SOAL POST TEST DAN FOTO KLINIS KASUS ORTHOPAEDI

• DR IGIN GINTING SP.OT , MKES

1. OPEN FRACTURE

• KALAU TIDAK DITANGANI (DEBRIDEMENT –JAHIT – STABILISASI) AKAN

MENJADIKANNYA INFEKSI KRONIS YANG BERKEPANJANGAN.

• “ONCE OSTEOMYELITIS, FOREVER” : APPLEY

• JANGAN SAMPAI MELEWATI GOLDEN PERIODE (0 S/D 6 JAM) PADA

AWALNYA INFESTASI KUMAN MASIH MELEKAT SECARA FISIK, SSD ITU AKAN

MELEKAT SECARA KIMAWI & SULIT DIBERSIHKAN DNG PENCUCIAN SAJA

DEFINISI FRAKTUR TERBUKA

• FRAKTUR DENGAN FRAGMEN TULANG

YANG PATAH MENEMBUS JARINGAN

LUNAK DI SEKITARNYA HINGGA

SAMPAI KULIT DAN MENYEBABKAN

ADANYA HUBUNGAN DENGAN

UDARA LUAR

KLASIFIKASI GUSTILLO-ANDERSON

Tipe I Tipe II Tipe III

Ukuran luka < 1 cm 1- 10 cm > 10 cm

Tingkat trauma Kecepatan rendah/energi

Kecepatan tinggi/energi

Kecepatan tinggi/energi

Soft tissue Kerusakan soft tissue yang minimal

Tidak ada kerusakan yang luas, flap atau avulsi.

Kerusakan soft tissue yang luas meliputi otot, kulit dan sering struktur neurovasculer

Kerusakan jaringan (Crush)

Tidak ada tanda-tanda kerusakan jaringan

Ringan sampai menengah

luas

Fraktur Biasanya simple, transversal atau oblik pendek dengan fragmen tulang cominutif yang sedikit

Fragmen fraktur cominutif tingkat menengah

Berat dan tidak stabil fragmennya

kontaminasi Sedikit menengah tinggi

Tipe III-A Tipe III-B Tipe III-C

Ukuran luka > 10 cm > 10 cm > 10 cm

Tingkat trauma Kecepatan tinggi/energi

Kecepatan tinggi/energi

Kecepatan tinggi/energi

Soft tissue Laserasi soft-tissue yang luas, lapisan flap yang bebas tidak diperlukan untuk menutupi tulang. Fraktur segmental seperti luka tembak

Trauma soft tissue yang luas dengan patahan periostal dan penampakan tulang setelah dilakukan debridement. Membutuhkan local atau flap bebas untuk menutupi tulang.

Sama dengan tipe IIII-B

Trauma vasculer Tidak significant Tidak significant Trauma vasculer yang membutuhkan perbaikan dalam menyelamatkan ekstremitas yang terkena

Kontaminasi Tinggi Massive Massive

FRAKTUR YANG HARUS DI OPERASI :

1. FR YG GAGAL DENGAN TX KONSERVATIF

2. FR. INTRA ARTIKULER

3. FR. JOINT DEPRESSED > 5 MM

4. FR. AVULSI : TARIKAN LIGAMENT

5. FR. DENGAN AVN DISTURBANCES

TUJUAN OPERASI :

1. EARLY MOBILIZATION

2. (“ LIFE IS MOTION / FUNCTION C’EST LA VIE”) LUCAS CHAMPIONERE

3. MENCEGAH KOMPLIKASI PROLONGED BEDREST (DECUBITUS,

PNEUMONIA, UTI, ATROFI OTOT 1 PERSEN /HR, KAKU SENDI)

4. MEMBERSIHKAN INFEKSI

KOMPLIKASI FRAKTUR Immediate :

Syok neurogenik

Kerusakan neurovascular

Early Complication :

Kerusakan Neurovascular

Compartment Syndrome

Syok hipovolemik

Late Complication :

Infeksi

Stiffness

Volkman Ischaemic

Malunion

Non Union

Delayed Union

COMPARTMENT SYNDROME

5 P 1. PULSELESS

2. PALOR

3. PAIN

4. PARESE

5. PARALYSE

DAN AKHIRNYA TJD VOLKMANN ISCHEMIC CONTRACTURE DENGAN OTOT NECROSIS & TAK

BERFUNGSI LAGI

FLEXOR TENDON INJURY

PATO ANATOMI

KELAINAN CTEV

a. EQUINUS : ANKLE-ARAH KAKI KEBAWAH

b. VARUS : CALCANEUS INVERSI SUBTALAR

c. ADUKSI :

• PILAR MEDIAL KECUALI TALUS BERSAMA PILAR LATERAL ROTASI

HORIZONTAL KE MEDIAL

• NAVICULARE SUBLUKSASI KE MEDIAL DARI CAPUT TALI

PATO ANATOMI

D. CAVUS :

• ADUKSI DISERTAI DENGAN GERAKAN ROTASI VERTIKAL KEDUA

PILAR

• CALCANEUS INVERSI (VARUS, SUPINASI)

• FORE FOOT SUPINASI + ADUKSI

• KEDUDUKAN FORE FOOT TERHADAP TUMIT ADALAH PRONASI

• MT FLEKSI : CAVUS BERTAMBAH

PATO ANATOMI

SOFT TISSUE

• SEMUA OTOT, TENDON, LIGAMEN BAGIAN POSTERIOR DAN MEDIAL MEMENDEK

CTEV

• DEVELOPMENTAL DEFORMATION BUKAN EMBRYONIC MALFORMATION

• AWAL EMBRIO TUMBUH NORMAL.

TRIMESTER II (MG 12-20), FAKTOR GENETIK PEMBENTUKAN KOLAGEN BERLEBIHAN PADA LIGAMEN

KOREKSI CLUB FOOT STRETCHING SEBELUM PLASTER CORRECTION

What is the earliest indication of Volkmann's ischaemia:

A Pain

В Pallor and poor capillary filling

С Paraesthesia in median nerve area

D Contracture of fingers

E Gangrene of tips of fingers.

WHICH OF THE FOLLOWING IS THE EARLIEST LABORATORY FINDING IN A CASE OF FAT

EMBOLISM:

• A INCREASED SERUM CHOLESTROL

• В INCREASED SERUM LIPASE

• С INCREASED SERUM FATTY ACIDS

• D LIPURIA

• E INCREASED ALKALINE PHOSPHATASE.

FIRST TREATMENT PRIORITY IN PATIENT WITH MULTIPLE INJURIES IS:

• A AIRWAY MAINTENANCE

• В BLEEDING CONTROL

• С CIRCULATORY VOLUME RESTORATION

• D SPLINTING OF FRACTURES

• E REDUCTION OF DISLOCATION.

IN A TRAUMA PATIENT WHO HAS A SUSPECTED CERVICAL SPINE INJURY, THE X-RAY

VIEW THAT WILL IDENTIFY THE MA JORITY OF SIGNIFICANT INJURIES IS

A. LATERAL.

B. OBLIQUE

C. ANTEROPOSTERIOR

D. ODONTOID

A 4 YEAR-OLD BOY PRESENTS TO THE ED AFTER SUSTAINING A CRUSH INJURY TO HIS

DISTAL THIRD PHALANX. PHYSICAL EXAM REVEALS AN ASSOCIATED NAIL BED INJURY.

WHICH OF THE FOLLOWING IS THE APPROPRIATE MANAGEMENT?

• A. REST, ICE, ELEVATION

• B. IMMOBILIZE, ANTIBIOTICS, ORTHOPEDICS REFERRAL

• C. SPLINT FOR 48 HOURS, ASPIRIN, ICE

• D. SURGICAL REFERRAL FOR AMPUTATION OF DIGIT

• HARE TRACTION IS APPLIED TO WHICH TYPE OF FRACTURE:

• A. DISTAL TIBIA FRACTURE

• B. PATELLA FRACTURE

• C. FEMUR FRACTURE

• D. ILIAC CREST FRACTURE

• PELVIC RING DISRUPTIONS ARE ASSOCIATED WITH:

• A. MINIMAL BLEEDING

• B. FAST RECOVERY PERIOD

• C. GENITOURINARY TRAUMA

• D. 10% TO 20% MORTALITY RATE

• THE MOST COMMON LOCATIONS FOR COMPARTMENT SYNDROME TO DEVELOP ARE:

• A. SHOULDER AND UPPER ARM

• B. UPPER ARM AND HANDS

• C. LOWER LEG AND FOREARM

• D. PELVIS AND HIPS

DURING THE RESUSCITATIVE PHASE OF MUSCULOSKELETAL TRAUMA, WHAT IS IMPERATIVE TO

RECOGNIZE EARLY?

• A. POTENTIAL FOR ILEUS

• B. PATIENTS AT RISK FOR NEUROLOGIC AND VASCULAR COMPROMISE

• C. PROBLEM WITH BODY IMAGE

• D. PATIENTS AT RISK FOR POST-TRAUMATIC STRESS SYNDROME

THE MOST APPROPRIATE INITIAL TREATMENT FOR AN OPEN ANKLE FRACTURE IS:

• A. IRRIGATION WITH BETADINE SOLUTION

• B. SPLINTING THE EXTREMITY IN THE POSITION FOUND, ABOVE AND BELOW THE JOINT WHILE

MAINTAINING PEDAL PULSES

• C. APPLICATION OF A HARE TRACTION OR SAGER TRACTION DEVICE

• D. REDUCTION OF THE OPEN FRACTURE MANUALLY

A 38 YEAR-OLD MALE SUSTAINED A FRACTURE OF THE LEFT DISTAL TIBIA FOLLOWING A 25-FOOT FALL AND IS TAKEN TO THE OPERATING ROOM FOR AN OPEN REDUCTION INTERNAL FIXATION OF THE DISTAL TIBIA. SIXTEEN HOURS POST-OP, THE PATIENT DEVELOPS SUSTAINED PAIN, WHICH IS NOT RELIEVED WITH NARCOTICS. ON PASSIVE RANGE OF MOTION OF THE TOES THE PATIENT "YELLS" IN AGONY. THE PATIENT ALSO STATES THAT THE TOP OF HIS FOOT HAS DECREASED SENSATION. ON PHYSICAL EXAMINATION THE PHYSICIAN ASSISTANT NOTES THAT THE LEG IS SWOLLEN AND THE FOOT IS COOL TO TOUCH. BASED UPON THIS INFORMATION WHAT DIAGNOSTIC TESTING SHOULD BE DONE?

A. X RAY OF LOWER LEG AND ANKLE

B. DOPPLER STUDIES

C. BONE SCAN

D. COMPARTMENT PRESSURE

WHICH OF THE FOLLOWING FRACTURE DOES NOT USUALLY NEED OPEN

REDUCTION AND INTERNAL FIXATION:

• A MID SHAFT FRACTURE OF FEMUR

• В PATHOLOGICAL FRACTURES

• С TROCHANTERIC FRACTURE IN ELDERLY

• D DISPLACED INTRA-ARTICULAR FRACTURES

• E DISPLACED FRACTURE OF BOTH BONES OF FOREARM IN ADULTS.

DEATH 3 DAYS AFTER PELVIC FRACTURE IS MOST LIKELY TO BE DUE TO:

• A HAEMORRHAGE

• В PULMONARY EMBOLISM

• С FAT EMBOLISM

• D RESPIRATORY DISTRESS

• E INFECTION.

INTERNAL FIXATION OF FRACTURE IS CONTRAINDICATED IN WHICH SITUATION:

• A ACTIVE INFECTION

• В WHEN BONE GAP IS PRESENT

• С IN EPIPHYSEAL INJURIES

• D IN COMPOUND FRACTURE

• E IN PATHOLOGICAL FRACTURЕ.

FRACTURE DISEASE CAN BE PREVENTED BY:

• A PLASTER IMMOBILIZATION OF FRACTURE

• В CAST BRACE TREATMENT OF FRACTURE

• С INTERNAL FIXATION OF FRACTURE

• D EXTERNAL FIXATION OF FRACTURE

• E PHYSIOTHERAPY

A PATIENT WHO HAS SUSTAINED OPEN WOUND ON LEG IS BLEEDING PROFUSELY. BEFORE

PATIENT ARRIVES IN HOSPITAL THE SAFEST METHOD TO STOP BLEEDING IS:

• A ELEVATION OF LEG

• В LOCAL PRESSURE ON WOUND AND ELEVATION OF LEG

• С LIGATION OF BLEEDING VESSEL

• D USE OF TOURNIQUET

• E PRESSURE OVER FEMORAL ARTERY IN GROIN.

WHICH OF THE FOLLOWING IS THE BEST WAY TO PRESERVE AMPUTATED PART FOR

REPLANTATION:

• A IMMERSION IN COLD SALINE

• В IMMERSION IN COLD RINGER LACTATE

• С IMMERSION IN COLD ANTIBIOTIC SOLUTION

• D DRY COOLING WITH ICE

• E DEEP FREEZING

WHAT IS THE MOST SERIOUS DISADVANTAGE OF EXTERNAL FIXATOR:

• A PIN TRACT INFECTION

• В LOOSENING OF PINS

• С STRESS PROTECTION OSTEOPOROSIS

• D FRACTURE CAN NOT BE COMPRESSED

• E ANOTHER FRACTURE CAN OCCUR THROUGH PIN TRACT.

WHAT IS THE MOST LIKELY INJURED STRUCTURE ?