CEDERA MUSKULOSKELETAL

YASIN W

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Kasus CM
• Fraktur
• Dislokasi sendi
• Sprain (ligamen)
• Strain (otot skeletal)
• Cedera tendon

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 FRAKTUR
• Adalah terputusnya kontinuitas tulang dan
ditentukan sesuai jenis dan luasnya.
• Fraktur terjadi jika tulang dikenai stress
yang lebih besar dari yang dapat
diabsorbsinya.
(Brunner & Suddart, 2010)

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Klasifikasi Fraktur
• Berdasarkan jenis
– transverse, spiral, dan greenstick (Stable)
– comminuted dan oblique (Unstable)
• Berdasarkan hubungan dengan lingkungan
– Open fraktur
– Closed fraktur
• Berdasarkan lokasi anatomis tulang
– 1/3 proksimal
– 1/3 tengah
– 1/3 distal
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• Fraktur komplet : patah pada seluruh garis tengah
tulang dan biasanya mengalami pergeseran.
• Fraktur tidak komplet: patah hanya pada
sebagian dari garis tengah tulang
• Fraktur tertutup: fraktur tapi tidak menyebabkan
robeknya kulit
• Fraktur terbuka: fraktur dengan luka pada kulit
atau membran mukosa sampai ke patahan
tulang.

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• Greenstick: fraktur dimana salah satu sisi tulang
patah,sedang sisi lainnya membengkak.
• Transversal: fraktur sepanjang garis tengah
tulang
• Kominutif: fraktur dengan tulang pecah menjadi
beberapa frakmen
• Depresi: fraktur dengan fragmen patahan
terdorong ke dalam
• Kompresi: Fraktur dimana tulang mengalami
kompresi (terjadi pada tulang belakang)
• Patologik: fraktur yang terjadi pada daerah tulang
oleh ligamen atau tendo pada daerah
perlekatannnya.
Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Etiologi
• Trauma
• Gerakan pintir mendadak
• Kontraksi otot ekstem
• Keadaan patologis : osteoporosis,
neoplasma

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Manifestasi klinis fraktur
• Edema
• Nyeri
• Spasme otot
• Deformitas
• Ecchymosis/kontosio
• Krepitasi
• Loss of Function

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 Fracture Healing
A. Fracture hematoma.
B. Granulation tissue.
C. Callus formation (Ossification)
D. Consolidation.
E. Remodeling.

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Pemeriksaan Diagnostik
• History and physical examination
• X-ray
• CT scan, MRI

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 Penatalaksanaan
• Prinsip penanganan fraktur :
1. Supporting
• Reposisi
• Reduksi (immobilisasi)
• Restorasi fungsi (rehabilitasi)
2. Reliefing (pain)
3. Preventing (infection, fibrosis, stiffness)
• Surgical debridement and irrigation
• Tetanus and diphtheria immunization
• Prophylactic antibiotic therapy

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
Limmer • O’Keefe • Dickinson All rights reserved.
Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Komplikasi
• Delayed union
• Nonunion
• Malunion
• Angulation
• Pseudoarthrosis
• Refracture
• Myositis ossificans
• Compartement syndrome
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 Pengkajian Keperawatan
• Pengkajian Primer
–A–B–C
• Pengkajian Sekunder
– Aktivitas-istirahat
– Neurosensori
– Kenyamanan
– Keamanan

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 Masalah Keperawatan
• Kerusakan mobilitas fisik b.d cedera
jaringan sekitasr fraktur, kerusakan rangka
neuromuskuler.
• Nyeri b.d spasme tot , pergeseran
fragmen tulang
• Kerusakan integritas jaringan b.d fraktur
terbuka , pembedahan.

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Dislokasi Sendi
• Dislokasi
– adalah keluarnya atau bercerainya kepala sendi dan
mangkuknya atau terlepasnya sebuah sendi dari
tempatnya.
– adalah suatu keadaan dimana terjadi perubahan dari
letak permukaan tulang satu terhadap lainnya yang
membentuk persendian (permukaan sendi tidak
berhubungan satu sama lain).
– adalah kondisi terjadinya kehilangan hubungan yang
normal antara kedua permukaan sendi secara
komplit atau lengkap.

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.
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 Etiologi
• Trauma
– Sebuah sendi yang pernah mengalami
dislokasi, ligamen- ligamennya menjadi
kendor, sehingga sendi itu akan mudah
mengalami dislokasi kembali.
• Kongenital
• Patologis
– Akibat destruksi tulang, misalnya tuberkulosis
tulang belakang.

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 Manifestasi Klinis
• Deformitas
– Hilangnya tonjolan, pemendekan, perubahan
letak.
• Nyeri
• Pembengkakan
• Functiolaesa

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 Area Dislokasi
• Dislokasi sendi rahang
• Dislokasi sendi jari
• Dislokasi sendi bahu
• Dislokasi sendi panggul

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 Penatalaksanaan
• Menurunkan nyeri
• Support dan proteksi sendi yang cedera

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 Komplikasi
• Nekrosis aseptik
• Kecacatan permanen
• Osteomyelitis

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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 Diagnosa Keperawatan
• Nyeri b/d spasme otot
• Disfungsi neurovaskuler perifer b/d
penurunan atau interupsi aliran darah dan
edema berlebihan
• Gangguan mobilitas fisik b/d nyeri,
imobilitas tungkai

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 SPRAINS & STRAINS

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 Sprains
• Adalah cedera pada struktur ligamen disekitar
sendi.
• Penyebabnya adalah gerakan memutar
(twisting).
• Klasifikasi (berdasarkan robekan serabut
ligamen:
– I (ringan) : robekan minim, nyeri-swelling (+)
– II (sedang) : robekan lebih luas , nyeri-swellg (++)
– III (berat) : terjd robekan ligamen, nyeri-swell (+++)

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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 Strains
• Adalah : peregangan yang berlebihan
pada otot dan lapisan fasia, terkadang
sampai tendon.
• Klasifikasi strains :
– I (ringan) : tarikan ringan pada otot
– II (sedang) : ada robekan pada otot
– III (berat) : ruptur pada otot

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 Etiologi
• Cedera traumatik
• Aktifitas latihan yang berlebihan

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 Manifestasi Klinis
• Nyeri
• Edema (tiny hemorrhage)
• Penurunan fungsi

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 Pemeriksaan Diagnostik
• X-ray / rontgen pada area yang cedera

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 Penatalaksanaan
• Hentikan aktifitas dan batasi pergerakan
• Berikan kompress dingin (es) pada area
cedera dan ekstrimitas disekitarnya.
• Elevasikan ekstrimitas
• Berikan analgesik bila diperlukan
• Intervensi bedah (jika ada ruptur berat)

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 Terimakasih
Semoga Bermanfaat

Emergency Care, Twelfth Edition Copyright ©2012 by Pearson Education, Inc.

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