236949367 Case Fraktur Digiti

8/18/2019 236949367 Case Fraktur Digiti

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LAPORAN KASUS

SEORANG LAKI-LAKI USIA 36 TAHUN DENGAN KELUHAN NYERI PADA JARI

KAKI SEBELAH KANAN

Disusun Oleh :

Muh!" Lu#$i Rh!#

%3%&%'%'()

Pe!*i!*in+ :

D, He,!n Gh.$,/ S0OT

KEPANITERAAN KLINIK ILMU BEDAH RUMKITAL DR MINTOHARDJO

1AKULTAS KEDOKTERAN UNI2ERSITAS TRISAKTI

&%'6


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BAB I

I. IDENTITAS PASIEN

N! : Tn S

U!u, : 36 #hun

Jenis el!in : Li-li

A+! : Isl!

Al!# : Su"i,!n/ J,# Pus#

N. 4M : '53(&

Tn++l !su : &6 M,e# &%'6

II. DATA DASAR

Primary survey

A : A"eu#

B : RR : &% 7 8!eni#

4 : TD : '&%8)% !!H+/ N : (%78!eni#/ ,e+ule,/ isi "n #e+n+n 9uu0/ ,l hn+#/

90il, ,e$ill ; &D : G4S '5 ! n+ llu Ne,i "i,sn

#e,us- !ene,us Ne,i "i,sn *e,#!*h *il i "i+e,n Psien >u+

!e,sn "n ese!u#n "i *+in i se*elh nn Psien !en+#n s#

e>"in 0sien se"n+ *e,"i,i "n #e,#i!0 00n #,i0le *e,uu,n 79! ",i


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e#in++in 3 ln#i n+ !eni!0 i nn 0sien Psien !sih s", "n #i"

!en+eluh !ul/ !un#h/ 0usin+

Ri$ayat Penyait Da#u"u

Ri@# #,u! se*elu!n "isn+l

Ri@# le,+i "isn+l

Ri$ayat Sosia" Eonomi

Psien *e,.*# "i#n++un+ 0e,ushn / esn e.n.!i u,n+

B. Data Obyeti!

Pe!e,isn 1isi "ilun #n++l &6 M,e# &%'6 0uul '5'5 ?IB "i

IGD RSAL D, Min#.h,">.

Status &enera"is

Ke"n u!u! : *i/ ..0e,#i$

Kes",n : 9.!0.s!en#is

Tn" 2i#l : Te D,h : '&%8)% !!H+

N"i : (%78!eni#/ ,e+ule,/ isi "n #e+n+n 9uu0

Pe,n0sn : &%78!eni#

Suhu : 36/% 4 < 7ille, =

Ke0l : !es.se$l

M# : 9.n>un+#i 0l0e*, 0u9#


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P : s#e! $,e!i#us nn C i,i

Pe : s.n., selu,uh l0n+n 0,u

Au : Su, "s, esiule,/ ,.ni -8-/ @heein+ -8-

4., I : i9#us 9.,"is # #!0

P : i9#us 9.,"is #e,* 0" SI4 2 & 9! !e"il Line

Mi"9liul,is Sinis#,

Pe : .n$i+u,si >n#un+ "l! *#s n.,!l

Au : Su, >n#un+ I-II !u,ni/ *isin+


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L* D,h


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$.#. 0e"is "e7#, AP8O*liueu#n

IPM7 : Ke"n u!u!/ #n" i#l/ 0e,*in #n" "n +e>l/ 0.l !n/

hsil 0e!e,isn 0enun>n+/ 0e,*in !.e!en#

IPE7 :


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Pen>elsn !en+eni 0eni# "n 0,.+n.sisn/ !inu! .*# #e,#u,/

!nn #in++i 0,.#ein "n lsiu!/ i#!in "n !ine,l/ 9uu0 is#i,h#

2. PROGNOSIS

u. " i#! : A" *.n!

u. " sn! : A" *.n!u. " $un9#i.n! : A" *.n!

-o""o$ U ,

& 6 - % 3 - & %' 6

S : ne,i 0" >,i i nn

O : 2S : "l! *#s n.,!l

s# l.lis : R Pe"is Des#, : lu #e,*u uu,n & 7 ' 9!/

#e0i #i" ,#/ "s, #uln+/ *.ne

e70.se i elu,+ *e,se"i

L 0 ., n . 0 e , s i :


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Tn++l .0e,si : &)-%3-&%'&6/ >! : %)%% %)35/ l! .0e,si 35 !eni#

Ahli *e"h : ", He,!n Gh.$,/ S0 OT

Asis#en : Muh!" Lu#$i "n I@n

Pen"e,i# #i"u, #e,len#n+ "en+n n,.se

Ase0si "en+n n#ise0#i l0n+n .0e,si

Dilun insisi e,il "i+i#i II 0e"is "es#, s!0i 0e,i.s#eu!

T!0 $,#u, 0hln7 0,.si!l "i+i#i II 0e"is "es#,

Dilun 0e!sn+n @i,in+ "i 0hln7 0,.si!l

Lu "i9u9i "en+n N9l %/ "n

He!.l.+ "i#!*h 0.i".ne i."ine s!0i *e,sih

Lu .0e,si "i#u#u0 l0is "e!i l0is

Lu "i>hi# si#usi "n 0,.si!si se0,.si!l !un+in

O0e,si selesi

In s #,u s i 0 . s # . 0 e , s i :

- B e " , e s # & > !

- I21D : RL: D5 C ':3 8 & >!

- 4e$#,i7.ne & 7 ' +, I2

- T,!".l 3 7 '% !+ I2

- Die# *e*s

& ( - % 3 -& % ' 6

S : ne,i lu .0e,si

O : 2S : "l! *#s n.,!l


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s# l.lis : R Pe"is Des#, : #e,0sn+ *9 sl0/ lu

#e,@#

A : Post 3irin% ec -r. P#a"an/ Prosima" Di%iti II Pedis

P : - Be" ,es # & > !- I21D : RL: D5 C ':3 8 & >!

- 4e$#,i7.ne & 7 ' +, I2

- T,!".l 3 7 '% !+ I2

- Die# *e*s


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BAB II

TIN+AUAN PUSTAKA

0.) -ratur

&'' De$inisi 1,#u,

1,#u, "lh "is.n#inui#s #u #e,0u#usn esin!*un+n/ se*+in #u selu,uh

.,#es "n s#,u#u, #uln+ n+ u!u!n "ise**n .leh ,u"0s Te,>"in $,#u, "0#

"i,enn .leh #,u! s0.n#n !u0un "n ele!hn ",i #uln+ i*# +n++un

!e#*.lis!e "in 0#h

#uln+ i*# "n #,u! n+ "eu# Se"n+n $,#u, 0#.l.+is #e,>"i >i #uln+ 0#h

"i"e,h n+ le!h ,en !en+l!i .s#e.0.,.sis/ #u!.,/ *i i#u >in !u0un +ns #u

,en in$esi i*# ##lsn n+ #i" "eu#'

&'& P,.ses #e,>"in $,#u, '/&/3

Un#u !en+e#hui !enis!e #e,>"in $,#u,/ h,us "ie#hui le*ih "hulu e"n

$isi #uln+ "n e"n #,u! n+ "0# !ene**n #uln+ 0#h Tuln+ .,#il

!e!0uni s#,u#u, n+ "0# !enhn .!0,esi "n #enn !e!un#i, Ke*nn $,#u,

#e,>"i ,en e++ln #uln+ !enhn #enn !e!un#i, "n .!0,esi

T,u! "0# *e,si$#:

• T,u! Ln+sun+

T,u! ln+sun+ "0# !ene**n #enn ln+sun+ 0" #uln+ "n #e,>"i $,#u,

0" "e,h #enn 1,#u, n+ #e,>"i *isn *e,si$# .!uni#i$ "n >,in+n lun

iu# !en+l!i e,usn

• T,u! Ti" Ln+sun+

T,u! n+ "ihn#,n le*ih >uh ",i "e,h $,#u,/ !isln >#uh "en+n #n+n

es#ensi "0# !ene**n $,#u, 0" liul P" e"n ini *isn >,in+n

lun #e#0 u#uh


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&'3 Klsi$isi 1,#u, &/3/

' Te,*u8 Te,#u#u0

Slh s#u lsi$isi $,#u, *e,"s,n "n lu n+ *e,hu*un+n "en+n "e,h

n+ 0#h/ i#u :

• 1,#u, Te,#u#u0

A0*il #i" #e,"0# hu*un+n n#, $,+!en #uln+ "en+n "uni lu,

• 1,#u, Te,*u

A0*il #e,"0# hu*un+n n#, $,+!en #uln+ "en+n "uni lu,/ *i $,+!en

#uln+ n+ !en.n>.l elu, ,in+n lun n+ lus/ !eli0u#i s#,u#u, uli#/ .#.# "n

neu,.sule, D0# "i*+i !en>"i &:

>,in+n lun n+ !enu#u0i $,#u, #uln+ "eu#/ !esi0un #e,"0# lse,si

lus8 $l08 ulsi #u $,#u, se+!en#l8 sn+# .!inu#i$ n+ "ise**n #,u! *e,ene,+i #in++i #n0 !elih# *es,n lu

* ehiln+n >,in+n lun "en+n $,#u, #uln+ n+ #e,00, #u #e,.n#!insi

!si$

9 lu 0" 0e!*uluh ",h ,#e,i8 s,$ 0e,i$e, n+ h,us "i0e,*ii #n0 !elih#

>,in+n lun

& 1,#u, K.!0li#8 in.!0li#

- 1,#u, K.!0li# : 0*il +,is $,#u, n+ !ellui selu,uh 0en!0n+ #uln+ #u

!ellui e"u .,#es #uln+ se0e,#i n+ #e,lih# "l! $.#.

- 1,#u, in.!0li# : 0*il +,is $,#u, #i" !ellui selu,uh 0en!0n+ #uln+/

se0e,#i : hairline $,#u,/ greenstick $,#u,/ buckle $,#u,

3 Menu,u# +,is $,#u,n : #,nse,sl/ .*li/ s0i,l/ .!0,esi/ ulsi

Menu,u# Ju!lh +,is $,#u,

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- 1,#u, .!inu#i$ : +,is $,#u, le*ih ",i s#u "n slin+ *e,hu*un+n

- 1,#u, se+!en#l : +,is $,#u, le*ih ",i s#u #e#0i #i" slin+ *e,hu*un+n

- 1,#u, !ul#i0el : +,is $,#u, le*ih ",i s#u #e#0i 0" #uln+ n+ *e,linn

#e!0#n

5 Be,+ese,8 #i" *e,+ese,

- 1,#u, undisplaced : +,is $,#u, .!0li# #e#0i e"u $,+!en #i" *e,+ese,

- 1,#u, displaced : #e,>"i 0e,+ese,n $,+!en-$,+!en $,#u,

&' Di+n.sis

a. Anamnesis

Keluhn U#! *isn *e,u0 ne,i/ "e$.,!i#s/ 0e!*en+n/ +n++un $un+si

n++.# +e,/ ,e0i#si #u "#n+ "en+n +e>l-+e>l lin

An!nesis "ilun un#u !en++li ,i@# !enis!e 9e"e, "in= "n

e>"in-e>"in n+ *e,hu*un+n "en+n 9e"e, #e,se*u# ,i@# 9e"e, #u $,#u,

se*elu!n/ ,i@# s.sil e.n.!i/ 0ee,>n/ .*#-.*#n n+ "i .nsu!si/ !e,../

,i@# le,+i "n ,i@# .s#e.0.,.sis se,# 0eni# lin

b. Pemerisaan -isi

Pe!e,isn @l/ "en+n !e!0e,h#in "n:

- s./ ne!i #u 0e,",hn

- e,usn .,+n lin

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- $#., 0,e"is0.sisi/ !isln 0" $,#u, 0#.l.+is

Pe!e,isn L.l/ "en+n Look


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I. & +!*,n/ anteroposterior (AP) dan lateral

II. Me!u# "u sen"i "i 0,.si!l "n "is#l $,#u,

III. Me!u# +!*,n $.#. "u es#,e!i#s/ i#u es#,e!i#s n+ 9e"e, "n n+

#i" #e,en 9e"e,


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3 M.*ilissi "ini

1,#u, !ul#i0le

5 1,#u, P#.l.+is

0. I*OBILISASI ( -IKSASI

Tu4uan !e!0e,#hnn 0.sisi $,+!en 0.s# ,e0.sisi s!0i Uni.n

+enis -isasi ,

Eterna" ( ORE-

- Gi0s < 0les#e, 9s#=

- T,si

#ndikasi '

• Pe!en"en ,in+n sei#,

' Trasi &ravitasi : U- Sl* 0" $,#u, hune,us

& Sin trasi

Tu>un !en,i .#.# ",i >,in+n sei#, $,#u, sehin++ $,+!en n e!*li e

0.sisi se!ul Be*n %aksi%al kg ,en *il ele*ihn uli# n le0s

3 See"eta" trasi , K-@i,e/ S#ein!nn 0in #u Denh! 0in

Di0sn+ 0" "is#l #u*e,.si#s #i*i


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& 1,#u, "en+n e,usn >,in+n lun n+ lus

3 $,#u, "en+n +n++un neu,.sule,

1,#u, K.!inu#i$

5 1,#u, Pelis

6 1,#u, in$esi n+ .n#,in"isi "en+n ORI1

) N.n Uni.n

( T,u! !ul#i0le

Interna" ( ORI- , K7$ire8 "atin%8 scre$8 7nai"

1. UNION

2. RE9ABILITASI

&'6 Pene!*uhn 1,#u, 5

Pene!*uhn $,#u, !e,u0n 0,.ses *i.l.+is n+ sn+# lu, *is Ti" se0e,#i >,in+n

linn/ $,#u, "0# se!*uh #n0 >,in+n 0,u# Pen+e,#in #en#n+ ,esi #uln+ n+ hi"u0

"n 0e,i.s#eu! 0" 0ene!*uhn $,#u, !e,u0n "s, un#u !en+.*#i $,+!en $,#u,

P,.ses 0ene!*uhn 0" $,#u, !uli #e,>"i se+e, se#elh #uln+ !en+l!i e,usn

0*il lin+un+n un#u 0ene!*uhn !e!"i s!0i #e,>"i .ns.li"si Selin $9#., *i.l.+is/ $#., !enis n+ 0en#in+ se0e,#i i!.*ilissi se9, $isi $,+!en $,#u, sn+#

0en#in+ "l! 0ene!*uhn5

Pene!*uhn $,#u, 0" #uln+ .,#il:

- 1se he!#.!

Ai*# ,.*en 0e!*uluh ",h e9il n+ !ele@#i nliuli-nliuli ss#e! he,si

sehin++ #e,>"i es#,ssi e "l! >,in+n lun/ n+ !eni!*uln su#u "e,h

9in9in sule, #uln+ n+ !#i 0" sisi-sisi $,#u, se+e, se#elh #,u!

- 1se 0,.li$e,si selule, su*0e,i.s#el "n n".s#el

Te,>"i ,esi >,in+n lun sei#, $,#u, se*+i su#u ,esi 0ene!*uhn

Te,*enn#u lus es#e,n n+ *elu! !en+n"un+ #uln+ sehin++ se9, ,"i.l.+

*e,si$# ,"i.lusen

- 1se 0e!*en#un lus

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Te,*en#u woven bone #u lus n+ #elh !en+n"un+ #uln+ 1se ini !e,u0n

in"isi ,"i.l.+i 0e,#! #e,>"in 0ene!*uhn $,#u,

- 1se .ns.li"si

?.en *.ne !e!*en#u lus 0,i!e,

- 1se ,e!."elin+

Uni.n #elh len+0 "n #e,*en#u #uln+ .!0 n+ *e,isi ss#e! he,si "n

#e,*en#u ,.n++ su!su!

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?#u 0ene!*uhn $,#u,/ *e,,isi se9, in"ii"ul/ "i0en+,uhi .leh *e*e,0 hl

n#, lin:

' U!u, 0en"e,i#

& L.si "n .n$i+u,si $,#u,

3 0e,+es,n @l $,#u,

sul,issi n#, e"u $,+!en

5 ,e"usi se,# i!.*ilissi

6 @#u i!.*ilissi

) ,un+n n#, e"u $,+!en se,# in#e,0.sisi .leh >,in+n lun

( "n in$esi

9i,n sin.i

'% +e,n #i$ "n 0si$ n++.# +e,

Penilin 0ene!*uhn $,#u, "i"s,n #s uni.n se9, linis "n uni.n se9,

,"i.l.+is

Pene!*uhn n+ *n.,!l ",i $,#u, "0# !ene**n !luni.n/ "ele" uni.n

#u0un n.n-uni.n

&') K.!0lisi 1,#u,

Kom"iasi -ratur

K.!0lisi $,#u, "0# "ii*#n .leh #,u! i#u sen"i,i #u i*# 0enn+nn $,#u,

n+ "ise*u# ko%plikasi iatrogenik

). *o%plikasi u%u%

S. ,en 0e,",hn #u0un .leh ,en ne,i/ .+ul.0#i "i$$us "n +n++un $un+si

0e,n$sn

Ke#i+ !9! .!0lisi #e,se*u# "i#s "0# #e,>"i "l! & >! 0e,#! 0s9 #,u!

"n se#elh *e*e,0 h,i #u !in++u n #e,>"i +n++un !e#*.lis!e/ *e,u0

0enin+#n #*.lis!e K.!0lisi u!u! lin "0# *e,u0 e%boli le%ak+ tro%bosis

vena dala% (,-)+ tetanus atau gas gangren

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2. *o%plikasi /okal

a. Kom"iasi dini

K.!0lisi "ini "lh e>"in .!0lisi "l! satu %inggu pasca trau%a/ se"n+

n0*il e>"inn sesu"h s#u !in++u 0s9 #,u! "ise*u# .!0lisi ln>u#

Pada Tu"an%

- In$esi/ #e,u#! 0" $,#u, #e,*u

- "steo%ielitis "0# "ii*#n .leh $,#u, #e,*u #u #in"n .0e,si 0"

$,#u, #e,#u#u0 Ke"n ini "0# !eni!*uln delayed union atau ba!kan non

union

K.!0lisi sen"i "n #uln+ "0# *e,u0 ,#,i#is su0u,#i$ n+ se,in+ #e,>"i 0"

$,#u, #e,*u #u 0s9 .0e,si n+ !eli*#n sen"i sehin++ #e,>"i e,usn

,#il+. sen"i "n *e,hi, "en+n "e+ene,si

Pada +arin%an "una

- Le0uh / Kuli# n+ !ele0uh "lh i*# ",i elesi uli# su0e,$isil ,en

e"e! Te,0in "lh "en+n !enu#u0 s s#e,il e,in+ "n !elun

0e!sn+n els#i

- Deu*i#us #e,>"i i*# 0enenn >,in+n lun #uln+ .leh +i0s Oleh ,en

i#u 0e,lu "i*e,in *n#ln n+ #e*l 0" "e,h-"e,h n+ !en.n>.l

Pada Otot

Te,0u#usn se,*u# .#.# n+ !en+i*#n +e,n #i$ .#.# #e,se*u# #e,+n++u

Hl ini #e,>"i ,en se,*u# .#.# n+ ,.*e !ele# 0" se,*u# n+ u#uh/ 0sul

sen"i "n #uln+ Kehn9u,n .#.# i*# #,u! "n #e,>e0i# "l! @#u 9uu0 l!

n !eni!*uln sindro%a crus! atau tro%bus


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P" >,in+n "is#l ",i lesi n !en+l!i ise!i *hn ne,.sis T,u! #u

!ni0ulsi se@#u !elun ,e0.sisi "0# !eni!*uln #,in !en"" 0"

0e!*uluh ",h sehin++ "0# !eni!*uln s0s!e L0isn in#i! 0e!*uluh

",h #e,se*u# #e,le0s "n #e,>"i #,.!*us P" .!0,esi ,#e,i n+ l! se0e,#i

0e!sn+n torniquet "0# #e,>"i sin",.!e crush. Pe!*uluh en n+ 0u#us 0e,lu

"ilun ,e0i, un#u !en9e+h .n+es#i *+in "is#l lesi


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Te,0i .nse,#i$ sel! 6 *uln *il ++l "ilun Osteotomi

Le*ih &% !in++u "ilun 9n9ellus +,$#in+ ,in+n $i*,us n+ !sih !e!0uni 0.#ensi un#u uni.n

"en+n !elun .,esi $issi "n bone grafting.

Tie II 5atro#ic non union6 "ise*u# >u+ sen"i 0lsu (pseudoartrosis) #e,"0#

>,in+n sinovial se*+i 0sul sen"i *ese,# ,.n++ sinovial n+ *e,isi 9i,n/

0,.sesunion #i" n "i90i @lu0un "ilun i!.*ilissi l!

Be*e,0 $#., n+ !eni!*uln non union se0e,#i "is,u0si 0e,i.s#eu! n+ lus/ hiln+n

sul,issi $,+!en-$,+!en $,#u,/ @#u i!.*ilissi n+ #i" !e!"i/ implant #u

+i0s n+ #i" !e!"i/ "is#,si in#e,0.sisi/ in$esi "n 0eni# #uln+ "i 0" $,#u, #e,*u #u #in"n .0e,si 0" $,#u,

#e,#u#u0 sehin++ "0# !eni!*uln delayed union s!0i non union (infected non

union). I!.*ilissi n++.# +e, n+ !en+l!i .s#e.!ieli#is !en+i*#n #e,>"in

#,.0i #uln+ *e,u0 .s#e.0.,.sis "n #,.0i .#.#

- *ekakuan sendi

Keun sen"i *i se!en#, #u !ene#0 "0# "ii*#n i!.*ilissi l!/ sehin++

#e,>"i 0e,len+e#n 0e,i ,#iule,/ 0e,len+e#n in#,,#iule,/ 0e,len+e#n n#, .#.# "n

#en".n Pen9e+hnn *e,u0 !e!0e,0en"e @#u i!.*ilissi "n !elun l#ihn #i$

20


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"n 0si$ 0" sen"i Pe!*e*sn 0e,ien+e#n se9, 0e!*e"hn hn "ilun 0"

0en"e,i# "en+n eun sen"i !ene#0


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Pen+.*#n $,#u, n+ #i" *e,+ese, "i#u>un un#u !en+u,n+i ne,i "en+n !e!sn+

e,*n els#i9 #u 0e!sn+n +i0s si,ule, sel! 3- !in++u 1,#u, "en+n 0e,+ese,n

n+ he*# se*in "ilun .0e,si "en+n !e!sn+ K-@i,e

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DA-TAR PUSTAKA

' A0le/ AG,h! uku !"ar #rtopedi dan Fraktur $istem !%L&' E") J,# : ?i"

Me"i'5

& B+in Be"h S#$ Pen+>, 1ul#s e".#e,n Unie,si#s In".nesi umpulan uliah

lmu edah J,# : Bin,u0 As,'5

3 Rs>"/ 4hi,u""in %engantar lmu edah #rtopedi J,# : PT Y,si$ ?#!0.ne

&%%) S>!suhi"># R/ De J.n+ ?i! uku !"ar lmu edah E"isi e-& J,# : Pene,*i#

Buu Ke".#e,n EG4&%%

5 S9h@,#/ Shi,es/ S0en9e, . ntisari %rinsip-%rinsip lmu edah* &disi + J,# :

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236949367 Case Fraktur Digiti

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