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KOLEJ SAINS KESIHATAN BERSEKUTU KUCHING
DIPLOMA PEMBANTU PERUBATAN TAHUN 3 SEMESTER 1
TAJUK : FRAKTUR TIBIA DAN FIBULA KLINIK ORTOPEDIK (MAOR 3111) CASE STUDY TUGASAN INDIVIDU
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PENGENALAN:
Kepatahan tibia dan fibula merupakan kepatahan lebih daripada satu atau dua tulang di ba kaki. Kepatahan ini boleh berlaku dimana sahaja iaitu diantara lutut hingga ke buku
Kebiasaannya, kepatahan tulang tibia sering terjadi kerana hanya tulang tibia sahaja y
menyokong berat badan manusia. Namun, kepatahan tulang tibia juga sering meliba kepatahan fibula kerana tekanan ditransmisikan melalui interosseous membrane
menghubungkan menghubungkan dua tulang. Isolated fracture fra cture yang melibatkan proximal or mid-shaft port of the fibula pula jarang terjadi.
Jika kepatahan adalah disebabkan tekanan atau hentakan secara langsung, tulang mun
akan patah di beberapa kawasan ( a comminuted or segmental fracture ), dan menembu
permukaan kulit (open fracture). Spiral fracture pula sering terjadi kepada kanak-k
“toddlers” (ages 1 to 3 years ) dan selalunya adalah disebabkan “ twisting force” ap
terjatuh atau penderaan. Kepatahan juga boleh disebabkan daripada low-energy tra
seperti stress fracture atau daripada repetitive impact seperti semasa berjoging. Kepat
yang berpunca daripada low-energy trauma seringkali adalah stabil dan minimally displa
High-energy injury (direct blow, gunshot wound, motor vehicle accident) pula se
menyebabkan trauma ke atas kawasan tisu lembut (muscle, ligaments, blood vessels, nerves).
Risiko kepatahan tulang tibia dan fibula pula adalah terhadap individu yang bekerja di tem
yang tinggi risiko atau merbahaya serta yang melibatkan dalam aktiviti high-risk s Individu
yang
menghidapi
penyakit
tulang
seperti
osteoporosis
juga
mempu
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Special offer forBagi students: Only $4.99/month. incidence dan prevalence kepatahan tulang tibia dan fibula pula, kepatahan tu
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Jenis – jenis jenis kepatahan
i.
K epata patahan han ter ter tutup
kepatahan yang berlaku di mana tiada luka ataupun tulang yang patah itu t terdedah kepada udara luar.
ii.
K epata patahan han ter ter buka buka
iii.
kepatahan tulang yang mempunyai luka dan terdedah kepada udara luar.
K ep epata atahan han penuh
kepatahan tulang yang berlaku di mana tulang itu patah kepada dua atau l serpihan.
iv.
K epata patahan han tida ti dakk pe penuh nuh
v.
keretakan yang berlaku kepada tulang tersebut.
K epata patahan han str stre ess
kepatahan yang berlaku disebabkan oleh pergerakan yang berulang di m
tulang itu tidak dapat menahan bebanan tersebut. Tulang akan menga
keretakan yang amat halus dimana tidak dapat ditunjukkan oleh sinar X p peringkat awal.
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PENYATA MASALAH
Maklumat pesakit Nama
: Lepong Ak Muti
No Pendaftaran
: 17386/17
Jantina
: LELAKI
Umur
: 64 TAHUN
Pekerjaan
: PESARA
Bangsa
: iban
Chief complain
Pesakit mengalami kemalangan dan bengkak pada betis. X-ray mendapati pes mengalami kepatahan pada tibia dan fibula kanan.
Pengambilam sejarah
Pesakit
menaiki
motosikal
dan
terbabas
sebelum
tercampak
dari
motosikalnya.Pesakit merasakan seperti kaki kanannya terhentak pada batu ke
kejadian.Pesakit tidak mempunyai sebarang penyakit yang berbahaya, pesakit t merokok, tidak mengambil alkohol, dan tidak pernah men gambil dadah.
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Pemeriksaan dibuat mendapati tiada pendarahan, ada bengkak dan tiada deform
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PENYIASATAN:
1. Plain Xray: untuk mengesan kepatahan pada tibia dan fibula. Juga pada bahagian lutu
2. CT (Computerize Tomography) scan: untuk memaparkan gambaran tulang yang p dan jelas.
3. BUSE (Blood Urea Serum Electrolite): bagi menilai fungsi ginjal dan keseimba electrolite. 4. FBC(Full/complete
blood
count(FBC):
bagi
mengesan
kehadiran
ane
thrombositopenia dan jangkitan pada darah. 5.
(GXM) /blood typing: menentukan blood type/group serta rhesus darah. Penting u blood transfusion prosedure.
6. PTT(coagulation profiles): ujian ini dijalankan untuk menilai fungsi dan kualiti pla
dan fibrinogen iaitu penentuan masa yang diambil untuk pembentukan pembekuan da
RAWATAN 1. Prehospital Care
Periksa salur pernafasan dan sirkulasi. Periksa status neurovascular.
Master your Bagi semester with Scribd sterile dressing pada luka terbuka. Read Free Foron 30this Days Sign up to vote title & The New York Times Useful the Not useful splint extremity. Apply gentle traction to reduce gross deformities;
Administer
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analgesics
for
an
isolated
extremity
injury
in
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Open fractures must be diagnosed and treated appropriately (also see Tibia see Tibia Fract
Open). Open). Tetanus should be updated and appropriate antibiotics given. This sh
involve antistaphylococcal coverage and consideration of an aminoglycoside for m severe wounds. Orthopedics should be consulted for emergent debridement
wound care. Fractures with tissue at risk for opening should be protected to pre further morbidity.
Compartment syndrome can develop in fractures of the lower leg. le g. o
Signs of compartment syndrome include crescendo symptoms, pain passive movement of involved muscles, paresthesias, and pallor, and
late finding is pulselessness. Increased compartment pressure is present du
compartment syndrome; therefore, external palpation frequently aids in diagnosis. However, a soft extremity on palpation does not rule compartment syndrome. o
Serial examinations should be performed on patients with high-risk injurie patients with equivocal symptoms.
o
If compartment syndrome is suspected, obtain an emergent orthopedic con
and measure compartment pressures. Compartment syndrome must be tre
promptly with an emergency surgical fasciotomy. If untreated, the incre
compartment pressures can cause ischemia and necrosis of the struc within that facial compartment and permanent disability. o
Risk factors for compartment syndrome of the lower leg include t diaphysis fracture, soft-tissue injury, and crush injury.
Open fractures in pediatric patients have a significantly increased ris
Master your semester with Scribd developing compartment syndrome. & The New York Tibial Times plateau fracture o
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Immobilize
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fractures
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rem
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Obtain an orthopedic consultation for an unstable knee, or displaced fracture possible surgical fixation.
Tibial tuberc tubercle le fracture o
For nondisplaced fractures, immobilize the knee.
o
Obtain an orthopedic consultation for a displaced fracture to consider o reduction and internal fixation.
Proximal tibia fractures o
Intra-articular fractures require reduction and internal fixation.
o
Other methods to surgically repair proximal tibia fractures include exte fixation, plating, and intramedullary nailing.
o
Closed treatment involves reduction and the placement of a long leg cast. I
extensor mechanisms can make it difficult to maintain good fracture alignmen
Tibial shaft fractures that are closed may be treated with cast immobilizatio
alignment is good or with intramedullary nailing.
Isolated midshaft or proximal fibula fracture o
Immobilization in a long leg cast generally is not required. Recommend a
days without weightbearing activity until swelling resolves, followed weightbearing activity as tolerated. o
Short leg walking cast usually is not required; however, some orthopedists prefer a short leg walking cast or cam walker with weight bearing.
Tibia and fibula stress fractures o
The keystone of treating stress fractures is the temporary cessation of offending activity.
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PENCARIAN LITERATURE:
Bagi “incidence dan prevalence” kepatahan tulang tibia dan fibula pula, kepat
tulang panjang tibia selalunya terjadi dan merupakan tulang yang seringkali akan patah da kebanyakan kemalangan kenderaan bermotor. “Incidence” yang paling tinggi bagi kep
tibial adalah dalam kalangan orang dewasa iaitu dalam kalangan kaum lelaki yang beru diantara 15-19 tahun (Norvell). “Stress fractures” bagi tulang tibia juga sering terjadi ke atas ahli-ahli ahli -ahli sukan
melibatkan diri dalam larian dan lompatan. Kebarangkalian “Stress fracture” terjadi d kalangan dewasa pula adalah 10% melibatkan kepatahan tulang fibula (Sanderlin).
Rehabilitasi pula akan menentukan kadar keterukan, lokasi dan jenis kepata
bagaimana kepatahan boleh distabilkan sama ada melalui melalui “operative atau nonoperative”,
kadar “immobilization”. Antara tujuan utama rehabilitasi pula adalah untuk mengurang
kadar kesakitan, dan menyimpan kefungsian penuh ke atas anggota bawah. Penggunaan pemanas atau penyejuk juga boleh digunakan untuk mengawal kesakitan dan
( B r addom) .
“The individual may progress from walker to crutches to cane based on ability
weight bearing status. If casted, range of motion exercises of the adjacent joints may
beneficial unless contraindicated based on fracture stability. After cast removal, rang
motion, proprioceptive and strengthening exercises of the involved limb should be sta
(Bucholz). Exercise intensity and difficulty should be progressed until full functio achieved”.
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PERBINCANGAN
Sejarah perubatan yang lengkap adalah amat diperlukan dalam rawatan pesakit y
mengalami kepatahan. Hal ini termasuklah tempoh masa kepatahan atau orthopedic surg
keadaan perubatan pesakit (terutamanya yang mengalami underlying bone disease, neopl arthritis), pengambilan ubat-ubatan, allergies, dan pekerjaan. Mekanisma kecederaan
kepatahan ini termasuklah magnitude kepatahan, lokasi kepatahan dan arah impact a
membantu dalam perawatan. Individu yang terbabit atau pesakit juga mungkin akan meng
pernah mengalami kecederaan/trauma sebelumnya seperti motor vehicle acci dent, kecede sukan, atau terjatuh yang teruk.
Kebanyakan individu yang mengalami kepatahan juga mungkin akan meng mengalami kesakitan yang teruk, tidak boleh menyokong badan menggunakan kaki, perubahan dalan deria sentuhan/sensation. Jika hanya mengalami kepatahan fibula,
mungkin boleh atau mampu lagi untuk berjalan. Bagi kes stress fracture pula, pesakit ters
mungkin akan mengadu mengalami perubahan dalam tahap melakukan aktiviti fiz
seharian, serta kemerosotan dalam latiahan bagi ahli sukan. Tahap kesakitan akan men lebih teruk lagi dengan weight-bearing activity dan boleh dikurangkan dengan berehat.
Ketika melakukan physical examination, keadaan swelling (edema) pada kaw
kepatahan akan ditemui, bruising atau lebam (ecchymosis), dan mengalami kesakitan apa
ditekan di kawasan kepatahan. Di kawasan tersebut juga mungkin mungkin akan membengkak mengurangkan pergerakan pesakit terutama di bahagian lutut hingga ke kawasan buku
bergantung kepada lokasi kepatahan. Jika kepatahan tersebut teralih (displace), kecac
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darah, dan otot-otot kaki adalah penting untuk menilai kadar keterukan kepatahan.
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CADANGAN/PENYELESAIAN
Banyak rawatan yang boleh dijalankan bergantung kepada lokasi dan kadar keteru
kepatahan. Bagi kepatahan yang tidak rumit, closed manipulative reduction dan pemasan cast sahaja yang mungkin diperlukan.
Compound atau displaced fractures misalnya mungkin memerlukan pins pl
externally (external fixation devices), atau pembedahan untuk open reduction inte
fixation (ORIF) bersama-sama pins, plates, screws, atau intramedullary rods pl longitudinally within the shaft of the bone. The treatment of open fractures begins
thorough irrigation under pressure, followed by surgical removal of dead tissue (o
debridement). Surgical incisions may be closed with sutures. Other wounds may be left o
for 48 hours and then closed with sutures, and drains left in place, or the wound may be
open to heal on its own. Bone grafting mungkin dijalankan pada awal atau akhir rawa
Rawatan termasuklah analgesics untuk mengurangkan kesakitan, antibiotics dan sunt tetanus prophylaxis untuk kepatahan terbuka.
Kepatahan tibia dan fibula kebiasaannya berlaku semasa terjatuh, kemalan
kenderaan, kecederaan semasa bersukan, dan pelbagai aktiviti yang lain.Kepatahan b dirawat bergantung kepada jenis kepatahan dan alignment tualang tersebut.
Antara rawatan yang selalu digunakan adalah:
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Intrameduallary (IM) Rodding
ii.
Intrameduallary rodding adalah suatu prosidur meletakkan medal rod di dalam ten tengah tulang tibia atau fibula untuk memegang atau memastikan
alignment tu
Tibial rodding ialah surgical procedure yang memerlukan masa sekurang-kurangnya
setengah jam dan selalunya dijalankan dengan menggunakan general anesthesia. Pros ini membabitkan satu incision yang akan dilakukan ke atas sendi lutut pesakit , dan
incisions kecil di bawah lutut dan di atas buku lali.dalam pada itu juga, seseten
kepatahan akan memerlukan insisi berdekatan dengan tempat kepatahan u
membetulkan kedudukan tulang (relign the bones). IM rods akan dikunci atau diketa dengan screws kedua-dua bahagian atas dan bawah kepatahan. Metal screws dan rod
dimasukkan tadi boleh dikeluarkan jika menyebabkan sebarang masalah kepada pes serta boleh tahan lama dan dibiarkan sahaja untuk sepanjang hayat.
Tibial rodding memberikan fixation yang terbaik dan dapat membetulkan alignm
tulang. Antara risiko yang biasa atau selalu terjadi adalah; kesakitan pada bahagian l
dan antara risiko yang paling dikhuatiri adalah komplikasi jangkitan/infeksi pada kaw pembedahan. Infeksi pada rod akan memerlukan pengeluaran rod daripada tulang mengubati tempat yang terinfeksi.
Plates and Screws
iii.
kaedah Plates and screws pula merupakan kaedah yang jarang digunakan tetapi a
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Kebanyakan pakar bedah juga memilih IM rod untuk kepatahan seperti kepatahan sha
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External Fixator
iv.
penggunaan external ex ternal fixator juga mungkin membantu dalam sesetengah jenis kepat
tulang. External fixators biasanya digunakan dalam kes kepatahan yang lebih t
terutamanya dalam open fracture dengan atau berkaitan dengan lecerations and soft-t
damage. Dalam keadaan sebegini, penggantian IM rods atau plate ke atas tulang ad
mustahil disebabkan oleh kerosakan atau kecederaan soft-tissue. Apabila keadaan berlaku, the external fixator mungkin akan memberikan kaedah immobilization terbaik sementara pemantauan dan perawatan dijalankan ke atas soft-tissues.
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RUMUSAN
Fraktur pada batang tibia dan fibula merupakan fraktur yang lebih sering te
dibandingkan dengan batang tulang panjang yang lain. Periosteum yang menutupi tibia p
orang dewasa adalah tipis, terutama di atas batas subkutannya, dan mudah koyak den
andaian bahwa frakture pada tulang tibia sering terjadi dengan berlakunya pergeseran y luas.
Fraktur diafisis tibia dan fibula pula lebih sering terjadi bersama-sama. Fraktur d
juga terjadi hanya pada tibia atau fibula saja.Fraktur juga dapat diakibatkan diakib atkan trauma lang dan trauma tidak langsung. Trauma yang tinggi diakibatkan kecederaan lalu lintas atau jatuh dari ketinggian
dari 4 m. Fraktur yang terjadi biasanya fraktur terbuka. Trauma langsung energy ren
diakibatkan kecederaan semasa bersukan. Biasanya fraktur yang terjadi adalah fra
tertutup. Trauma tidak langsung diakibatkan oleh gaya gerak tubuh sendiri seperti p tubuh, serta kekuatan trauma yang disalurkan melalui sendi. Kawasan
yang
patah
akan
kelihatan
bengkak,
deformity,
angulasi
endo/eksorotasi, ditemukan juga dengan kurang pergerakan dan sakit apabila ditekan p kawasan yang patah. Seringkali juga ditemukan penonjolan tulang keluar kulit. Komplikasi kepatahan pula adalah, Compartment syndrome, terutama terjadi
fraktur proksimal tibia tertutup. Komplikasi ini sangat berbahaya kerana dapat menyebab
gangguan vaskularisasi ekstrimitis bawah yang dapat mengancam kelangsungan h Master your semester with Scribd Read Free Foron 30this Days Sign up to vote title anggota bawah. Komplikasi yang sering terjadi ialah anterior compartment syndro & The New York Times Useful Not useful Cancel anytime.
ini $4.99/month. boleh terjadi dalam masa kurang dari 12 jam dan harus dilakukan emerg Special offer forKeadaan students: Only fasiotomi.
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Study Case Ortho FIFI
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2. Delayed union:
Terutama terjadi pada fraktur terbuka yang diikuti dengan infeksi atau pada fra
yang komunitif. Hal ini dapat diatasi dengan operasi tandur alih tulang spongiosa. 3. Non union:
Disebabkan karena terjadi kehilangan segmen tulang tibia disertai dengan infeksi. ini dapat diatasi dengan melakukan bone grafting menurut cara Papineau. 4. Kekakuan sendi:
Hal ini disebabkan karena pemakaian gips yang terlalu lama. Pada persendian
dan jari-jari biasanya terjadi terbatasnya pergerakan. Hal ini dapat diatasi de fisioterapi.
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Study Case Ortho FIFI
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RUJUKAN:
i.
Niemeyer KH: Fracture of the tibia. In Bojrab MJ (ed): Current Techniques in Animal Surgery, pp 486-490. Philadelphia, Lea & Febiger, 1975.
ii.
Pettit GD, Slattet DH: Tension-band wires for fixation of an avulsed canine t tuberosity. J Am Vet Med Me d Assoc 164:242, 1973.
iii.
Withrow S, DeAngelis M, Arnoczky S et al: Treatment of fractures of the t tuberosity in the dog. J Am Vet Med Assoc 168:122, 1976
iv. v.
www.fracture.com.my www.wiley.com/college/tortora
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LAMPIRAN:
Lateral, AP, and oblique radiographs o
tibia and fibula. These reveal m displaced spiral fractures of both the and fibula.
AP radiograph of the tibia and fibula in a different patient.
demonstrates comminuted and mildly displaced fractures of distal fibula and tibia.
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Lateral radiograph of the tibia and fibula. Notice the dense ban
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