Penggunaan Splinting sebagai Modalitas Fisioterapi Pada Kasus Muskuloskeletal (upper & lower extremities) Lalu Suprawesta, SST.FT

Perkenalkan,… Nama : Lalu Suprawesta, SST.FT, MAT Lahir : Selong, 11 April 1990 Riwayat Akademi Terakhir : 2012 : Lulus Politeknik Kesehatan Surakarta Jurusan DIV Fisioterapi 2013-Sekarang : Universitas Udayana Magister Fisiologi Olahraga Riwayat Profesi ; Fisioterapis : 2013-Sekarang

Contact : Hp :081933120523 E-mail : elwest1104@gmail.com

Selayang pandang Splinting

Perban dan alat buatan sendiri lainnya digunakan oleh para tenaga medis selama berabad-abad yang lalu untuk imobilisasi dan membantu anggota gerak yang cedera Sebelum ada spesialisasi tenaga kesehatan modern, ahli bedah dokter dibangun perangkat atau meminta bantuan pandai besi lokal atau tukang kayu. Banyak cedera akibat perang dunia pertama dan kedua dan sejumlah besar pasien polio mendorong pengembangan disiplin ilmu orthotic dan prostetik pada awal abad ke-20 untuk produksi alat bantu dan alat ganti anggota tubuh. Banyaknya jumlah pasien yang membutuhkan pembidaian harus memenuhi pernyataan Bunnell ini: "splints harus distandarisasi sebanyak mungkin untuk memfasilitasi sejumlah besar pekerjaan yang dilakukan oleh banyak orang“ Sejarah www.themegallery.com

Fisioterapi Bentuk pelayanan kesehatan kepada individu dan atau kelompok agar mereka dapat mengembangkan, memelihara dan memulihkan gerak serta fungsi tubuh sepanjang daur kehidupan dengan menggunakan secara manual, peningkatan gerak, peralatan (fisik, elektroterapeutis, dan mekanis), pelatihan fungsi, komunikasi. (Kepmenkes : Nomor 1363/MENKES/SK/XII/2001)

Fisioterapi Pelayanan kepada individu dan masyarakat Mengembangkan, memelihara, memulihkan gerak dan fungsi Sepanjang daur kehidupan Dengan modalitas fisioterapi

Kasus Muskuloskeletal pada anggota gerak Fracture/Patah tulang Dislokasi/subluksasi sendi Osteoarthritis Osteoporosis Tendinitis Ligament tear Contracture Muscle/ tissue Sprain/strain Dll.

Proses Penyembuhan PHASE 1: Acute phase: ( 1 to 7 days) In this phase treatment exists out of the RICE-method. This method exists of Rest, Ice, Compression and Elevation. The main goal of this method is to minimize inflammation and pain. During the treatment with ice, a flexion and extension exercises are important but must be pain free (to prevent further injury). PHASE 2: Subacute phase: (Day 3 to < 3 weeks) This phase starts when signs of inflammation begin to reduce. Inflammation signs are heat, swelling, redness and pain. Muscle action is important to prevent muscle atrophy. When the patient has a full range of motion without any pain during this movement, concentric strength exercises can be done. When there is pain, the intensity must be immediately decreased. This classification is based on a treatment protocol of “Clanton et al.” [1] (Level of evidence: 3B) But is not indifferent from other classifications. It is possible that some phases overlap, dependable on the individual response to healing and the type of injury. Not every patient undergoes all phases to achieve a full rehabilitation.

3. PHASE 3: Remodeling phase: ( 1 to 6 weeks ) In this phase, the patient can begin with stretching exercises to avoid a decrease in flexibility of the hamstrings. Eccentric strengthening exercises can also be done in this stage. These exercises are heavier than concentric exercises. Therefore it is important that the muscle is already regenerated because otherwise, reinjury is possible. 4. PHASE 4: Functional phase: ( 2 weeks to 6 months) The main goal in this stage is to return to sport without a reinjury. To accomplish this goal, the patients need to increase their strength, endurance, speed, agility, flexibility and proprioception until the normal values of patient. Sport specific activities are the best indicators for a patient who returns to his sport.

5. PHASE 5: Return to competition phase: ( 3 weeks to 6 months) When a patient returns to the competition, it is important that he can avoid a reinjury. Only when the patient has a full range of motion, strength, coordination and psychological readiness, he is allowed to return to competition.

Penatalaksanaan Fisioterapi Assesment Functional limitation Cedera Musculoskeletal Diagnosa Participation restriction Impairment Evaluasi Splinting?? www.themegallery.com

Splinting Teknik Splinting digunakan untuk menangani kelainan sistem muskuloskeletal. Indikasi utama untuk splinting adalah untuk mengurangi gerak secara sementara pada anggota tubuh antara lain dari rasa sakit dan spasme otot, untuk mengurangi pembengkakan, dan untuk meminimalkan potensi lebih lanjut cedera jaringan lunak atau neurovaskular terkait dengan memar, keseleo, luka, patah tulang, dislokasi, atau nyeri sendi akibat gangguan inflamasi (1,2,3,4) 1.Egol K, Koval K, Zuckerman J. Part I. In: Handbook of Fractures. 4th ed. Lippincott and Williams; 2010. 2.Fitch MT, Nicks BA, Pariyadath M, McGinnis HD, Manthey DE. Videos in clinical medicine. Basic splinting techniques. N Engl J Med. Dec 25 2008;359(26):e32. [Medline]. 3.DeMaio M, McHale K, Lenhart M, Garland J, McIlvaine C, Rhode M. Plaster: our orthopaedic heritage: AAOS exhibit selection. J Bone Joint Surg Am. Oct 17 2012;94(20):e152. [Medline]. 4.Kim JK, Kook SH, Kim YK. Comparison of forearm rotation allowed by different types of upper extremity immobilization. J Bone Joint Surg Am. Mar 7 2012;94(5):455-60. [Medline].

Indikasi Splinting Indikasi Splinting meliputi: Imobilisasi sementara pada keseleo, patah tulang, dan mencegah dislokasi Pengendalian nyeri Pencegahan jaringan lunak lebih lanjut atau cedera neurovaskular

Kontra Indikasi Tidak ada kontraindikasi mutlak untuk penggunaan splints dalam manajemen yang sudah pernah ada atau pelaksanaan di lapangan untuk menstabilkan gerakan . Digunakan sebagai perangkat pengurangan gerak sementara baik sampai tindak lanjut (misalnya, untuk fraktur stabil) atau sampai pengobatan definitif (misalnya, patah tulang pergelangan kaki), kontraindikasi relatif adalah sebagai berikut:      Fraktur terbuka      Sindrom kompartemen yang akan datang      Gangguan neurovaskular      Penyebaran atau aktifasi refleks distrofi simpatis

pada kasus muskuloskeletal Splinting Splinting pada kasus muskuloskeletal Immobilisasi splint. 1.Mengurangi peradangan dari trauma 2. Mengurangi peradangan dari arthritis 3. Kontrol nyeri 4. Sebagai pendukung eksternal 5. Sebagai penggangti otot yang lemah, kehilangan fungsi dan tidak seimbang 6. Evaluasi potensi untuk operasi Mobilisasi splint 1. Perlindungan struktur penyembuhan 2. Menambah atau pemeliharaan gerak sendi dan meluncur jaringan 3. Pengaruh pada pembentukan bekas luka kulit

Apa saja jenis splint? Jenis-jenis Splint A Splints plaster B D B C A Splints plaster Splints fiberglass Splints prefabricated Splints udara Jenis-jenis Splint

Splinting Splinting Plaster Advantage Disadvantage • Easier to mold • Less expensive Disadvantage • More difficult to apply • Gets soggy when getting wet

Splinting Splints fiberglass Disadvantage • More expensive Advantage • Easier to apply • Set more quickly • Lighter • Water resistant Disadvantage • More expensive • More difficult to mold

Jenis Splint Splints prefabricated Add Your Title Plastic shells lined with air cells, foam, or gel components • Same advantages and disadvantages as fiberglass splints www.themegallery.com

Splint Udara Provide less support than plaster and fiberglass splints • Used for ankle sprains rather than fractures or dislocations Used to prevent eversion/inversion while permitting free flexion and extension of ankle www.themegallery.com

Prinsip yang harus di Ingat Dislocations that cannot be reduced Open,angulated, or displaced fractures Any injury that causes or could potentially cause Neurovascular compromise Ingatlah Impaired sensation Joints above and below the fracture site should be immobolized Excessive swelling and Circulatory Insuffiency www.themegallery.com

Bentuk splint Upper extremity splints • Figure of eight • Sling and swathe • Sugar tong-proximal and distal • Long arm posterior splint Volar Splint • Ulnar gutter • Thumb spica • Hand, Wrist and Finger splints Upper Extremity

Figure of eight • Use: – Clavicle fractures

Sling and Swathe • Use: – Shoulder and humeral injuries • Slings supports weight of shoulder • Swathe holds arm against chest to prevent shoulder rotation

Sugar tong • Use: – Humeral shaft, forearm, and wrist fractures • 2 Types: – 1) Proximal sugar tong – 2) Distal sugar tong

Proximal sugar tong 1) Proximal sugar tong – Used for humeralfractures – Applied from the axilla around the elbow and up the arm to lateralshoulder

2) Distal sugar tong – Wrist and distal forearm fractures – Extends from MCP joints on dorsum of hand, tracks along the forearm, wraps around back of elbow to volar surface of the arm, and extends down to midpalmer crease – Immobolizes wrist, forearm, and elbow

• Long arm posterior splint Use: – Forearm and elbow injuries – Olecranon and radial head fractures • Not recommended for unstable fractures • Applied from palmer crease, wrapping around lateral metacarpals, extending up to posterior arm with elbow flexed at 90 degrees

Volar Splint Use: – Distal forearm and wrist fractures • Applied from volar palmer crease to 2/3 forearm • Allows elbow and finger ROM

Ulnar Gutter Splint Use: – Phalangeal and metacarpal fractures • Most common use-Boxer • 5th MCP fracture

Thumb Spica Splint Use: – Scaphoid fractures, thumb phalanx fractures or dislocations • Most Common use: – 1) Gamekeepers thumb or skiers thumb • ulnar collateral ligament – 2) Dequiervans Tenosynovitis Extends from DIP joint of thumb, encorporates the thumb, and extends up 2/3 of the proximal lateral forearm

Hand Wrist and Finger Splint

Bentuk Splint Lower extremity Lower extremity splints • Knee splint • Posterior leg splint • Stirrup splint • Budding taping

Knee Splint Use: – Knee injuries and proximal Tib/fibFractures • Place knee in full extension • The plaster is placed from the posterior buttocks to 3 inches above level of bilateral malleoli

Posterior Leg Splint Use: – Distal leg, ankle, tarsal/metatarsal fractures – Ankle dislocations – Severe sprains Placed from metatarsal heads on plantar surfacefoot, extends up back of leg to level of fibular neck

Posterior Leg Splint with Stirrup If ankle fracture is unstable – Use posterior leg splint with a stirrup splint No weight bearing Use: – Unstable ankle fracture • Prevents eversion and inversion of the ankle The splint should be long enough to involve the leg from below the medial side of knee, wrap around the under surface of the heel, and back up to the lateral side of the same knee.

Budding taping Use: – Phalangeal fractures of the toes • Small piece of wadding placed between toes to prevent maceration • Fractured toe secured to adjacent toe with tape • Use a small piece of wadding and place between the injured toe and an adjacent toe to prevent maceration • The fractured toe is secured to the adjacent toe with a piece of tape

Kesimpulan Splinting memainkan peran utama dalam pengelolaan awal cedera muskuloskeletal, terutama yang melibatkan patah tulang ekstremitas, dislokasi sendi, dan keseleo parah Fisioterapi sebagai salah satu disiplin ilmu yang bisa mengaplikasikan Splinting untuk tahap preventif dan rehabilitatif pada kasus muskuloskeletal.

Kesimpulan Splint yang diterapkan dengan benar akan menstabilkan ekstremitas yang cedera, mengurangi ketidaknyamanan, dan memungkinkan untuk memulai proses penyembuhan. Tergantung pada jenis cedera, splinting mungkin satu-satunya pengobatan yang diperlukan, atau mungkin menjadi ukuran penting untuk mengurangi ketidaknyamanan sampai evaluasi lebih lanjut atau intervensi bedah dilakukan

Thank You !