case report - juliet - closed fracture middle of the left femur
TRANSCRIPT
CLOSED FRACTURE 1/3 MIDDLE OF THE
LEFT FEMUR
Orthopaedic and Traumatology DeptMedical Faculty of Hasanuddin University
Makassar, 2013
Presented by:Juliet C G Umbas
Advisor :dr. Salman Al Wahabydr. Syarif Hidayatullah
Supervisor:dr. Notinas Horas, M. Kes, Sp. OT
Patient Identity
• Name : Mr. M• Age : 16 years old• Sex : Male• Date of admittance : 24th June 2013• MR : 615468
History TakingChief Complaint: Pain at the left thigh
History of illness Suffered since 6 hours before admitted to the
hospital due to a traffic accident.
History of unconsciousness (-), nausea (-) vomiting (-)History of previous illnesses (-)
Mechanism of trauma:The patient was a passenger of a motorcycle an then suddenly got hit by a car from behind, fell down, and then rolled on the road.
Primary SurveyPatentA
RR 20x/min regular, spontaneous thoracoabdominal type, symmetricalB
BP 120/80 mmHg HR = 88 x/min regular.C GCS 15 (E4V5M6),
isochoric pupil, Ø : 2.5 mm, light reflex +/+D
T = 36,70 C (axilla) E
LOCALIZED STATUS :Left femur region
– Inspection: deformity (+), swelling (+), haematoma (-)– Palpation: Tenderness (+)– ROM: Active and passive motion of hip joint and knee joint are limited
due to pain.– NVD: Sensibility is good,
dorsalis pedis artery and tibialis posterior artery palpable, Capillary refill time <2”
Secondary Survey
Right LeftALL 98 96
TLL 93 91
LLD 2 cm
Clinical Picture
Laboratory Findings
WBC : 10.000/mm3
HGB : 13,5 mg/dl RBC : 5.260.000/mm3
PLT : 259.000/mm3
Ur : 30 Cr : 0,9
GOT : 61 GPT : 60 CT : 8’00” BT : 2’00” HbsAg : non reactive GDS : 72 Elektrolit
Na : 136K : 5,0Cl : 102
X-ray :Femur (S)
AP/Lateral view 24th June 2013
Fracture 1/3 middle (L) femur
Pelvic X-ray24th June 2013Within normal
limit
Resume•A 16 years old boy came with closed fracture 1/3 middle of the left femur.
•From the physical examination vital sign is normal and at the left femur there are deformity, swelling, hematoma, tenderness.
•ROM is limited and NVD is normal •X-Ray examination is confirm the fracture•Laboratorium findings within normal limit
Diagnosis
Closed fracture 1/3 middle of the left femur
Management
• IVFD RL• Analgesic• Skin traction• Plan for ORIF
Femur Shaft Fracture
Anatomy of Femur
Thompson, Jon C. Netter’s Concise Orthopaedics Anatomy 2nd Edition
MUSCULATURE COMPARTMENT OF THE THIGH
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition
Introduction• A fracture is a break in the structural continuity
of bone• A femoral shaft fracture is a fracture of the
femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle.
• Fracture patterns are clues to the type of force that produced the break.
1. Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th Edition2. Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd edition.
Principles of Fracture
• Classification of Fracture– Open versus closed– Level of fracture : proximal, middle, distal third– Fracture pattern : transverse, spiral, or oblique– Comminuted, segmental, or butterfly fragment– Shortening, angulation or rotation deformity
• Fractures result from– Injury– Repetitive stress– Pathological fracture
Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th Edition
Mechanism of Injury
Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th Edition
PATHOLOGY ANATOMY• Fracture displacement often follows a
predictable pattern dictated by the pull of muscles attached to each fragments.– In proximal shaft fracture the proximal fragment is
flexed, abducted and externally rotated because of gluteus medius and iliopsoas pull, the distal fragment is frequently adducted.
– In mid-shaft fracture the proximal fragment is again flexed and externally rotated but abduction is less marked.
– In lower third fractures the proximal fragments is adducted and the distal fragment is tilted by gastrocnemius pull.
Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th Edition
PHYSICAL EXAMINATION• Inspection: deformity, sweling, haematoma.• Present with tenderness• Decreased range of motion at the hip or knee,
depending on the location of the fracture– Hip :
• Flexion 120-135° • Extend 20-30 °• Abduct 40-50 °• Adduct 20-30 °• Internal rotate 30 °• External rotate 50 °
• NVD evaluation
Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th EditionThompson, Jon C. Netter’s Concise Orthopaedics Anatomy 2nd Edition
- Knee :•Flexion : 125 - 135 °•Extend : 5 - 15 °
TREATMENT• Nonoperative
– Skin Traction– Skeletal traction– Casting – Splint
• Operative– Intramedullary Nailing– External Fixation– Plate and Screw Fixation
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition
COMPLICATION
Early Late• Shock• Vascular injury• Nerve Injury• Fat embolism• Thromboembolism• Infection
• Non union or delayed union
• Malunion• Joint stiffness• Refracture and
implant failure
Solomon Louis, Warwick David, Nayagam Selvadurai : Apley’s System of Orthopaedics and Fractures 9th Edition
Thank You