LAPORAN KASUS

Oleh:
dr. Lendy Nusa Bika Ika

Pendamping:
dr. Syarif
 Laporan Kasus

Identitas Pasien
• Nama : An. H
• Umur : 17 tahun
• Jenis kelamin : Laki-laki
• Alamat : Mataram
• Status: Belum Menikah
• Pendidikan : SMA
• Pekerjaan : Pelajar
• Agama : Islam
• Tanggal MRS: 27 Januari 2023
Primary Survey
Mode of Injury: Pasien post KLL tunggal
• A: Paten (+)
• B: Nafas spontan, RR 20 x/menit, simetris
+/+, sonor +/+, vesikuler +/+, rhonki -/-,
wheezing -/-
• C: Nadi 70 x/menit regular, tekanan darah
120/80 mmHg
• D: Alert, PBI 3mm/3mm, Reflek Cahaya +/+
• E: -
 Secondary Survey B1: Nafas spontan, RR 20 x/menit,
simetris +/+, sonor +/+, vesikuler +/+,
rhonki -/-, wheezing -/-
Riwayat Penyakit Sekarang: Pasien post B2: Nadi 70 x/menit regular
KLL tunggal sepeda motor karena B3: GCS 456, PBI 3mm/3mm, Reflek
tergelincir. Pasien memakai helm, dan Cahaya +/+
pada saat terjatuh pasien dalam keadaan B4: BAK (+)
sadar. Mual (-), muntah (-).  B5: BAB (-)
A: - B6: Close fraktur radius 1/3 distal dextra
M: -
P: Hipertensi (-), Diabetes Mellitus (-)
L: -
E: -
Status Lokalis wrist joint dextra:
Look: Deformitas (-), edema (+)
Feel: Nyeri (+), sensorik (+)
Movement: ROM terbatas nyeri
(+), motorik (+)

Keluhan Utama
• Nyeri pada tangan kanan
Riwayat Penyakit Sekarang
• Pasien post KLL tunggal sepeda motor karena tergelincir.
Pasien memakai helm, dan pada saat terjatuh pasien dalam
keadaan pingsan. Mual (-), muntah (-).
• Kejadian ini terjadi 5 hari yll, dan pasien tidak berobat ke
dokter.
• Saat ini nyeri dirasakan semakin memberat disertai bengkak
pada bagian pergelangan dan sulit digerakkan.
Riwayat penyakit dahulu
• Hipertensi (-), Diabetes Mellitus (-)
Riwayat Penyakit Keluarga
• Hipertensi (-), Diabetes Mellitus (-)
Riwayat Pengobatan: -
Riwayat Sosial Lingkungan Ekonomi
• Pasien merupakan anak kedua dari 2 bersaudara.
Riwayat Gizi
• Sehari-hari pasien rutin makan 2 kali sehari dengan menu
rata-rata nasi, sayur, tempe, tahu, kadang lauk (ikan , daging
dan ayam ) kadang makan buah-buahan.
ANAMNESIS
• Sistem serebrospinal: pusing(-),
penurunan kesadaran (-), kejang (-),
badan gemetar (-)
• Sistem kardiovaskular : nyeri dada (-),
palpitasi (-)
• Sistem pernapasan : sesak (-), batuk (-),
mengi (-)
• Sistem gastrointestinal: mual (-), muntah
(-), diare (-), nafsu makan menurun (-),
nyeri perut (-), BAB normal
• Sistem urogenital: BAK lancar, tidak ada
keluhan
• Sistem integumentum :turgor kulit
normal, pucat (+), gatal (-), purpura (-),
ptekie (-)
• Sistem musculoskeletal : edema (+), atrofi
(-), deformitas (-)
 Pemeriksaan Fisik

• Keadaan umum : cukup Kepala

• Kesadaran : compos mentis, GCS 4-5-6 • Bentuk :bulat lonjong, simetris
• Vital sign • Rambut : hitam, lurus, pendek
• • Mata :konjungtiva anemis: -/-
TD : 120/80 mmHg
• sklera ikterus: -/-
• Nadi : 70 x/menit, regular, kuat angkat
• edema palpebra: -/-
• RR : 20 x/menit • refleks cahaya: +/+
• Suhu Aksila : 36,5o C • Hidung : sekret (-), bau (-), pernapasan
• Pernapasan : sesak (-), batuk (-) cuping hidung (-)
• Kulit : turgor kulit normal, purpura (-), • Telinga : sekret (-), bau (-), perdarahan (-)
ptekie (-), • Mulut : sianosis (-), bau (-)
• Kelenjar limfe : pembesaran KGB (-), Leher
pembesaran kelenjar tiroid (-) • KGB : tidak ada pembesaran
• Tiroid : tidak membesar
• Otot : edema (-), atrofi (-)
• JVP : normal
• Tulang : deformitas (-), renal
osteodistrofi (-), kalsifikasi (-)
 Pemeriksaan Fisik

Pulmo

Thorax
• Cor:
• Inspeksi : ictus cordis tidak tampak
• Palpasi : ictus cordis teraba di ICS V
MCL S
• Perkusi: redup di ICS IV PSL D s/d ICS
V MCL S
• Auskultasi : S1S2 tunggal, reguler,
e/g/m (-)
 Pemeriksaan Fisik

Pulmo
 Ekstremitas
• Superior : Akral hangat
Abdomen +/+, edema-/-
• Inspeksi : Flat, spider nevi (-), • Inferior : Akral hangat
sikatriks (-), striae (-) +/+, edema-/-
• Auskultasi : Peristaltik (+) normal,
Bising usus (+) normal
• Palpasi : Nyeri tekan epigastrik (-),
hepatomegaly (-)
• Perkusi: Pekak beralih (-), pekak sisi
(-), timpani di semua kuadran
abdomen
 Pemeriksaan Penunjang
Radiologi Foto wrist join dextra AP/LATERAL

Hasil Pemeriksaan;
Fraktur komplit oblik )non
displaced) os radius dextra
pars tertia distal.
Dislokasi ulna dextra
 Pemeriksaan Penunjang
Radiologi Thorax PA

Hasil Pemeriksaan;
Pulmo dbn
Besar cor normal
 Pemeriksaan Penunjang
HEMATOLOGI LENGKAP
Laboratorium Jenis Hasil Nilai Normal
27-01-2023 Pemeriksaan Pemeriksaan

Hemoglobin 12.0 gr/dL 13.0 – 18.0 gr/dL

Leukosit 6.12 x109/L 4.0 – 11.0 x109/L

Hematokrit 36.4 40 – 50 %
Trombosit 260 x109/L 150-400 x109/L
BT  3  1-6
CT 11  6-14
GDS 86 70-140
 Resume

Pasien laki-laki usia 17 tahun. Pasien datang dengan keluhan nyeri pada tangan
kanan post kecelakaan lalu lintas.
Pemeriksaan fisik : Didapatkan keadaan umum pasien cukup, kesadaran compos
mentis, TD 120/80 mmHg, Nadi 70 x/menit, RR 20 x/menit dan didapatkan edema
pada tangan kanan.
Pada hasil pemeriksaan radiologis didapatkan Fraktur komplit oblik (non displaced)
os radius dextra pars tertia distal.
Dislokasi ulna dextra
 Diagnosis Kerja
Close fraktur radius dextra 1/3 distal
Penatalaksanaan
Planning Terapi
- Inf. RL 30 Tpm
- Inj. Ketorolac 3x1
- Inj. Ceftriaxone 2 g
- Pro Close reduction
Planning Monitoring Planning Diagnostik
- Tanda-tanda vital - Foto Radiologi pre op
- Skala nyeri
Planning Edukasi
- Istirahat cukup
- Menjelaskan tentang penyakit yang di
derita kepada pasien, keluarga pasien,
perjalanan penyakit, perawatan, prognosa
komplikasi serta usaha pencegahan
komplikasi
Prognosis

Quo ad vitam : dubia ad bonam

Quo ad functionam : dubia ad bonam
Quo ad sanationam : dubia ad bonam
 Laporan Operasi
Nama Lengkap An. H
Tanggal Lahir 16-10-2006
Diagnosa
 
Pra Bedah
Close fraktur radius dextra
 
Post close reduction
Pasca Bedah
Tindakan Operasi Close Reduction
Golongan operasi Khusus, Bersih, Elektif
Informed consent
Persiapan Operasi
Inj. Ceftriaxone 2 gram
Posisi Pasien Supine
Povidone Iodine 10% dipersempit dengan
Desinfeksi
duk steril
Insisi kulit dan
pembukaan lapangan Anterior dan subcutaneous approach
operasi
Pendapatan pada
Fraktur komplit non displaced
eksplorasi
Debridement
Anestesi General
Deskripsi / uraian
operasi Reposisi

Pasang Gips
Nama Operasi Close reduction
Komplikasi Perdarahan
Penutupan lapangan
Jahit lapis demi lapis
operasi
Hasil operasi Fraktur radius dextra 1/3 distal
Pengiriman jaringan
Tidak dilakukan
operasi
Jumlah perdarahan Perdarahan ± 20 cc
PEMBAHASAN
 Fraktur adalah terputus atau hilangnya
kontinuitas dari struktur tulang atau tulang
rawan

faktur tertutup, yaitu

patahan tulang tidak ada
hubungan dengan dunia luar

fraktur terbuka, yaitu adanya

hubungan dengan dunia luar dan
memungkinkan risiko infeksi
semakin besar
 most common during metaphyseal growth spurt
 peak incidence occurring from:
10-12 years of age in girls
12-14 years of age in boys
 most common fracture in children under 16 years old

Pathophysiology
mechanism
 usually fall on an outstretched hand, extended at wrist
 often during sports or play
remodeling
 greatest closer to physis and in plane of joint (wrist) motion
 sagittal plane (flexion/extension)
 least for rotational deformity
 Anatomy

The forearm is made up of two bones: the radius and the ulna.
The radius is on the "thumb side" of the forearm, and the ulna is
on the "pinky finger side."
Growth plates are areas of cartilage near the ends of the long
bones in children and adolescents. The long bones of the body
do not grow from the center outward. Instead, growth occurs at
each end of the bone around the growth plate. When a child is
fully grown, the growth plates harden into solid bone. Both the
radius and the ulna have growth plates.
Fractures can occur in one or both bones of the forearm, and in a number of
places along the bone:
 Near the wrist, at the farthest (distal) end of the bone
 In the middle of the forearm
 Near the elbow, at the top (proximal) end of the bone
 There are several types of forearm fractures in children:

 Torus fracture : This is also called a "buckle" fracture. The topmost layer of bone on one side of the
bone is compressed, causing the other side to bend away from the growth plate. This is a stable
fracture, meaning that the broken pieces of bone are still in position and have not separated apart
(displaced).
 Metaphyseal fracture: The fracture is across the upper or lower portion of the shaft of the bone and
does not affect the growth plate.
 Greenstick fracture: The fracture extends through a portion of the bone, causing it to bend on the other
side.

 Galeazzi fracture: This injury affects both bones of the forearm. There is usually a displaced fracture
in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
 Monteggia fracture: This injury affects both bones of the forearm. There is usually a fracture in the
ulna and the top (head) of the radius is dislocated. This is a very severe injury and requires urgent
care.
 Growth plate fracture:  Also called a "physeal" fracture, this fracture occurs at or across the growth
plate. In most cases, this type of fracture occurs in the growth plate of the radius near the wrist.
Because the growth plate helps determine the future length and shape of the mature bone, this type of
fracture requires prompt attention.
 Fracture types

1. Torus (buckle) fractures: buckling of one or more cortices of the bone as a result of a compressive force,
typically a fall from standing height into the outstretched hand. These fractures usually occur in children <10
years, and the distal radius and/or ulna metaphysis is the most common site.
2. Greenstick fractures are incomplete fractures involving disruption of 1–3 sides of the bone with bending of the
others, skin to bending and splintering a tongue depressor without snapping it clean in two.
3. Complete fracture disrupts the entire cortex, with resultant deformity and angulation. These are often found in
higher-energy injuries, such as falls from a height, sports and road traffic accidents.
4. Growth plate injuries; ‘SALTR’ Straight across the physis, Above the physis extending into the metaphysis,
Low to the physis extending into the epiphysis and articular surface, Through the physis going above and
below, and cRushed.
5. Fracture-dislocation; Galeazzi fracture-dislocations involve a fracture of the distal third of the radius and
dislocation of the distal radioulnar joint at the wrist. Monteggia fracture-dislocations, involve a fracture of the
ulna associated with dislocation of the proximal radius (radial head).
 Causes

Children love to run, hop, skip, jump and tumble, all of which are activities
that could potentially result in a fracture to the forearm should an
unexpected fall occur. In most cases, forearm fractures in children are
caused by:
 A fall onto an outstretched arm
 A fall directly on the forearm
 A direct blow to the forearm

Gambaran Klinis: ditemukan nyeri, pembengkakan atau adanya

krepitasi dan deformitas pada lengan bawah.
 Physical Examination
 Deformity about the elbow, forearm, or wrist
 Tenderness
 Swelling
 An inability to rotate or turn the forearm
 During the physical examination, also test to make sure that the nerves and
circulation of hand and fingers have not been affected.

Diagnosis is made by AP and lateral radiographs of the wrist or forearm

X-rays provide clear images of dense structures such as bones.

Because the hand, wrist, arm, and elbow can all be injured during a fall on an
outstretched arm
 Treatment
Non Surgical Surgical
• Some stable fractures, such as buckle fractures, • The bone has broken through the skin—this type of injury

may simply need the support of a cast or splint (called an open fracture) is at risk for infection and
requires specific treatment
while they heal.
• The fracture is unstable—the ends of the broken bones
• For more severe fractures that have become
will not stay lined up
angled, we may be able to manipulate or gently
• Bone segments have been displaced
push the bones into place without surgery.
• The bones cannot be aligned properly through
• This procedure is called a closed reduction. manipulation alone
Afterward, the arm is immobilized in a cast or • The bones have already begun to heal at an angle or in an
splint while it heals. improper position
During surgery, we may open the skin and reposition the

Closed reduction is a procedure to set (reduce) a broken broken bone fragments (a procedure called an open reduction).
bone without cutting the skin open. The broken bone is use pins, metal implants, or a cast to hold the broken bones in
put back in place, which allows it to grow back together place until they have healed.
in better alignment.
 Close Reduction Method
Benefit
• Menghilangkan ketegangan pada kulit dan
mengurangi pembengkakan
• Memperbaiki fungsi anggota tubuh Kembali
secara normal
• Mengurangi rasa sakit
• Mempercepat kesembuhan
• Menurunkan risiko infeksi pada tulang
Possible Risk
• The nerves, blood vessels, and other soft tissues
near your bone may be injured.
• A blood clot could form, and it could travel to
your lungs or another part of your body.
• You could have an allergic reaction to the pain
medicine you receive.
• There may be new fractures that occur with the
reduction.
• If the reduction does not work, you may need
surgery.
 Close Reduction

Open Reduction
 Indikasi Operasi
a. Fraktur terbuka
b. Kegagalan reduksi tertutup
c. Malunion

Komplikasi
a. Refraktur terjadi apabila union belum solid
b. Gangguan vaskularisasi karena pemasangan gips yang terlalu ketat 
kompartemen sindrom (5 P) pain, paralysis, paraesthesia,
Teknik Cast Splintage
pallor, dan perishing cold
c. Ulkus  pressure sores
d. Trauma saraf, yaitu pada nervus medianus, ulnaris, atau nervus interoseus
posterior
Teknik Traksi
e. Malunion
 Faktor-faktor yang menyebabkan kegagalan reposisi tertutup

a. Gips menjadi longgar karena pembengkakan/edema sebelumnya

b. Kegagalan mendeteksi dan mengoreksi perubahan posisi
c. Kegagalan reduksi awal
d. Kegagalan mempertahankan fraktur dalam posisi yang stabil
 Recovery

 The length of time the cast is worn will vary depending on the severity of the fracture.
 A stable fracture, such as a buckle fracture, may require 3 to 4 weeks in a cast.
 A more serious injury, such as a Monteggia fracture, may need to be immobilized for 6 to 10 weeks.
 When the cast is removed, the wrist and elbow joints may be stiff for 2 to 3 weeks. This stiffness will go
away on its own, usually without the need for physical therapy.
 For a short period of time, the forearm bones may be weaker due to immobilization in the cast.
 To allow the bones to safely regain their normal strength, the child should avoid playing on playground
structures, such as monkey bars, for 3 to 4 weeks after the cast is removed.
 If the fracture disrupts the growth plate at the end of the bone, it could affect the development of the bone.
 Summary

 Distal Radius Fractures are the most common site of pediatric forearm fractures and generally occur as a result
of a fall on an outstretched hand with the wrist extended.
 Diagnosis is made with radiographs of the wrist. 
 Treatment is generally closed reduction and casting for the majority of fractures. Surgical intervention is
indicated for significantly displaced or angulated fractures in patients approaching skeletal maturity.