CASE REPORT SESSION

Osteomielitis e/r Digiti

Minimi Dextra

Reissa Amira Pratiwi

G1A217018
 Pendahuluan

01 Osteomielitis merupakan infeksi yang terjadi pada tulang.

Insidensi osteomielitis pada anak di Amerika pada tahun 1970

02 telah mengalami pengurangan dari 87 per 10.000 kejadian
menjadi 47 per 10.000 kejadian

Penyebab tersering pada infeksi tulang adalah

03 Penyebab tersering
Staphylococcus aureus.
Staphylococcus aureus.
pada infeksi tulang adalah

Osteomielitis masih merupakan permasalahan di Indonesia karena

04 tingkat higienis yang masih rendah dan pengertian mengenai pengobatan
yang
belum baik.
.
IDENTIFIKASI
• Nama : Tn. B
• Umur : 55 tahun
• Jenis Kelamin : Laki-laki
• Alamat : RT.023 jelutung
• Kebangsaan : Indonesia
• Agama : Islam
• Status : Menikah
• Pekerjaan : Petani

ANAMNESIS :
Keluhan Utama :
Luka menghitam pada semua jari kaki bagian kanan sejak + 2 bulan SMRS
Riwayat Perjalanan Penyakit :
Os datang dengan keluhan luka menghitam pada semua jari k
aki kanan sejak + 2 bulan SMRS . Awalnya luka timbul pada ibu jari
kaki kanan sebesar kelereng, kemudian makin lama luka makin mel
uas hingga ke semua jari kaki. Keluhan luka disertai nyeri seperti be
rdenyut,berair dan mengeluarkan nanah. Os mengaku bahwa kelu
han luka timbul pada saat os berjalan dan tak sengaja tersandung
batu, dan tanpa ia sadari timbul luka kecil. Saat itu luka hanya dibe
rsihkan dengan air dan dibiarkan tanpa diobati, namun keluhan lu
ka tidak kunjung sembuh dan makin membesar dan menghitam hi
ngga meluas ke semua jari kaki kanan. Pasien mengeluh sedikit sus
ah untuk menggerakan jari-jari kakinya.
+ 1 minggu yang lalu os mengeluh badan terasa lemas, dise
rtai nafsu makannya mulai menurun, sehingga pasien hanya
berbaring di tempat tidur, keluhan disertai demam mendad
ak dan dirasakan terus-menerus, tidak disertai menggigil, pa
sien mengaku sudah meminum obat penurun panas dari bi
dan namun lupa nama obatnya, dan demam tetap tidak tur
un
 Riwayat perjalanan penyakit
2 Bulan SMRS
makin membesar dan menghitam
hingga meluas ke semua jari kaki .
kanan. Pasien mengeluh sedikit
susah untuk menggerakan jari-jari
kakinya.
3 bulan
SMRS
luka timbul pada saat os
berjalan dan tak sengaja
tersandung batu, luka hanya
dibersihkan dengan air dan
dibiarkan tanpa diobati
4 April 2018
1 minggu SMRS
+ 1 minggu yang lalu os mengeluh
lemas, nafsu makannya menurun,
demam dan dirasakan terus-menerus.
 Riwayat penyakit Riwayat penyakit Riwayat sosial
dahulu keluarga ekonomi

• Riwayat amputasi • Riwayat kencing • Riwayat minum jamu-

pada jari-jari kaki manis (+) pada ibu jamuan (-), riwayat
bagian kiri + 4 tahun kandung minum obat-obatan (-),
merokok (-), alcohol (-)
yang lalu
• Riwayat kencing
manis (+) diketahui
sejak 5 tahun yang
lalu
• PEMERIKSAAN FISIK
• Pemeriksaan Umum
• Keadaan umum : Tampak sakit sedang
• Kesadaran : Compos mentis
• HR : 98x/menit, reguler isi dan tegangan cukup
• RR : 22x/menit
• Tekanan Darah :110/60 mmHg
• Suhu : 37,2oC
• BB : 60 Kg
• TB : 167 cm
• Status gizi : Baik
• Kesan : gizi baik
 Mata : CA (+/+), SI(-/-), RC (+/
+), pupil isokor
Kepala : Normocephalic,
Mulut dan faring : karies (-) simetris, deformitas (-)

Leher : Pem. KGB (-), deviasi

trakea(-), peningkatan JVP (-)
Abdomen
Inspeksi : datar, sikatrik (-), spider nevi (-),
benjolan (-)
Thorak : datar, simetris Palpasi :Soepel, nyeri tekan (-), turgor baik
Paru : Hepar, Lien & Ginjal: tidak teraba
pernapasan regular, NT Perkusi : timpani (+), pekak hepar melebar
Auskultasi : Bising usus (+) normal
(-), fremitus ka=ki, sonor,
vesikuler

Jantung :
ictus kordis tak terlihat,
batas jantung : dbn, BJ Ekstremitas :Akral hangat, edema (- /-), CRT <2 detik, Luka pada
I/II reguler digiti minimi dextra ± berukuran akral hangat, CRT <2 Detik, Edem
(+) kedua tungkai, Luka pada digiti minimi pedis dextra ±
berukuran 7 x 3 cm, dengan bentuk tidak beraturan. Warna kulit luka
hitam. Tepi luka merata, dan terdapat pus, kulit sekitar luka edema
 Natrium :130.17mEql/L
WBC 26.17 x 103/mm3 (135-146)
RBC 3,.4 x 106/mm3 Kalium : 4.73mEq/L (3,5 –
HGB 8.3 g/dl 5,3)
HCT 24.5 %
Klorida : 77.16mEq/L (98 –
MCV 72.1 fl
110)
MCH 24.4 pg
MCHC 339 g/dL Kalsium : 1,23 mEq/L
PLT 599 x 103/mm3 (1,12 – 1, 23)
Hasil Lab
Leukositosis, anemia mikrositik hipokrom
Hiperglikemi 04-04-
2018 Protein total : 5,6
Ureum : 30 Albumin :2,4
Creatinin : 1.2 Globulin : 3,2
GDS : 336 SGOT : 13
SGPT : 15
Hasil X-Ray
Diagnosis
Primer : Osteomielitis kronis e/r digiti minimi dextra
e.c Ulkus diabetikum dd Selulitis
Sekunder : Anemia e.c Penyakit Kronis

Penatalaksanaan
• IVFD Nacl 0,9% 20tpm
• Wound care
• Inj. Cefotaxim 2x2
Prognosis
• Quo ad vitam : dubia ad malam
• Inj. Omeprazole 2x40mg
• Quo ad functionam : dubia ad
• Ketorolak 1x30 mg
malam
• Levemir 1x20
• Quo ad sanactionam : dubia ad
• Novorapid 3x18 bonam
• As. Folat 3x1 gr
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