Outcome pemasangan Plate and Screw dibandingkan Long Leg Cast pada penanganan fraktur Kruris terbuka derajat III di RS Dr. Sardjito Yogyakarta

PRIYADI, Agus, Prof.dr. H. Armis, SpB,SpOT.,FICS

2006 | Tesis | PPDS I Ilmu Bedah

Latar Belakang Masalah: Fraktur kruris terbuka derajat III sangat potensial untuk terjadi infeksi. Diperlukan penanganan awal yang adekuat untuk mengurangi dan mencegah infeksi. Stabilisasi fraktur adalah salah satu langkah penting dalam penanganan fraktur kruris terbuka derajat III. Pemilihan metode stabilisasi yang tepat pada penanganan fraktur berperan penting dalam mengembalikan struktur anatomi dan fungsi anggota gerak bawah. Metode penanganan yang sering digunakan adalah secara operatif dengan pemasangan plate and screw atau secara non operatif dengan pemasangan long leg cast. Tujuan Penelitian: Mengetahui outcome penanganan fraktur kruris terbuka derajat III dengan pemasangan plate and screw dan penanganan secara non operatif dengan pemasangan long leg cast berdasarkan kejadian infeksi, union, komplikasi dan penilaian fungsional sesuai kriteria Edward. Bahan dan Cara: Penelitian ini mengunakan rancangan penelitian observasional potong lintang (cross sectional). Variabel bebas yang diteliti metode stabilisasi fraktur secara operatif dan non operatif. Variabel tergantung meliputi kejadian infeksi, union, komplikasi dan penilaian kriteria Edward. Data penelitian bersumber pada catatan medik pasien fraktur kruris terbuka derajat III yang dirawat pada SMF Orthopaedi dan Traumatologi RS Dr. Sardjito Yogyakarta periode 1 Januari 2001 sampai dengan 30 Juni 2004 dan dilengkapi dengan pengisian kuesioner dan data hasil penilaian klinis pada Maret-Mei 2005. Perhitungan statistik dengan analisis chi-square digunakan untuk menilai perbedaan outcome. Hasil: Kejadian infeksi pada penanganan secara operatif sebesar 4/25 (16%) dan 3/25 (12%) pada penanganan secara non operatif (p-value > 0,05). Kejadian union fraktur pada penanganan secara operatif sebesar 22/25 (88%) dan 19/25 (76%) pada penanganan secara non operatif (p-value > 0,05). Kejadian komplikasi pada penanganan secara operatif sebesar 7/25 (28%) dan sebesar 14/25 (56%) pada penanganan secara non operatif (p-value > 0.05). Penilaian fungsional menurut kriteria Edward mendapatkan kategori baik 16/25 (64%), kategori sedang 7/25 (28%), kategori buruk 2/25 (8%) pada penanganan operatif dan mendapatkan kategori baik 9/25 (36%), kategori sedang 10/25 (40%) dan kategori buruk 6/25 (24%) pada penanganan non operatif (p-value < 0,05). Kesimpulan: Tidak didapatkan perbedaan yang bermakna outcome penanganan fraktur kruris terbuka derajat III secara operatif maupun non operatif dinilai berdasarkan kejadian union fraktur, infeksi maupun komplikasi. Namun pada penilaian fungsional sesuai kriteria Edward penanganan secara operatif dengan pemasangan plate and screw menunjukkan outcome lebih baik secara bermakna dibandingkan non operatif dengan pemasangan long leg cast.

Background: Type III of lower leg open fracture very potentially to happened infection. Early adequate management needed to decrease and prevent infection. Stabilization of fracture is one of important step in management of type III lower leg open fracture. Election of correct stabilization method at handling of fracture management important role in returning anatomical structure and restoration function of lower leg. Handling method which often used by operative with installation of plate and screw or non operative with installation of long leg cast. Objective: To know outcome management type III of lower leg open fracture with installation of plate and screw and non operative management with installation of long leg cast based on occurrence of infection, union fracture, complication of fracture and functional assessment according to Edward’s criterion Materials and Method: This Research had been prepared by observational (cross-sectional study). Free variable of research were stabilization method of fracture by operative or non operative procedure. Variable depended of research were occurrence of infection, union fracture, complication and assessment of Edward’s criterion. Research data based on medical record patient of type III of lower leg open fracture where hospitalized at SMF Orthopedic and Traumatology RS Dr. Sardjito Yogyakarta period 1 January 2001 up to 30 June 2004, and provided with admission filling of questioner and result data of clinical assessment at March-May 2005. Calculation of statistic with chi-square analysis used to assess difference of outcome. Result: Occurrence of infection at operative management 4/25 (16%) compared with 3/25 (12%) at non operative management (p-value > 0,05). Occurrence of union fracture at by operative management equal to 22/25 (88%) and 19/25 (76%) at non operative management (p-value > 0,05). Occurrence of complication by operative management equal to 7/25 (28%) and 14/25 (56%) by non operative management (p-value > 0.05). Functional assessment according to Edward’s criterion get good category 16/25 (64%), moderate category 7/25 (28%), poor category 2/25 (8%) by operative management and get good category 9/25 (36%), moderate category 10/25 (40%) and poor category 6/25 (24%) by non operative management (p-value < 0,05). Conclusion: No Significant difference outcome type III of lower leg open fracture by operative management compared with non operative based on occurrence of union fracture, infection rate and complication of fracture. Result of functional assessment according to Edward’s criterion, operative management with installation of plate and screw show significant better outcome compared with non operative management with installation of long leg cast.

Kata Kunci : Fraktur Kruris Terbuka Derajat III,Plate and Screw,Long Leg Cast, type III lower leg open fracture - union fracture – Edward’s criterion