contoh Gr.III C Open FractureThe Gustilo-Mendoza-Williams open-fracture classification separately identifies, as type IIIC, those grade III open fractures with arterial injuries that require vascular repair to restore limb viability. Gustilo et al. demonstrated a 50% risk of osteomyelitis after such injuries, with amputation (early or late) a frequent outcome (Gustilo et al. (1990) The management of open fractures. J Bone Joint Surg 72(2):299-304).**

  • 2. Principles of surgical care for open fractures

    Open fractures need : prompt diagnosis appropriate intravenous antibiotics meticulous injury zone excision (dbridement) * fracture stabilization second look early soft-tissue cover after soft-tissue recovery

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  • Intravenous antibiotics for open fractures(Geroulanos & Hell /1989, Antimicrobial Prophylaxis in Surgery)

    Most infecting bacteria, except in very dirty wounds, are typical skin flora. A first generation cephalosporin (e.g., cefazolin 1-2 grams/8 hours) is often used, except for patients with penicillin allergy. For more severe open-fracture wounds, add an aminoglycoside (e.g., gentamycin 80 mg/8-12 hours). If agricultural contamination is present, high-dose intravenous penicillin is usually added (e.g., 5 million-10 million units/24 hours) and consider metronidazole. They should be started as soon as the open fracture is diagnosed, but continued for only 2-3 days.

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  • 3. DbridementBacterial contamination is always present with open fractures. Bacterial count and infection rate can be significantly reduced by prompt administration of intravenous antibiotics, in combination with surgical dbridement. Such surgery is frequently referred to as dbridement. This term is open to interpretation and denotes different procedures in different surgical contexts. Dbridement, as used in this discussion, means the surgical exposure of the whole pathological injury zone and the removal of all necrotic, contaminated, and/or damaged tissue, whether bony or soft-tissue.**

  • Dbridement of the injury zone in open fracturesThe injury zone excision must be complete, meticulous and radical. Early wound dbridement is the most important component of the care of any open fracture. The surgical site should be thoroughly irrigated (several liters of fluid optimally, a balanced salt solution, such as Ringer-lactate - to reduce the bacterial population). The epithet dilution is the solution to pollution has certain merit in this context.

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  • 4. Fixation of open fracturesOpen fractures need :surgical stabilization, usually external consider delayed definitive ORIFSurgical fixation, external, or internal, is the best way to stabilize an open fracture. This is done only after thorough injury zone dbridement.

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  • 5. Soft-tissue careOpen wound care :Avoid contamination Avoid desiccation Consider special dressings Cover promptlyAny open wound needs to be protected from secondary contamination

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  • Second lookIn cases with significant amounts of contaminated, dead, or possibly ischaemic, tissue, additional wound excision 48 hours later (second look) is often necessary if in doubt, look again.

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  • 6. Primary amputation for OFA mangled extremity is a life-threatening injury.Some extremity injuries are so severe that amputation is a safer and more humane option than attempted limb preservation.Injudicious efforts at salvage may be doomed to failure, with the risk of life-threatening complications, particularly infection.

    **The decision whether to amputate, or to try to save, a severely injured limb is one of the most controversial in trauma surgery

  • 7. Modifiable risk factores Poor nutrition In the malnourished, dietary supplements, vitamins and other forms of nutritional support should be instituted as soon as possible after emergency surgery.Malnourished patients have difficulty healing wounds and resisting infection. Simple screening tests, such as total lymphocyte count (
  • B. DISLOKASIKeluar / bergesernya salah satu permukaan tulang persendian dari tempatnyaMerupakan kasus emergensi yg harus segera di reposisiPada kasus neglected sering harus dilakukan open reduction /reposisi terbukaDapat menimbulkan AVN dikemudian hari

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  • Contoh kasus dislokasi dan reposisi

    COE KE 60 BALI

  • C. Fraktur dan dislokasi

    COE KE 60 BALI

  • D. Fraktur dengan dislokasi

    COE KE 60 BALI

  • E. Fraktur dengan gangguan NVD*

  • F. Fraktur teramputasi**

  • Pasca Amputasi**

  • Post amputation activities**

  • PRINSIP PENANGANAN TRAUMA DG FR TERBUKAAIR WAY DGN MENGAMANKAN C SPINEBREATHINGCIRCULATIONDISABILITYEXPOSUREATASI PERDARAHAN, dgn KLEM ATAUPUN BALUT TEKAN4 RMM : ATS, AB, ANALGETIK

  • KASUS-KASUS LAINAda kasus-kasus lain yang sebenarnya tidak fraktur atau simple fraktur tetapi mengalami overtreatment.Kasus-kasus tumor ekstremitas yang sebenarnya dapat diselamatkan harus diakhiri dengan amputasi.Kasus kongenital yang tidak mendapat pertolongan sejak awal **

  • Kasus-kasus pasca dukun**

  • Kasus-kasus tumor tulang**

  • Kasus-kasus neglected pd tumor **

  • Kasus-kasus kongenital**

  • PENUTUPHadapi semua kasus dengan tenangJangan membuat keadaan menjadi lebih parahKerjakan sesuai kewenangan dan kemampuanSelalu berada dalam lingkup SOP dan SPK

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  • Sekian dan terimakasih**

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