Refleksi Kasus 2 Lili Endra 3

8/17/2019 Refleksi Kasus 2 Lili Endra 3

http://slidepdf.com/reader/full/refleksi-kasus-2-lili-endra-3 1/34

Case Reflection : Left

CLAVICLE Fracture - group Oleh : lili Widianto & dwi endra !p!

"e#$i#$ing : dr! s%aiful #uhtar' sp!$ $d



introduction

( Cla)icle is the #ost fre*uentl% fractured $one in thechildhood' accounting for +,-+. of all fractures in group!

( Cla)icular inuries affect + in +,,, people per %ear! incidence occurs in #en %ounger than 01 %ears and olde%ears!

(2iddle third 3group I4 5-60. of all fractures of thewhereas distal third 3group II4 +0.' and #edial third 3g. of cases!

( Cla)icular inuries occur 0!1 ti#es #ore co##onl% 7fe#ales!



Identit%

( 8a#e : 2r! AW9

( Age : + %o

( Address : ua#au treet' R; 1

( <ospitali=ed : >rd April 0,+



Ana#nesis

( Chief co#plaint :

Right ar#s cannot $e #o)ed

( <istor% of co#plaint :

Right ar#s of the pasien cannot $e #o)ed after ind

#otorc%cle accident 0 da%s ago' the patient use hel#et! other co#plaint is pain in the left shoulde

nausea 3-4' )o##it 3-4' headache 3-4!



( "ast illnes histor%: 3-4

( Fa#il% illnes histor%: 3-4

( Alergi : 3-4

( 2edical histor% : 3-4



"h%sic E?a#ination

( Conciousness : Co#pos#entis' E@V12

( Vital sign

/" : ++,6, ##<g

<R : 6, ?i' reguler

RR : 0, ?i' reguler ;o : >B'0oC



( <ead and nec :

ane#is 3--4' iteri 3--4' pupil isoor >##>##' light perception 34' sign of trau#a 3-4!

( ;hora? :

inspesi: retraction 3-4' si#etris

palpasi : $reathing #o)e#ent and )ocal fre#itus 9 si#etris

perusi : sonor in all of lung fieldausultasi: )esiuler 34' rh 3--4' wh= 3--4' s+s0 reguler

( A$do#en :

inspesi : flat' sign of trau#a 3-4

palpasi : soefl' tenderness 3-4

perusi : t%#phani' acites 3-4

ausultasi : /D 34' nor#al

( Estre#itas :

war# acral' in the left shoulder' ede#a 34' hipere#is 34' CR; 0 deti



Local tatus

Regio houlder inistra

( Loo

ede#a 34' hipere#is 34

( Feel

"ain 34' AV8 clear' CR; 0 sec( 2o)e

RO2 restricted



La$orator% Finding

( La$oratoriu# @ april 0,+

W/C : +5!6 +,>ul

<G/ : +@'1 gdl<C; : @6'6.

/; : 0H

C; : 5H

G9 : +50 #gdl

Dreu# : 0@'0 #gdl

Creatinin : ,'1 #gdl

8atriu# : +>5 ##olL

aliu# : 1'+ ##olL

Chloride : +,B ##olL

<$sag :non reatif

A$<i) : non reatif



Case

MRS 3/4/16

PRO ORIF4/4/16 – 7/4/16ARM SLING (-)

KELUARGAPIKIR-PIKIR

KELUARGAMENOLAK

PASIEN MEKONSERVA

A V N D

A L A M

B A T A S N O

R M A L



Interpretation :- Middle third left clavicle fracture wit

displacement



discussion



clasification

( Group I 3#iddle third fractures4'( Group II 3lateral third fractures4'

J 3a4 those with the coracocla)icular liga#ents intact' J 3/4 those where the coracocla)icular liga#ents are

detached fro# the #edial seg#ent $ut the trape=oid

re#ains intact to the distal seg#ent' J 3C4 factures which are intra-articular!

( Group III 32edial third fractures4! Lateral third fractu$e further su$-classified into



Group I



Group II



Group iii



#echanis#



igns & s%#pto#s

;he patient #a% cradle the inured e?tre#it% with the uninured ar#

;he shoulder #a% appear shortened relati)e to the opposite side and #a% droop

welling' ecch%#osis' and tenderness #a% $e noted o)er the cla)icle

A$rasion o)er the cla)icle #a% $e noted' suggesting that the fracture was fro# a direct #echa

Crepitus fro# the fracture ends ru$$ing against each other #a% $e noted with gentle #anipula

9ifficult% $reathing or di#inished $reath sounds on the affected side #a% indicate a pul#onar%a pneu#othora?

"alpation of the scapula and ri$s #a% re)eal a conco#itant inur%

;enting and $lanching of the sin at the fracture site #a% indicate an i#pending open fracture'

often re*uires surgical sta$ili=ation 3see the i#age $elow4



treat#ent

(Group I J si#ple ar# sling

J Figure of eight

J Internal fi?ation

(Group ii

J i#ple ar# sling J Internal fi?ation

(Group iii J i#ple ar# sling

( E!"#$%&'

( %"

( P#%' %"#$%&'

( F&**&+-!



"rognosis

( 2ost cla)icle fractures treated nonoperati)e

although with )aria$le a#ounts of cos#etic de

Kounger children generall% re*uire shorter pe

i##o$ili=ation 30-@ w4 than do adolescen

adults 3@-6 w4!



co#plication

(Neurovascular injuries

(Intrathoracic injuries

(Non-union

(Malunion



;han %ou

Refleksi Kasus 2 Lili Endra 3

Documents

Transcript of Refleksi Kasus 2 Lili Endra 3