Rahayu Tri Nuritasari

8/18/2019 Rahayu Tri Nuritasari

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Rahayu Tri Nuritasari

Jumat, 25 Oktober 2013

ASKEP GEN !A"G# $AN GEN !AR#

#AKA"A%

S&STE# #SK"OSKE"ETA" &

“GENU VALGUM DAN GENU VARUM“

$&SSN O"E% 'CAHYO SANG WAHYU

NILSA PRIH UTAMI

NURVINA TAURIMASARI

RAHAYU TRI NURITASARI

TRIONO

SEKO"A% T&NGG& &"# KESE%ATAN

PATR&A %SA$A ("&TAR

2013

(A( &

PEN$A%"AN

1)1 "atar (e*aka+Deformitas ar!s "a# a$%!s mer!&!' 'e(a"a a#%!$asi a)#orma$ "ari s!at!

e'stremitas* Deformitas a#%!$asi terse)!t "a(at ter&a"i (a"a se#"i+ ata! (a"a t!$a#% "i "e'at

se#"i+ #am!# "a(at &!%a ter&a"i (a"a ta#%'ai t!$a#%*

Ge#! ar!m "a# %e#! a$%!m+ mer!(a'a# 'e',a-atira# !m!m (a"a ta,!#.ta,!#

a-a$ 'e,i"!(a#* Ge#! ar!m a"a$a, a#%!$asi t!$a#% "ima#a se%me# "ista$ "ari se#"i $!t!t

me#!&! %aris te#%a,+ se"a#%'a# %e#! a$%!m a"a$a, a#%!$asi t!$a#% "ima#a se%me# "ista$

"ari se#"i $!t!t me#&a!,i %aris te#%a,* U#t!' ma/oritas a#a'+ masa$a, i#i mer!(a'a# ariasi

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#orma$ 0fisio$o%is1+ "a# mem)ai' seara s(o#ta#* Se)a%ia# $ai##/a+ a'a# me#%a$ami masa$a,

'osmeti' ata!(!# f!#%si /a#% memer$!'a# (e#/a#%%a 0brace1 "a# ti#"a'a# (em)e"a,a#*

A#am#esis+ (emeri'saa# fisi'+ "a# (emeri'saa# (e#!#&a#% /a#% )ai' "a(at mem)a#t!

me#%ea$!asi masa$a, terse)!t*

1)2 Rumusa+ #asa*ah

3* A(a'a, /a#% "ima's!" "e#%a# Ge#! ar!m "a# %e#! a$%!m4

2* A(a (e#/e)a) "ari Ge#! ar!m "a# %e#! a$%!m4

5* 6a%aima#a ma#ifestasi '$i#is "ari Ge#! ar!m "a# %e#! a$%!m4

7* 6a%aima#a (atofisio$o%i "ari Ge#! ar!m "a# %e#! a$%!m4

8* A(a (emeri'saa# (e#!#&a#% !#t!' Ge#! ar!m "a# %e#! a$%!m4

9* 6a%aima#a 'om($i'asi Ge#! ar!m "a# %e#! a$%!m4

:* 6a%aima#a (e#ata$a'sa#aa# Ge#! ar!m "a# %e#! a$%!m4

;* 6a%aima#a as!,a# 'e(era-ata# (a"a '$ie# "e#%a# Ge#! ar!m "a# %e#! a$%!m41)3 Tu-ua+

1)3)1 Tu-ua+ mum

Me#&e$as'a# te#ta#% Ge#! ar!m "a# %e#! a$%!m "a# As!,a#


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T&NJAAN PSTAKA

2)1 $e/i+isi

Deformitas ar!s "a# a$%!s mer!&!' 'e(a"a a#%!$asi a)#orma$ "ari s!at!

e'stremitas* Deformitas a#%!$asi terse)!t "a(at ter&a"i (a"a se#"i+ ata! (a"a t!$a#% "i "e'at

se#"i+ #am!# "a(at &!%a ter&a"i (a"a ta#%'ai t!$a#%*

Varus a"a$a, a#%!$asi /a#% me#%i'!ti (o$a $i#%'ara# ima%i#er "ima#a (asie# )era"a*

• Cubitus varus a"a$a, )er'!ra#%#/a s!"!t $i(at si'! 0carrying angle1*

• Coxa vara a"a$a, )er'!ra#%#/a s!"!t $e,er.ta#%'ai femora$ 0=35>?1*

• Genu varum ata! bow leg 0'a'i O1 a"a$a, 'o#"isi "ima#a $!t!t )er&a!,a# saat 'a'i

"isat!'a#*

• Heel varus a"a$a, )er'!ra#%#/a s!"!t a#tara a'sis 'a'i "e#%a# t!mit+ se(erti (a"a (osisi

i#ersi*

• Talipes equinovarus a"a$a, "eformitas i#ersi "ari 'a'i+ )iasa "isertai "e#%a# e@!i#!s

0"eformitas f$e'si ($a#tar1 "ari se#"i (er%e$a#%a# 'a'i 0seri#% "item!'a# (a"a 'e$ai#a#

'o#%e#ita$ clubfoot 1*

• Metatarsus varus ata! metatarsus aduktus 0isti$a, /a#% $e)i, te(at1 a"a$a, "eformitas

a"!'t!s "ari )a%ia# 'a'i "e(a# 0 forefoot 1 ter,a"a( )a%ia# 'a'i )e$a'a#% 0hind foot 1*

• Hallux varus a"a$a, "eformitas a"!'si i)! &ari 'a'i me$a$!i se#"i metatarsofa$a#%ea$*

Valgus a"a$a, a#%!$asi /a#% ti"a' me#%i'!ti (o$a $i#%'ara# ima%i#er "ima#a (asie#

)era"a*

• Cubitus valgus a"a$a, me#i#%'at#/a s!"!t $i(at si'! 0carrying angle1

• Coxa valga a"a$a, me#i#%'at#/a s!"!t $e,er.ta#%'ai femora$ 035>?1

• Genu valgum ata! knock knee 0'a'i B1 a"a$a, 'o#"isi "ima#a 'a'i )er&a!,a# saat $!t!t

"isat!'a#*

• Heel valgus a"a$a, me#i#%'at#/a s!"!t a#tara a'sis 'a'i "e#%a# t!mit+ se(erti (a"a (osisi

eersi*

• Talipes calcaneovalgus a"a$a, "eformitas eersi "ari 'a'i "e#%a# 'om)i#asi "e#%a#

a$a#e!s 0"eformitas f$e'si "orsa$1 "ari se#"i (er%e$a#%a# 'a'i*

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•

Hallux valgus a"a$a, "eformitas a)"!'si i)! &ari 'a'i me$a$!i se#"i metatarsofa$a#%ea$*

Gambar 1 !eformitas varus dan valgus



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Genu varum a"a$a,

a#%!$asi t!$a#% "ima#a se%me# "ista$ "ari se#"i $!t!t me#!&! %aris te#%a,* Genu valgum

a"a$a, a#%!$asi t!$a#% "ima#a se%me# "ista$ "ari se#"i $!t!t me#&a!,i %aris te#%a,*

Gambar " Genu varum #$% dan Genu valgum #&%

2)2 A+atomi Se+i "utut

Se#"i $!t!t mer!(a'a# se#"i si#oia$ ter)esar (a"a t!)!,* Se#"i $!t!t ter"iri "ari

• Arti'!$asi a#tara fem!r "a# ti)ia+ mer!(a'a# se#"i (e#a,a# )e)a# 0weightbearing 'oint 1

• Arti'!$asi a#tara (ate$$a "a# fem!r

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6/32

Gambar ( )endi lutut #kapsul sendi tidak ditampilkan%

Permukaa+ Artiku*ar

Perm!'aa# arti'!$ar "ari t!$a#% (em)e#t!' se#"i $!t!t "i$a(isi o$e, 'arti$a%o ,ia$i#*

Perm!'aa# !tama /a#% ter$i)at a"a$a,

•


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A"a "!a me#is'!s+ /a#% mer!(a'a# fi)ro'arti$a%o )er)e#t!' C+ (a"a se#"i $!t!t+ sat! (a"a

sisi me"ia$ 0me#is'!s me"ia$is1 "a# $ai##/a (a"a sisi $atera$ 0me#is'!s $atera$is1*


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i#ferior "ari me#is'!s* Pa"a )a%ia# (osterior+ mem)ra# si#oia$ memisa,'a# mem)ra#

fi)rosa 'a(s!$ se#"i (a"a tia( sisi $i%ame# 'r!siat!m (osterior "a# me$i#%'ari 'e"!a

$i%ame#t!m /a#% memisa,'a# mere'a "ari ro#%%a se#"i* Pa"a )a%ia# a#terior+ mem)ra#

si#oia$ ter(isa, "ari $i%ame#t (ate$$ar o$e, )a#ta$a# $ema' i#fra(ate$$ar 0 infrapatellar fat

pad 1*

Gambar / Membran sinovial dan bursa sendi lutut

#embra+ ibrosa

Mem)ra# fi)rosa "ari se#"i $!t!t sa#%at $!as+ se)a%ia# ter)e#t!' "a# "i(er'!at o$e,

te#"o# "ari otot se'e$i$i#%#/a* Seara !m!m+ mem)ra# fi)rosa me#!t!(i ro#%%a se#"i "a#

re%io i#ter'o#"i$er

• Pa"a sisi me"ia$ "ari se#"i $!t!t+ mem)ra# fi)rosa )er%a)!#% "e#%a# $i%ame# 'o$atera$ ti)ia

"a# )eri'ata# "e#%a# (erm!'aa# i#ter#a$ 'e me#is'!s me"ia*• Pa"a sisi $atera$+ (erm!'aa# e'ster#a$ "ari mem)ra# fi)rosa "i(isa,'a# o$e, e$a, "ari

$i%ame# 'o$atera$ fi)!$a "a# (erm!'aa# i#ter#a$ "ari mem)ra# fi)rosa ti"a' me#em(e$ (a"a

me#is'!s $atera$*

• Pa"a sisi a#terior+ mem)ra# fi)rosa me#em(e$ (a"a mar%i# (ate$a "a# "i(er'!at o$e,

(er$!asa# te#"o# "ari otot ast!s $atera$is "a# ast!s me"ia$is+ /a#% a'a# )er%a)!#% "e#%a#

te#"o# @!a"rie( femoris (a"a )a%ia# atas "a# $i%ame# (ate$a (a"a )a%ia# )a-a,*



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Gambar 0 Membran fibrosa kapsul sendi lutut $ Tampakan anterior & Tampakan posterior

Li%ame#t!m


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Li%ame# ma/or /a#% )er,!)!#%a# "e#%a# se#"i $!t!t a"a$a, $i%ame# (ate$a+ $i%ame#

'o$atera$ ti)ia 0me"ia$1 "a# fi)!$a 0$atera$1+ "a# $i%ame# 'r!siat!m a#terior "a# (osterior*

Gambar 2igamen kolateral sendi lutut $ Tampakan lateral & Tampakan medial

Pereara+ $arah a+ &+erasi

Pere"ara# "ara, 'e se#"i $!t!t ter!tama o$e, a)a#% "ese#"e# "a# %e#i'!$ar "ari

arteri femora$+ (o($itea$+ "a# femora$ sir'!mf$e's $atera$ (a"a (a,a 0t!#%'ai atas1 "a# arterifi)!$aris sir'!mf$e'sa "a# a)a#% re!rre#t "ari arteri ti)ia$is a#terior (a"a t!#%'ai )a-a,*



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Pem)!$!, "ara, i#i mem)e#t!' &ari#a%a# a#astomosis "i se'itar se#"i* Se#"i $!t!t "i(ersarafi

o$e, a)a#% "ari saraf o)t!rator+ femora$+ ti)ia+ "a# fi)!$aris 'om!#is*

Gambar 9. Perdarahan sendi lutut


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2)3 isio*oi Pertumbuha+ $a+ Remoe**i+ Tu*a+

Proses Pertumbuha+ Tu*a+T!$a#% mema#&a#% o$e, s!at! (roses 0me$i(!ti osifi'asi e#"o'o#"ra$1 "a# me$e)ar

o$e, (roses $ai##/a 0me$i(!ti osifi'asi i#tramem)ra#osa1*

Proses (ertam)a,a# (a#&a#% t!$a#% ter&a"i o$e, 'are#a (ert!m)!,a# i#terstisia$ (a"a

'arti$a%o "ii'!ti "e#%a# osifi'asi e#"o'o#"ra$* O$e, 'are#a it!+ a"a 2 tem(at /a#%

mem!#%'i#'a# !#t!' (ert!m)!,a# 'arti$a%i#osa i#i+ /ait! 'arti$a%o arti'!$ar "a# 'arti$a%o

$em(e#% e(ifisis*



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Gambar 13 +ertumbuhan tulang pada masa kanak4kanak

Kartilago articular


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• The

5one of calcifying cartilage ti(is "a# 'o#"rosit#/a te$a, mati se)a%ai a'i)at 'a$sifi'asi

matri's*

Gambar 11 Histologi dari lempemg epifisis

Proses (ertam)a,a# $e)ar t!$a#% ter&a"i o$e, 'are#a (ert!m)!,a# a(osisio#a$ "ari

osteo)$as (a"a )a%ia# "a$am (erioste!m+ me$a$!i (roses osifi'asi i#tramem)ra#osa* Seara

)ersamaa#+ ro#%%a me"!$$a "ari t!$a#% &!%a sema'i# mem)esar me$a$!i resor(si osteo'$as*

Proses Remodelling Tu*a+


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Se$ai# it!+ (roses remodelling t!$a#% "a(at ter&a"i a'i)at stress fisi'* T!$a#%

ter"is(osisi (a"a )a%ia# /a#% me#"a(at stress fisi'+ "a# tereso(rsi (a"a )a%ia# /a#% '!ra#%

me#"a(at stress fisi'* e#ome#a i#i "i'e#a$ "e#%a# #ama H!'!m Wo$f*

2). Eiemio*oi

Ge#! ar!m fisio$o%is seri#% ter&a"i+ )iasa#/a ter&a"i (a"a a#a'.a#a' )er!sia =2

ta,!#* Seara 'o#tras+ ar!s (ato$o%is+ /a#% "a(at ter&a"i a'i)at )er)a%ai 'o#"isi+ $e)i,

&ara#% ter&a"i+ ',!s!s#/a "e#%a# sema'i# )ertam)a,#/a !sia* Pe#/e)a) terseri#% %e#!

ar!m (ato$o%is a"a$a, (e#/a'it )$o!#t+ ri'etsia+ "a# "is($asia s'e$eta$*

Ge#! a$%!m fisio$o%is )iasa#/a ter&a"i (a"a ta,!# 'e"!a "a# 'eti%a

'e,i"!(a#*Pe#/e)a) si#"roma+ se(erti eFostoses m!$ti(e$ ,ere"iter+ si#"roma Do-#+ "a#"is($asia s'e$eta$+ seri#%'a$i ter&a"i (a"a (asie# )er!sia 5.3> ta,!#* Ge#! a$%!m i"io(ati'

(a"a rema&a m!#%'i# "it!r!#'a# "a$am 'e$!ar%a ata! "a(at ter&a"i s(ora"i'* Pe#/e)a)

terseri#% %e#! a$%!m a"a$a, osteo"istrofi re#a$*

Pa"a #e%ara "ima#a ma$#!trisi !m!m ter&a"i "a# a'ses ter,a"a( )a#t!a# me"is

ter)atas+ i#si"e#si 'ese$!r!,a# ter&a"i#/a %e#! a$%!m "a# ar!m $e)i, ti#%%i* Wa$a!(!#

(o$io se)a%ia# )esar s!"a, terera"i'asi+ (e#/a'it i#fe'si $ai# "a# tra!ma /a#% ti"a' "ita#%a#i

"e#%a# )ai' 0ata! ti"a' "ita#%a#i sama se'a$i1 me#/e)a)'a# 'er!sa'a# fisea$ me#&a"i

(e#/e)a) terseri#% "ari "eformitas '$i#is )er'e$a#&!ta# /a#% "a(at me#/e)a)'a#

'e$!m(!,a#*

2)5 Etio*oi

Ge#! ar!m "a# %e#! a$%!m "a(at mer!(a'a# 'o#"isi fisio$o%is #orma$ ata!(!#

(ato$o%is*

Ge+u !arum a+ Ge+u !a*um isio*ois

Ge#! ar!m "a# %e#! a$%!m fisio$o%is "i&e$as'a# o$e, Se$e#i!s "a# Va#''a* Mere'a

mem(e$a&ari (er'em)a#%a# s!"!t ti)iofemora$ (a"a ta,!# 37;> (a"a a#a' #orma$* S!"!t

ti)iofemora$ (a"a ta,!# (ertama 'e,i"!(a# a"a$a, ar!s 38?* Se&a' a#a' )er!sia 3; )!$a#+

s!"!t terse)!t me#i#%'at me#&a"i #etra$+ "a# e'stremitas )a-a, tam(a' $!r!s* Se$ama ta,!#

'e"!a "a# 'eti%a+ s!"!t ti)iofemora$ me#i#%'at me#&a"i '!ra#% $e)i, 32? a$%!s* Se$ama

ta,!# )eri'!t#/a+ a$%!s )er'!ra#% me#&a"i se(erti (a"a ora#% "e-asa+ :? (a"a (ria+ "a# ;?

(a"a -a#ita*



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Gambar 1" +erkembangan sudut tibiofemoral selama pertumbuhan

Ge+u !arum Pato*ois

Pa"a a#a'+ (e#/a'it )$o!#t mer!(a'a# (e#/e)a) !tama %e#! ar!m (ato$o%is*

Nam!# )e%it!+ (a"a a#a' terse)!t ,ar!s "iea$!asi 'em!#%'i#a# (e#/e)a) $ai##/a se(erti+

"is($asia metafisis+ osteo'o#"romatosis+ ,emi,i(ertofi+ ,emime$ia fi)!$a ata! ti)ia+ "is($asia

e(ifisis m!$ti(e$+ osteo'o#"ro"istrofi+ a'o#"ro($asia+ "is($asia fi)rosa* Tra!ma ata! i#fe'si (a"a fisis ata! e(ifisis "a# fra't!r metafisis &!%a "a(at )era'i)at (a"a "eformitas ar!s*


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Osteo"istrofi re#a$ se'!#"er "ari i#s!fisie#si %i#&a$ 'ro#i' 0renal rickets1 mer!(a'a#

(e#/e)a) terseri#% "ari %e#! a$%!m* Pe#ata'sa#aa# me"is /a#% sema'i# )ai'+ "ia$isis re#a$

"a# tra#s($a#tasi re#a$ /a#% sema'i# terse"ia seara )erma'#a me#i#%'at'a# 'em!#%'i#a#

,i"!( a#a'.a#a' i#i* Ti"a' &ara#%+ a#a'.a#a' "e#%a# o)esitas "a(at )er'em)a#% me#&a"i

%e#! a$%!m i"io(ati'* Se$ai# it!+ osteo'o#"roma (a"a fem!r "ista$ ata! ti)ia (ro'sima$

me#/e)a)'a# %a#%%!a# (ert!m)!,a# "eformitas a$%!s ata! $e)i, &ara#% ar!s* Tra!ma

$a#%s!#% "ari $em(e#% e(ifisis ti)ia (ro'sima$ ata! fem!r "ista$ 0se(erti sa$ter IV ata! V1

)era'i)at (a"a "eformitas a#%!$ar (a"a 'em!"ia# ,ari* Pa"a a#a' /a#% $e)i, m!"a+ tra!ma

metafisis ti)ia &!%a me#/e)a)'a# a$%!s (ro%resif ata! a#%!$asi "i 'em!"ia# ,ari* Pe#/e)a)

$ai##/a me$i(!ti i#fe'si+ t!mor+ 'e$ai#a# 'o#%e#ita$+ "a# 'o#"isi ,ere"iter se(eti "is($asia

metafisis "a(at me#/e)a)'a# "eformitas a#%!$ar* Ga#%%!a# (ara$isis se(erti cerebral palsy

"a# (o$io &!%a "a(at me#/e)a)'a# "efomitas rotasio#a$ "a# a$%!s 'are#a (ita i$ioti)ia$ /a#%

'!at+ me#&a"i "eformitas a$%!s*

2)4 Pato/isio*oi

$lignment #orma$ arti#/a a"a$a, (a#&a#%

e'stremitas )a%ia# )a-a, sama 0sat! "e#%a# $ai##/a1 "a# a'sis me'a#i' 0(!sat %raitasi1

mem)a%i $!t!t 'e "a$am 2 )a%ia# sama )esar 'eti'a (asie# )er"iri "e#%a# (ate$$a me#%,a"a(

'e "e(a#*Posisi i#i mem)eri'a# te'a#a# /a#% re$atif seim)a#% (a"a 'om(arteme# me"ia$ "a#

$atera$*


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Gambar 1( +embagian kuadran sendi lutut

Ge+u !arum

Pa"a a#a' )er!sia '!ra#% "ari 2 ta,!#+ %e#! ar!m fisio$o%is seri#% ter&a"i+ #am!#

"a(at mem)ai' "e#%a# se#"iri#/a 0 self4limited 1 "a# ti"a' )er)a,a/a* Pa"a a#a' /a#% $e)i,

t!a "e#%a# ar!s (ato$o%is+ "e#%a# $!t!t )er%eser 'e $atera$+ a'sis me'a#i' &at!, (a"a

'!a"ra# "a$am se#"i $!t!t (a"a 'as!s /a#% $e)i, )!r!'+ a'sis terse)!t )a,'a# ti"a'

)er(oto#%a# (a"a $!t!t* Se)a%ai a'i)at#/a+ 'o#"i$!s femora$ me"ia$ "a# ($atea! me"ia$ "ari

ti)ia me#"a(at )e)a# (ato$o%is* Efe' Heuter46olkmann a'a# me#e'a# fisis "a# )a%ia#

'arti$a%i#osa str!'t!r i#i "a# me#%,am)at osifi'asi #orma$ "ari e(ifisis*

Gambar 1* !eviasi aksis mekanik pada genu varum

Ge+u !a*um

Pa"a %e#! a$%!m+ a'sis me'a#i' )er%eser 'e $atera$+ stress (ato$o%is mem)eri )e)a#

(a"a fem!r "a# ti)ia $atera$+ me#%,am)at (ert!m)!,a# "a# )a,'a# memi! ter&a"i#/a

$i#%'ara# seta#* Ti"a' ,a#/a (ert!m)!,a# fisis ter,am)at+ teta(i &!%a ter&a"i efe' Heuter4

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6olkmann (a"a se$!r!, e(ifisis /a#% me#%,am)at e's(a#si t!$a#% #orma$* Me#!r!t (ri#si(

Heuter46olkmann+ te'a#a# )er'e$a#&!ta# ata! )er$e)i, (a"a e(ifisis mem)eri'a# efe' i#,i)isi

ter,a"a( (ert!m)!,a#*

2) #a+i/estasi K*i+is

Tam(a'a# '$i#is (a"a a#a' "e#%a# %e#! ar!m "a# %e#! a$%!m /a#% (a$i#% !tama

a"a$a, (e#"e'#/a (sot!r t!)!, a#a'+ 'are#a (a"a es'tremitas )a-a, a#a'+ ter)e#t!' %aris

'ese&a&ara# ti)ia "a# fem!r /a#% a)#orma$ 0mem)e#t!' s!"!t 'e ara, me"ia$ ata! 'e ara,

$atera$1* 6iasa#/a a#a' "e#%a# %e#! ar!m me#!#&!''a# (ost!r t!)!, (e#"e' /a#% $e)i,

a)#orma$ "i)a#"i#%'a# (a"a a#a' "e#%a# %e#! a$%!s*


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(A( &&&

AS%AN KEPERA6ATAN

3)1 PENGKAJ&AN

3)1)1 A+am+esis

Ea$!asi '$i#is %e#! ar!m "a# %e#! a$%!m "im!$ai "e#%a# -a-a#ara me"is

0a#am#esis1* Seri#%'a$i (asie# me#%e$!,'a# a"a#/a #/eri $!t!t* Ri-a/at (e#/a'it 'e$!ar%a

"a# "es'ri(si me#%e#ai a-ita# "a# (er&a$a#a# (e#/a'it "ari "eformitas+ (e#ti#% "a$am

me#e#t!'a# etio$o%i* Ri-a/at 'e$!ar%a (e#ti#% !#t!' me#%eta,!i a"a#/a (e#/a'it /a#%


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"it!r!#'a# se(erti si#"rom marfa#+ osteo%e#sis im(refe'ta+ "a# se)a%ai#/a* Seora#% a#a'

/a#% asim(tomati' ata! "e#%a# (er&a$a#a# (e#/a'it /a#% e(at (er$! "i!ri%ai a"a#/a

'o#"isi /a#% $e)i, seri!s se(erti %a#%%!a# #e!ro$o%is+ 'e$ai#a# 'o#%e#ita$+ t!mor+ ata!

i#fe'si*

3)1)2 Pemeriksaa+ isik

Pa"a (ermeri'saa# a-a$ "i$a'!'a# (e#i$aia# (e#i$aia# ti#%%i )a"a# a#a'+ 'em!"ia#

"i$a'!'a# (e#%ee'a# ses!ai "e#%a# '!ra ti#%%i )a"a# ses!ai !m!r* 6iasa#/a "i"a(ati

ti#%%i )a"a# a#a' "i)a-a, (erse#ti$ #orma$ "ari ti#%%i )a"a# a#a' ter,a"a( !m!r /a#%

se,ar!s#/a*3

Se$a#&!t#/a "i$a'!'a# ea$!asi e'tremitas )a-a, (a"a a#a'* Pa"a a-a$ (emeri'saa#

!#t!' "a(at me#%ea$!asi seara 'ese$!r!,a# e'stremitas )a-a, a#a'+ ma'a (a'aia# /a#%

me#%,a$a#%i (emeri'saa# e'stremitas ,ar!s "i$e(as* Di#i$ai (o$a )er"iri a#a'+ a(a'a, a"a

(osisi a)#orma$ "ari 'ese%arisa# e'stremitas )a-a, a#a'+ "i#i$ai a"a ata! ti"a'#/a

'ea)#orma$a# ara &a$a# a#a'* i'a "i"a(at'a# 'ea)#orma$a#+ 'em!"ia# a#a' "imi#ta !#t!'

)er)ari#% (a"a me&a (emeri'saa# !#t!' me#i$ai a(a'a, a"a %e#! ar!m "a# %e#! a$%!s*

U#t!' (e#e#t!a# 'e$ai#a# (a"a a#a' "a(at "i$a'!'a# "e#%a# "!a ara+ /a#% (ertama a"a$a,

"e#%a# me#%!'!r s!"!t femora$.ti)ia+ /ait! s!"!t /a#% "i)e#t!' a#tara (a,a "a# 'a'i )a%ia#

)a%ia# )a-a, ata! "a(at "i#i$ai "e#%a# me#%,it!#% &ara' a#tar t!$a#%+ /ait! &ara'

i#ter'o#"i$ar 0(a"a %e#! ar!m1 &ara' /a#% a"a "ia#tara 'o#"i$!s me"ia$ fem!r "ari 'e"!a

$!t!t ata! "e#%a# me#%!'!r &ara' i#terma$eo$ar 0(a"a %e#! a$%!m1+ /ait! &ara' a#tara

ma$$eo$!s me"ia$ (a"a (a"a (er%e$a#%a# 'a'i* Pa"a (emeri'saa# &ara' i#ter'o#"i$ar !#t!'

me#e#t!'a# a"a#/a %e#! ar!m+ (asie# "a$am (osisi )er"iri "e#%a# 'e"!a (er%e$a#%a# 'a'i

sa$i#% )erse#t!,a#+ se"a#%'a# !#t!' (emeri'saa# &ara' i#terma$$eo$ar+ a#a' "imi#ta )er"iri

"e#%a# $!$!t /a#% "ira(at'a# "a# sa$i#% )erse#t!,a#* Pemeri'saa# i#i "i$a'!'a#+ 'are#a

,ar!s#/a (a"a saat a#a' )er"iri "a$am (osisi 'e"!a 'a'i sa$i#% mera(at+ se,ar!s#/a )ai' $!t!t

"a# (er%e$a#%a# 'a'i 0'o#"i$!s "a# ma$eo$ar1 a'a# sa$i#% )ertem!* Pa"a a#a' !sia 3> sam(ai

"e#%a# 39 ta,!#+ &ara' i#ter'o#"i$ar #orma$ '!ra#% "ari 7 m (a"a a#a' (erem(!a# "a#

'!ra#% "ari 8 m (a"a a#a' $a'i.$a'i+ se"a#%'a# !#t!' &ara' i#terme$$eo$!s #orma$ a"a$a,

'!ra#% "ari ; m !#t!' a#a' (erem(!a# "a# '!ra#% "ari 7 m !#t!' a#a' $a'i.$a'i*


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Pemeriksaa+ -arak i+terma**eo*us Pemeriksaa+ -arak i+terko+i*er

aa a+ak e+a+ Ge+u !a*um) Paa a+ak e+a+ Ge+u !arus

3)2 Pemeriksaa+ ia+ostik)

Pemeri'saa# ra"io$o%i "i$a'!'a# &i'a a#a' memi$i'i ti#%%i )a"a# "i)a-a, (erse#ti$ 28

0)er"asar'a# '!ra ti#%%i )a"a# ter,a"a( !m!r1* U#t!' %e#! ar!m ma!(!# %e#! a$%!m+

(emeri'saa# ra"io$o%is "i$a'!'a# "e#%a# me#%am)i$ foto a#tero.(osterior (a,a ,i#%%a

(er%e$a#%a# 'a'i !#t!' 'e"!a es'tremitas* A'sis me'a#i'a$ "a# &!%a a'sis a#atomi' "arie'stremitas )a-a, "i!'!r !#t!' (e#e#t!a# "ia%#osis* Pa"a a#a'.a#a' "e#%a# %e#! ar!m+


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"i$a'!'a# (e#%!'!ra# s!"!t metafisis."ia(fisis 0meta(,/sea$."ia(,/sea$ a#%$e1* Pa"a a#a'

"e#%a# 'e!ri%aa# memi$i'i 'e$ai#a# %e#! ar!m+ "a(at "i$a'!'a# (e#i$aia# s!"!t metafisis.

"iafisis 0meta(,/sia$.Dia(,/sia$ A#%$e+ MDA1 !#t!' mem)e"a'a# a#tara %e#! ar!m "a#

ti)ia ara+ (a"a %e#! ar!m s!"!t /a#% "i)e#t!' )iasa#/a '!ra#% "ari 33 "era&at+ se"a#%'a#

(a"a ti)ia ara s!"!t /a#% "i)e#t!' me$e)i,i 33 "era&at*


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Pa"a (emeri'saa# %e#! a$%!m+ "i$a'!'a# (e#%!'!ra# a'sis me'a#i'a$+ /ait! a'sis /a#%

"i%am)ar "ari te#%a, 'e(a$a fem!r ,i#%%a (a"a (erte#%a,a# "ari se#"i (er%e$a#%a# 'a'i

,ar!s#/a %aris i#i a'a# te(at mem)a%i "!a "ari se#"i (er%e$a#%a# 'a'i* Pa"a ariasi #orma$+

se,ar!s#/a %aris terse)!t masi, )era"a (a"a 8>J te#%a, "ari se#"i (er%e$a#%a# 'a'i* Ge#!

a$%!m "i"efi#isi'a# se)a%ai "eiasi $atera$ "ari a'sis ata! "eiasi "i$!ar "ari mar%i# se#"i

'r!ris* Deformitas m!#%'i# ter&a"i (a"a fem!r+ ti)ia+ ata! 'e"!a#/a* S!"!t #orma$ "ari

femora$is "ista$ a"a$a, ;7? 09? "ari a$%!s1+ "a# s!"!t (ro'sima$ ti)ia$ me"ia$ ;:? 05? "ari

ar!s1*

3)3 $ia+osa Keera7ata+

3* N/eri a'!t )er,!)!#%a# "e#%a# a%e# e"era )io$o%i

2*


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- Me#"emo#trasi'a# (e#%%!#aa# 'eteram(i$a# re$a'sasi "a# a'tifitas ,i)!ra# ses!ai i#"i'asi

sit!asi i#"ii"!*

No* I#tere#si Rasio#a$

3


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)* T!&!a# me#%!#%'a(a# (er!)a,a# (ema,ama# "a$am %a/a ,i"!( te#ta#% t!)!,+ (erasaa#

ti"a' )er"a/a+ (!t!s asa "a# ti"a' mam(!

*


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-


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.)1 Sara+

Se)a%ai seora#% (era-at+ se"a, me#&a"i 'e-a&i)a# !#t!' mem)eri'a# ti#"a'a#

(era-ata# "a$am as!,a# 'e(era-ata# /a#% "iara,'a# 'e(a"a (em)e#t!'a# ti#%'at

'e#/ama#a# (asie#+ ma#a&eme# rasa sa'it "a# 'eama#a#* Pera-at ,ar!s mam(! mama,ami

fa'tor (si'o$o%is "a# emosio#a$ /a#% )er,!)!#%a# "e#%a# "ia%#osa (e#/a'it+ "a# (era-at

&!%a ,ar!s ter!s me#"!'!#% (asie# "a# 'e$!ar%a "a$am me#&a$a#i (roses (e#/a'it#/a*

$ATAR PSTAKA

Car(e#ito+ L/#"a &!a$$* 2>>3* Do'!me#tasi As!,a# >2* 6!'! A&ar 3*>7


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=..if msoQ )e,aior!r$0"efa!$tVML1o***

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