PRESENTASI KASUS

IMPENDING OPEN FRACTURE

DIGITI V MANUS DEXTRA +
COMPARTMENT SYNDROME
dr. MONICA TRI APRIANA
Identitas Pasien
Nama Pasien : Tn. W
Umur : 22 tahun 0 bulan 1 hari.
Jenis kelamin : Laki-laki
Alamat : KP Wetan 3/1 Ambalresmi Ambal
No. RM : 062069-19
Anamnesis
Keluhan Utama :
Bengkak dan nyeri kelingking tangan kanan.

Riwayat Penyakit Sekarang :

Seorang pasien datang ke IGD dengan keluhan nyeri kelingking
tangan kanan disertai dengan bengkak. Keluhan terjadi post
terjepit rem saat terjatuh dari motor karena menghindari
kucing. Terdapat luka pada kelingking tersebut. Kelingking
tangan kanan sulit digerakkan.
Anamnesis
Riwayat Penyakit Dahulu
• -

Riwayat Penyakit Keluarga

• -
Anamnesis Sistem
• Sistem cerebrospinal : kejang (-), nyeri kepala (-).
• Sistem respiratori : batuk (-), pilek (-), sesak (-).
• Sistem kardiovaskular : tak ada kelainan
• Sistem gastrointestinal : mual (-), muntah (-).
• Sistem muskuloskeletal : Nyeri dan bengkak di kelingking
tangan kanan.
• Sistem integumentum : tak ada kelainan
Pemeriksaan Fisik
Kesadaran : Compos Mentis, terlihat kesakitan.

GCS: E4V5M6
• Tekanan Darah : 120/70 mmHg
• Nadi : 88x/menit
• RR : 20x/menit
• Suhu : 36 C
Pemeriksaan Fisik
Status Generalisata

Kepala dan Leher

• Kepala : Normocephal.
• Wajah : Dalam batas normal
• Mata : Cojungtiva anemis (-/-), Sklera ikterik (-
/-)
• Telinga : discharge (-/-)
• Hidung : discharge (-/-)
• Mulut : Mukosa basah, bibir tidak sianosis,
lidah kotor (-).
• Leher : Tidak teraba benjolan dan tidak ada
pembesaran kelenjar limfe
Pemeriksaan Fisik
Thorax
• Jantung : S1, S2 reguler.
• Paru :Auskultasi vesikuler (+/+), Ronkhi (-/-), wheezing
(-/-)
Abdomen
• Supel, BU (+), Nyeri tekan (-).
Ekstremitas : Hangat (+), edema (-/-).
Pemeriksaan Fisik
• Status Lokalis.
Look : Hematom (+), deformitas (+).
Feel : Nyeri tekan (+).
Move : Terbatas karena nyeri.
 Pemeriksaan Penunjang
Hasil laboratorium tanggal 10 Oktober 2017

Pemeriksaan Hasil Nilai Rujukan

Leukosit 15400 mm3 4800-10800 mm3
Gula darah sewaktu 73 mg/dl <120
SGPT 10 IU/L <32
Ureum 23 mg/dl 10-50
Kreatinin 0,59 mg/dl 0,6-1,4
HbsAg Non reaktif Non reaktif
Eritrosit 4,9 juta / mm3 4,7 juta- 6,1 juta
Hemoglobin 15, 3 g/dL 14 – 18 g/dL
Hematokrit 44 % 42-52 %
Trombosit 263 ribu/mm3 150-450 ribu/mm3
Pemeriksaan Penunjang
X-ray Manus Dextra
Kesan : Fracture
cominutiva os phalanx
medial digiti V manus dextra.
Diagnosis
• Impending Open Fracture Digiti V Manus Dextra +
Compartement Syndrome.
Terapi
Terapi saat di IGD :
• Infus Ringer Lactat 20 tpm
• Injeksi Ketorolac 3x30 mg
• Pasang buddy tapping

Terapi Post OP :
• IVFD RL 20 tpm
• Injeksi Cefotaxime 1 gr/12 jam
• Injeksi Ketorolac 30 mg/8 jam
• Injeksi Ranitidin 50 mg/ 12 jam
Definisi
Fraktur adalah terputusnya kontinuitas struktur tulang. Setiap
jari (kecuali ibu jari) mempunyai tiga tulang (phalanx), yaitu :
• Proximal ( closest) phalanx,
• Middle phalanx,
• Distal (furthest) phalanx.

• Fracture phalanx biasanya berhubungan dengan injuri lainnya

seperti injuri pada tendon, ligament, dan kuku.
Manifestasi Klinis
• Deformitas
• Bengkak
• Discoloration
• Berkurangnya kemampuan gerak
• Kelemahan
• Perdarahan
Penegakkan Diagnosis
• Anamnesis
• Pemeriksaan Fisik : Tes strength, sensation, and ROM.
• Pemeriksaan Penunjang.
Kapan harus pergi ke layanan
kesehatan?
• Nyeri yang sangat atau ada deformitas,
• Perdarahan yang tidak terkontrol,
• Numbness (loss of sensation),
• Jari menjadi pucat atau perubahan warna,
• Terdapat tulang yang terexposure.
Kapan harus ke IGD?
• Pasien mengalami perdarahan yang hebat atau perdarahan
yang tidak bisa berhenti,
• Terdapat kehilanggan soft tissue atau amputasi,
• Pasien tidak dapat membersihkan benda asing yang terdapat
pada luka,
• Terdapat numbness atau weakness,
• Pasien tidak dapat menggunakan jarinya secara normal,
• Terdapat redness, pus, swelling, fever, atau tanda-tanda lain
infeksi.
Finger Injury Self Care at Home
Control bleeding by direct, continuous pressure for at least several
minutes. Elevate the hand above the level of the heart to help slow the
bleeding.
Find torn or missing tissue and save it, if possible.
• Gently rinse the tissue off with water if it is very dirty, and place it in
a sealed plastic bag.
• Place the bag in ice water and bring it to the hospital with the
patient.
• Cover the wound with a clean, dry bandage.
Remove loose dirt or foreign bodies.
• Do not try to remove objects that are deeply or firmly embedded.
• Run the patient's hand under tap water for several minutes,
scrubbing gently with a washcloth if needed to remove dirt.
• Dry and then apply an antibacterial ointment.
Finger Injury Self Care at Home
If the finger is obviously deformed, immobilize it with a splint in
whatever position is least painful.
• Almost any small rigid item such as a popsicle stick, a pen, or a
piece of cardboard can be tied or taped to the finger as a
splint.
• A finger can also be buddy-taped-that is, taped to the finger
next to it. Tape securely, but not tightly. If the fingers are
taped too tightly it can cause additional swelling and may cut
off circulation to the injured finger.
Finger Injury Medical
Treatment
• Pain management
• Open Wound
• Avulsions and amputations
Compartemen Syndrome on
the hand
Hand. Compartment syndrome of the hand usually manifests as
a swollen hand, tenseness to palpation, pain on passive motion
of the fingers, global hand dysesthesias, decreased vibratory
sensation, and increased 2-point discrimination.[25] Motor
weakness to the fingers may be present, but is often difficult to
assess due to pain and swelling. A convex-shaped palm can be
associated with compartment syndrome. Physical examination
of the hand for compartment syndrome is very difficult. We
recommend pressure measurements be done at the site of
maximum swelling, as well as in the thenar, hypothenar, first
dorsal interosseous, and third dorsal interosseous
compartments and in the carpal canal. Pressure measurements
cannot be obtained from the fingers, so the decision for digital
fasciotomies is based on clinical findings.
Terapi
• Nonoperative
For initial treatment, compressive dressings should be removed
and the limb elevated to heart level. Careful nursing and
physician assessments should be done serially to assess changes
in limb swelling, pain level, neurologic function, and vascular
function. Often, standardized reporting documents are useful in
documenting changes in the injured extremity.
Terapi
• Operative
General Principles. General operative principles for fasciotomy
and/or epimysiotomy include:
(1) longitudinal exposures, (2) complete fasciotomy, (3) careful
muscle and nerve inspection, (4) excision of necrotic muscle, (5)
measurement of tissue pressures after decompression, (6)
secondary closure of wounds, and (7) splinting of the hand in a
functional position.
Terapi
Postoperative Care.
The early institution of occupational therapy
is important in obtaining an optimal
outcome. Initial evaluation by a hand
therapist should include the application of a
well-molded, customized orthotic in a
functional position (metacarpophalangeal
joint at 70° to 90° of flexion and
interphalangeal joints in 0° to 10° of flexion).
Subsequent visits should focus on edema
control and the institution of early, active
range of motion exercises.
TERIMAKASIH

WASSALLAMU’ALLAIKUM WR.WB