RUMAH SAKIT TINGKAT II Prof. dr. J.A.

LATUMETEN
INSTALASI PENDIDIKAN

Lampiran Surat Ketua Komite Medik

Nomor
:B/
/ III/ 2015

Pada tanggal

: 27 Maret 2015

RINCIAN KEWENANGAN KLINIS DOKTER SPESIALIS

ORTHOPAEDI DAN TRAUMATOLOGI
dr. Ayiq Mahmud, Sp. OT

No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.

Rincian Kewenangan Klinis

Trauma
Trauma general
Free flap
Full thickness skin graft
Muscle flap
Nerve repair
Predicle flap
Removal external fixator or frame
Removal foreign body from skin / subcutaneous tissue
Removal K wires or skeletal traction
Split skin graft
Transpositional flap
Wound closure, delayed primary or secondary
Wound Debridement
Internal Fixation of Long Bone
Internal Fixation of complex Fracture
External Fixation
Periarticuler fracture
Tendon repair
Vascular repair
Casting and splinting
AXIAL SKELECTON:
Cervical Spine
Anterior fixation fracture / dislocation cervical spine
Application halo / tong traction cervical spine
MUA fracture / dislocation cervical spine
Posterior fixation fracture / dislocation cervical spine
Thoracic Spine
Anterior decompression / fixation thoracic spine
Posterior decompression / fixation thoracic spine

Disetujui Keterampilan
Klinis
1
2
3
4

No

Rincian Kewenangan Klinis

30.
31.
32.
33.
34.
35.

Lumbar Spine
Anterior decompression / fixation lumbar spine
Posterior decompression / fixation lumbar spine
Pelvis
Simple acetabular fracture ORIF
Complex acetabular fracture ORIF
Pelvic fracture:
Pelvic fracture external fixator application
Simple pelvic fracture ORIF
Complex pelvic fracture ORIF
UPPER LIMB:
Brachial Plexus
Exploration / repair / gralting brachial plexus
Clavicle
ORIF clavicle fracture
ORIF non-union clavicle
Shoulder
Anterior dislocation shoulder
Anterior dislocation shoulder closed reduction
Anterior dislocation shoulder open reduction +/- fixation
Acromioclavicular joint dislocation acute ORIF
Fracture proximal humerus ORIF
Glenoid fracture ORIF
Posterior dislocation shoulder closed reduction
Humerus
Dislocated elbow +/- fracture:
Dislocated elbow +/- fracture closed reduction
Dislocated elbow +/- fracture open reduction +/- fixation
Intraarticular distal humerus fracture ORIF
Lateral condyle fracture ORIF
Medial condyle / epicondyle fracture MUA / K wire/ ORIF
Olecranon fracture ORIF
Dislocated elbow +/- fracture:
Radial head / neck fracture MUA +/- K wire
Radial head / neck fracture ORIF
Radial head replacement for fracture
Supracondylar fracture:
Supracondylar fracture MUA +/- K wires
Supracondylar fracture ORIF
Forearm
Fasciotomy for compartment syndrome

36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.

Disetujui Keterampilan
Klinis
1
2
3
4

No

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis
1
2
3
4

66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93
94.
95.
96.
97
No

Fracture distal radius:

Fracture distal radius closed non-op
Fracture distal radius external fixation
Fracture distal radius MUA & percutaneous wires
Fracture distal radius MUA & POP
Fracture distal radius ORIF
Fracture shaft radius / ulna:
Fracture shaft radius / ulna IM nailing
Fracture shaft radius / ulna MUA & percutaneous
wires
Fracture shaft radius / ulna MUA & POP
Fracture shaft radius / ulna ORIF
Wrist
Carpal fracture / dislocation:
Carpal fracture / dislocation MUA & percutaneous
wires
Carpal fracture / dislocation MUA & POP
Carpal fracture / dislocation ORIF
Scaphoid fracture non-op
Scaphoid fracture ORIF
Scaphoid fracture MUA & percutaneous wires
Scaphoid fracture non-union ORIF +/- graft
Hand
Carpal fracture / dislocation:
5th metacarpal fracture / dislocation non-op
5th metacarpal fracture / dislocation MUA &
percutaneous wires
5th metacarpal fracture / dislocation MUA & POP
5th metacarpal fracture / dislocation ORIF
Finger tip reconstruction
Infection:
Infection hand drainage (not tendon sheath)
Infection tendon shealt drainage
IPJ fracture / dislocation:
IPJ fracture / dislocation MUA & percutaneous wires
IPJ fracture / dislocation MUA +/- POP
IPJ fracture / dislocation ORIF
Ligament repair hand
Metacarpal fracture ( not Ist or 5th ) non-op
Metacarpal fracture ( not Ist or 5th ) MUA &
percutaneous wires
Metacarpal fracture ( not Ist or 5th ) MUA +/- POP

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis

1
Metacarpal fracture ( not Ist or 5th ) ORIF
98.
Phalangeal fracture non-op
99.
100. Phalangeal fracture MUA & percutaneous wires
101. Phalangeal fracture MUA +/- POP
102. Phalangeal fracture ORIF

103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126

No

Tendon repair:
Tendon repair extensor
Tendon repair flexor
MCPJ fracture / dislocation:
MCPJ fracture / dislocation MUA & percutaneous
wires
MCPJ fracture / dislocation MUA +/- POP
MCPJ fracture / dislocation ORIF
LOWER LIMB:
Hip
Dislocation hip:
Dislocation hip closed reduction
Acute dislocated hip open reduction +/- fixation
Neglected dislocated hip open reduction +/- fixation
Extracapsular fracture:
Extracapsular fracture CHS / DHS
Extracapsular fracture intramedullary fixation
Extracapsular fracture other fixation
Intracapsular fracture:
Intracapsular fracture hemiarthroplasty
Intracapsular fracture internal fixation
Intracapsular fracture intracapsular fracture THR
Femur
Diaphyseal fracture closed:
Diaphyseal fracture traction or spica in child
Diaphyseal fracture intramedullary nailing
Diaphyseal fracture plate/ screw fixation
Fasciotomy for compartment syndrome
Subtrachanteric fracture:
Subtrachanteric fracture intramedullary fixation
Subtrachanteric fracture plate / screw fixation
Supracondylar fracture (not intraarthicular):
Supracondylar fracture (not intraarthicular) DCS /
blade plate etc
Supracondylar fracture (not intraarthicular)
intramedullary fixation

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis

1
127. Knee
128. Acute haemorthrosis arthroscopy
129. Acute ligament repair
130. Intaarticular fracture distal femur ORIF
131. Patella dislocation closed reduction +/- open repair
132. Patella fracture ORIF
133. Patella tendon repair
134. Quadriceps tendon repair
135. Simple tibia plateau fracture
136. Complex tibia plateau fracture
137. Tibia plateau fracture arthroscopically assisted fixation
138. Tibia plateau fracture ORIF with plates & screws
139. Tibia plateau fracture treatment with circular frame
140. Tibia & fibula
141. Diaphyseal tibia fracture external fixation (including
142.
143.
144.
145.
146.
147.
148.
149.
150.
151.
152.
153.
154.
155.
156.
157.
158.
159.
160.
161.

frame)
Diaphyseal tibia fracture intramedullary nailing
Diaphyseal tibia fracture MUA & POP
Tibial shaft plating
Fasciotonmy for compartment syndrome
Tibial non-union:
Tibial non-union circular frame management
Tibial non-union intramedullary nailing +/- bone
grafting
Ankle
Ankle fracture / dislocation :
Ankle fracture / dislocation MUA & PO
Ankle fracture / dislocation ORIF
Pilon fracture:
Simple pilon fracture ORIF
Complex pilon fracture ORIF
Pilon fracture with circular frame
Tendoachilles repair
Foot
Amputation toe / ray for trauma
Simple calcaneal fracture ORIF
Complex calcaneal fracture ORIF
Metatarsal fracture ORIF
Phalangeal fracture MUA +/- K wire +/- ORIF
Talar, subcular or midtarsal frature / disloc:
Talar, subcular or midtarsal fracture / dislocation MUA
+/- POP +/- K wires

Disetujui Keterampilan

No

Rincian Kewenangan Klinis

1

162.
163.
164.
165.
166.
167.
168.
169.
170.
171.
172.
173.
174.
175.
176.
177.
178.
179.
180.
181.
182.
183.
184.
185.
186.
187.
188.
189.
190.
191.
192.
193.
194.
195.
196.

Talar, subcular or midtarsal fracture / dislocation ORIF

Achilles Tendon Repair
Elective
Elective Site Non Specific
Aspiration / injection joint
Benign tumour axcision (not exostoses)
Biopsy bone - needle
Biopsy bone - open
Bursa excision
Cyst bone curettage +/- bone graft
Epiphysiodesis
Malignant tumour excision
AXIAL SKELETON:
Cervical spine
Anterior decompression +/- fixation / fusion (C2-C7)
Atlantoaxial fixation +/- fision
Biopsy cervical spine
Excision cervical / Ist rib
Nerve root / facet joint injection cervical spine
Occipito-cervical fusion +/- fixation / fusion (C2OC7)
Thoracic Spine
Anterior decompression +/- fixation / fusion
Scoliosis correction - anterior release +/instrumentation
Scoliosis correction - posterior release +/instrumentation
Lumbar Spine
Caudal epidural injection
Decompression lumbar spine with fusion +/- fixation
Decompression lumbar spine without fision (not
discectomy alone)
Discectomy open/ micro
Nerve root / facet joint injection lumbar spine
Brachial plexus
Exploration / repair / grafting brachial plexus
UPPER LIMB:
shoulder
Acromioclavicular joint excision-arthroscopic / open /
lateral clavicle
Acromioclavicular joint reconstruction ( e.g. Weaver
Dunn )
Acromioplasty open

Klinis
2
3

No

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis
1
2
3
4

197.
198.
199.
200.
201.
202.
203.
204.
205.
206.
207.
208.
209.
210.
211.
212.
213.
214.
215.
216.
217.
218.
219.
220.
221.
222.
223.
224.
225.
226.
227.
228.
229.
230.
231.
232.

No

Anterior repair for instability arthroscopic

Anterior repair for instability open including capsular
shift
Arthroscopic subacromial decompression
Arthroscopy diagnostic
Rotator cuff repair (open or arthroscopic) +/acromioplasty
Total shoulder replacement
UPPER ARM:
Elbow
Arthrolysis elbow (open / arthroscopic)
Arthroscopy elbow diagnostic
Arthroscopy elbow therapeutic
Arthrotomy elbow
Excision radial head +/- synovectomy
Radial head replacement
Tennis / golfer elbow release
Total elbow replacement
Ulnar nerve decompression / transposition
FORE ARM:
Wrist
Arthrodesis wrist (includes partial arthrodesis)
Arthroscopy wrist
Carpal tunnel decompression
De Quervains decompression
Excision distal ulna
Ulna shortening
Ulna nerve decompression at wrist
Ganglion excision at wrist
Hand
Dupuytrens contracture operation
Excision synovial cyst
Fusion of MCPJ or IPJ
MCPJ replacement
Soft tissue reconstruction hand
Tendon transfer hand
Trapezium excision or replacement
Trigger finger release
Trigger thumb release
LOWER LIMB:
HIP

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis
1
2
3
4

233. Arthrodesis hip

234. Arthrogram hip
235. Arthroscopy hip - diagnostic
236. Arthroscopy hip - therapeutic
237. Arthrotomy hip
238. Excision arthroplasty hip (e.g. Girdlestone)
239. Open reduction for DDH
240 Osteotomy hip - pelvic for DDH
241. Osteotomy hip - proximal femoral for DDH
242. Osteotomy pelvis - not for DDH
243. Revision Total Hip Replacement
244. Revision THR acetabular component
245. Revision THR both components
246. Revision THR remoral component
247.
248.
249.
250.
251.
252.
253.
254.
255.
256.
257.
258.
259.
260.
261.
262.
263.
264.
265.
266.
267.
268.
269.
270.
271.

No

Slipped upper femoral epiphysis:

Slipped upper femoral epiphysis open reduction
Slipped upper femoral epiphysis pinning
Total Hip Replacement:
THR cemented
THR hybrid
THR surface replacement
THR uncemented
Femur
Amputation above knee
Femoral lengthening
Osteotomy corrective (not for DDH)
Knee
Open ACL reconstruction
Arthroscopy ACL reconstruction
Arthroscopic lateral release
Arthroscopic partial meniscectomy
Arthroscopic removal loose bodies knee
Arthroscopic synovectomy
Arthroscopic knee diagnostic
Osteotomy distal femoral
Osteotomy proximal tibial
Patella realignment
Patella resurfacing alone
Revision TKR
TKR
Unicompartment knee replacement

Rincian Kewenangan Klinis

Disetujui Keterampilan
Klinis
1
2
3
4

272.
273.
274.
275.
276.
277.
278.
279.
280.
281.
282.
283.
284.
285.
286.
287.
288.
289.
290.
291.
292.
293.
294.
295.
296.
297.
298.
299.
300.
301.
302.
303.

Rehabilitasi Medik
Pemilihan Orthosis dan Prosthesis
Pemilihan Alat bantu gerak (alking aids) pasca operasi
Mobilisasi Pasca operatif
Tibia & Fibula
Amputation below knee
Tibial lengthening
Ankle
Arthrodesis ankle
Arthroplasty ankle
Arthroscopy ankle diagnostic
Arthroscopy ankle therapeutic
Arthrotomy ankle
Decompression tendons at ankle
Tendoachilles lengthening
Foot
Amputation toe / ray
Calcaneal osteotomy
CTEV correction
Fifth toe soft tissue correction
First metatarsal osteotomy
First MTPJ arthrodesis
First MTPJ excision arthroplasty
First MTPJ soft tissue correction
Hindfoot arthrodesis
Ingrowing toenail operation
Lesser metatarsal osteotomy
Lesser toe arthrodesis
Lasser toe excision part/ all phalanx
Lesser toe tenotomy
Tendon decompression or repair
Tendon transfer foot
Wedge tarsectomy

KETERANGAN KEMAMPUAN KLINIS DOKTER SPESIALIS :

Tingkat kemampuan 1 : Mengenali gambaran - gambaran klinis sesuai penyakit
Tingkat kemampuan 2 : Mampu membuat diagnosis klinis
Tingkat kemampuan 3 : Mampu mendiagnosisi klinis, memberi terapi, pendahuluan

Tingkat kemampuan 4 : Mampu mendiagnosisi klinis, memutuskan dan mampu

menangani problem itu secara mandiri hingga tuntas.

Ketua Komite Medik

dr. Rahmat Saptono. Sp.OG

Kolonel Ckm NRP 190010054530768