case icha ortho.ppt

7/27/2019 case icha ortho.ppt

1/35

CLOSE FRACTURE1/3 MIDDLE LEFT HUMERUS

By

Icha Marissa Sofyan

(C 111 08 318)

Advisor

dr. Lutfi

dr. Dhedi P.sam

Supervisor

dr. JAINAL ARIFIN, M. KES, SP.OT (K)

DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

MAKASSAR2013

Case Report

July 2013


2/35


3/35


4/35

General Status

Moderate illnes/Wellnourished/Composmentis

Vital SignsT : 130/70 mmHg

N : 82x/minutes, reguler

P : 20x/minutes, simetris, spontan, tipethoracolabdominal

S : 37,3 c


5/35

LOCALIZED STATUSLeft Upper Arm Region

Look: deformity (+), swelling (+), hematoma (-),

open wound (-)Feel: tenderness (+)

ROM: Active and passive motion of shoulder

elbow joint limited due to painNVD: Sensibility is good, radialis artery palpable,

capillary refill time


6/35

Clinical Pictures


7/35

Radiologic Findings

AP and lateral

radiograph of upper

arm


8/35

Laboratory Findings

Leukocyte 15,0 103/L 4,0-10.0

Eritrocyte 4,57 103

/L 4,0-6,0Hemoglobin 14,4 g/dL 12,0-16,0

Hematocrit 43,9% 37,0-48,0

Trombocyte 411 103

/L 150-400MCV 96,0 fl 80-97

MCH 31,4 pg 26,5-33,5

MCHC 32,7g/dL 31,5-35,0


9/35

Laboratory Findings

Na+ 145 mmol/L 136-145

K+ 4,2 mmol/L 3,5-5,1Cl- 110 mmol/L 97-111

GDS 103 mg/dL


10/35


11/35

Diagnosis

Closed fracture 1/3 middle left humerus


12/35

Management

Immobilization

Analgetics

apply U slab

Plan ORIF


13/35

DISCUSSIONFracture of Shaft Humerus


14/35

EPIDEMIOLOGY

Common injury, representing 3% to 5% of all

fractures.

Brinker et al

mean age 28.9 years 13.1 per 100,000

persons per year.

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006

Bucholz, Robert W.; Heckman, James D.; Court-Brown, Charles M. Rockwood & Green's Fractures in

Adults, 6th Edition. 2006


15/35

ANATOMY (1)

Putz R. and Pabs R. Sobotta Atlas of Human Anatomy. Volume 1 Head, Neck, Upper Limb. 2006


16/35


17/35

ANATOMI (3)

Thompson JC. Arm. In: Netters Concise Orthopaedic Anatomy. Second edition.

muscle : brachialis,biceps brachii, dancoracobrachialis.

Neurovascular :brachial a.,musculocutaneus n.,media n., and radial n

Anterior

compartments:

muscle : tricepsbrachii.

Neurovascular : radial

n.and ulnar n.,radialrecurrent arteries

Posterior

compartments:


18/35

AO Clasificcation

W.M MURPHY , D. LEU. In AO PRINPCLES Of FRACTURE MANAGEMENT. EDITION 2000


19/35

CLASSIFICATION

Open vs. closed.

Location: proximal third, middle third, distal

third.

Degree: nondisplaced, displaced.

Direction and character: transverse, oblique,

spiral, segmental, comminuted.

Articular extension.



20/35


21/35

MECHANISM OF INJURY (2)

Fracture pattern depends on the type of force applied:

Compressive: proximal or distal humeral fractures

Bending: transverse fractures of the humeral shaft

Torsional: spiral fractures of the humeral shaft Torsional and bending: oblique fracture, often

accompanied by a butterfly fragment



22/35


23/35

CLINICAL EVALUATION

pain, swelling, deformity, and shortening

neurovascular examination

radial nerve function

compartment pressures

instability

Soft tissue abrasions and minor lacerationsmust be differentiated from open fractures.



24/35

RADIOLOGICAL EXAMINATION

The site of the fracture,its line (transverse,

spiral or comminuted)

and any displacement

are readily seen.

The possibility that the

fracture may be

pathological should beremembered.

Solomon L, Warwick DJ, Nagayam S. Apley's system of orthopaedics and fractures2001.

Closed transverse fracture with moderate displacement.


25/35

TREATMENT (1)

Humeral

Fracture

NonOperative

Operative



26/35


27/35

TREATMENT (3)

OPERATIVE Indications are:

Multiple trauma

Inadequate closed

reduction orunacceptable malunion

Pathologic fracture

Associated vascular injury

Floating elbow

Segmental fracture

Intraarticular extension

Bilateral humeral

fractures

Open fracture

Neurologic loss

following penetrating

trauma

Radial nerve palsy after

fracture manipulation

(controversial)

Nonunion



28/35

TREATMENT (4)


Operative

OPEN REDUCTION AND PLATE FIXATION INTRAMEDULLARY FIXATION EXTERNAL FIXATION


29/35

TREATMENT (5)

Fractured humerus and other methods of fixation. (a,b) Compression plating, and

(c,d,e) external fixation.

Solomon L, Warwick DJ, Nagayam S. Apley's system of orthopaedics and fractures2001.


30/35

Postoperative Rehabilitation

Range-of-motion exercises for the hand and

wrist should be started immediately after

surgery; shoulder and elbow range of motion

should be instituted as pain subsides.



31/35


32/35

Thankyou


33/35


34/35


35/35

Radiologic ORIF

case icha ortho.ppt

Documents