orthopedi
dr. Bagas, Sp.OT
Kegawatan Orthopedi
• Fraktur Terbuka
• Sindroma Kompartemen Akut
• Fraktur pelvis unstable
• Fraktur dengan Cedera Neurovaskular
• Dislokasi
• Septic arthritis
• Sindroma Emboli Lemak
Fraktur Terbuka
Penanganan di IGD
• ATLS
• Kontrol Nyeri imobilisasi (k/p reduksi fraktur), analgetik
• Wound toilette + hecting situasi
• Antibiotik
• Assesment lanjutan x-ray, lab, USG, CT scan, dll
Kapan perlu anti tetanus?
Sindroma Kompartemen Akut
• Meningkatnya tekanan intra-kompartemen (faktor eksternal /
internal)
ACS-
Findings
• 5 Ps of ischaemia
• Severe pain, "bursting"
• Pain (out of proportion to
sensation
injury)
• Pain with passive
• Paresthesias
stretch
• Paralysis
• Tense compartment
• Pulselessness
• Tight, shiny skin
• Pallor
- - - - 3 0 m m H g
>---elevatedPressure
==----- - - - - 10 mm
Hg
Normal
-- - ■ - - - - 0 mm
Hg
Komplikasi
• > 4 jam kerusakan otot dan saraf
lebih lanjut
• Saraf akan regenerasi, tp otot yg
infark akan diganti dengan jaringan
parut (Volkmann's ischaemic
contracture)
• Komplikasi : VIC, kerusakan saraf
permanen, iskemi tungkai &
amputasi, rabdomyolisis & gagal
ginjal
Penanganan di IGD
• ATLS
• Bebaskan dari tekanan luar (lepas gips/ bandage /
pakaian yg terlalu ketat
• Elevasi tungkai yg cedera
• Kontrol nyeri imobilisasi, analgetik
• Assesment lanjutan x-ray, lab, dll
Lokasi
• Lutut (40 -50%)
• Panggul (20 -25%) paling sering pada anak
• Pergelangan tangan (10%)
• Bahu, pergelangan kaki, siku (10 -15%)
Septic Joint- Signs and Symptoms
• Rapid onset
• Joint pain
• Joint swelling
• Joint warmth
• Joint erythema
• Decreased range of motion
• Pain with active and passive ROM
• Fever, raised WCC/CRP, positive blood cultures
Septic Joint- Treatment
• Diagnosis by aspiration
• Gram stain, microscopy, culture
• Leucocytes >50.000/µl highly
suggestive of sepsis
• Joint washout in operating theatre
• IV Abx 4-7 days then orally for
another 3 weeks
• Analgesia
• Splintage
Septic Joint- Complications
• Rapid destruction of joint with delayed treatment (>24 hours)
• Growth retardation, deformity of joint (children)
• Degenerative joint disease
• Osteomyelitis
• Joint fibrosis and ankylosing
• Sepsis
• Death
Gurd’s criteria
Sindroma emboli lemak
Management Supportive
• Oxygen
• Hydration
• Steroid, albumin
Sindroma kauda equina
• Kompresi pada cabang saraf lumbosacral di bawah level conus
medularis akibat herniasi sentral diskus / massa ekstrinsik / infeksi /
trauma