case sharizal
TRANSCRIPT
-
7/30/2019 Case Sharizal
1/36
-
7/30/2019 Case Sharizal
2/36
PATIENT IDENTITY
Name : Mr. A
Age : 20 y/o,
Sex : Male
Admission : January 3rd 2013
Registration : 587062
-
7/30/2019 Case Sharizal
3/36
HISTORY TAKING
Chief complaint
Pain at the right thigh
History of illness
Suffered since 8 hours prior admission to theWahidin Hospital
Mechanism of trauma
Patient was riding a motorcycle and got hit byanother motorcycle from the right side and fell down
with his right thigh hit the ground first. History of unconscious (-), nausea (-), vommiting (-)
History of prior treatment at the Sinjai GeneralHospital
-
7/30/2019 Case Sharizal
4/36
PRIMARY SURVEY
A : Patent
B : RR = 20x/min, spontaneous,
thoracoabdominal
C : BP = 110/70 mm/Hg, PR = 86x/min,
reguler, strong pulse
D : GCS 15 ( E4M6V5), pupil isochor 2.5mm/2.5mm, light reflex +/+
E : T =36,50 C (axillar)
-
7/30/2019 Case Sharizal
5/36
SECONDARY SURVEY
RIGHT THIGH REGION
I : Deformity (+), swelling (+),hematom (+), wound (-)
P : Tenderness (+)
ROM : Limited active and passivemovement of the hip join and knee joint
due to pain NVD : sensibility is good, pulsation of
dorsalis pedis artery is palpable, capillaryrefill time
-
7/30/2019 Case Sharizal
6/36
LEG LENGTH DISCREPANCY
R L
ALL 80 cm 83 cmTLL 74 cm 77 cm
LLD 3 cm
-
7/30/2019 Case Sharizal
7/36
CLINICAL PICTURE
-
7/30/2019 Case Sharizal
8/36
CLINICAL PICTURE
-
7/30/2019 Case Sharizal
9/36
CLINICAL PICTURE
-
7/30/2019 Case Sharizal
10/36
LABAROTORY FINDINGS
WBC : 12,41 x 103 /uL
RBC : 3,32x 106 /uL
HGB : 13,8 gr/dL
HCT : 37,0 % PLT : 332 x 103 /Ul
CT : 730
BT : 230
HBsAg : Negative
-
7/30/2019 Case Sharizal
11/36
RADIOLOGY FINDING
-
7/30/2019 Case Sharizal
12/36
RADIOLOGY FINDING
-
7/30/2019 Case Sharizal
13/36
RADIOLOGY FINDING
-
7/30/2019 Case Sharizal
14/36
RESUME
A 20 years old man came to the hospital withchief complaint of pain at the right thigh due totraffic accident. He got hit by a motorcyclefrom his right side and fell down with rightthigh hit the ground first. From the physicalexamination of the right thigh : deformity (+),hematoma (+), tenderness (+), active andpassive motion of the hip and knee joint due tothe pain.
From radiologic finding, there is communitivefracture at the 1/3 proximal of the right femur
-
7/30/2019 Case Sharizal
15/36
DIAGNOSIS
Closed communitive fracture at
1/3 proximal of the right femur
-
7/30/2019 Case Sharizal
16/36
TREATMENT
Analgetic
Apply skin traction with load 3 kg
Plan for ORIF ( Open reductioninternal fixation )
-
7/30/2019 Case Sharizal
17/36
DISCUSSION
Fracture of shaftfemur
-
7/30/2019 Case Sharizal
18/36
DEFINITION
A femoral shaft fracture is a
fracture of the femoral diaphysis
occurring between 5 cm distal tothe lesser trochanter and 5 cm
proximal to the adductor tubercle.
Koval KJ, Zuckerman JD. In : Handbook of Fractures Thi rd Edition.
USA : L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
19/36
EPIDEMIOLOGY
Femoral shaft fractures occur
most frequently in young men
after high-energy trauma andelderly women after a low-energy
fall.
Koval KJ, Zuckerman JD. In : Handbook of Fractures Thi rd Edition.
USA : L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
20/36
ANATOMY
Thompson, J. Netters Concise Orthopaedic Anatomy 2ndEdi tion. Kansas : Elsevier
-
7/30/2019 Case Sharizal
21/36
ANATOMY
Muscles of the thigh are arranged in three
compartments separated by intermuscular septa.
Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA :
L ippincott Wil li ams & Wilki ns. 2002
-
7/30/2019 Case Sharizal
22/36
ANTERIOR COMPARTMENT
1. Quadriceps femoris
- Rectus Femoris
- Vastus Intermedius
- Vastus Medial- Vastus Lateral
2. Sartorius
3. Psoas major and iliacus
Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition.
USA: L ippincott Wil li ams & Wilkins. 2002
-
7/30/2019 Case Sharizal
23/36
ANTERIOR COMPARTMENT
-
7/30/2019 Case Sharizal
24/36
-
7/30/2019 Case Sharizal
25/36
-
7/30/2019 Case Sharizal
26/36
POSTERIOR COMPARTMENT
1. Biceps femoris
2. Semitendinosus
3. Semimembranosus
Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition.
USA: L ippincott Wil li ams & Wilkins. 2002
-
7/30/2019 Case Sharizal
27/36
POSTERIOR COMPARTMENT
-
7/30/2019 Case Sharizal
28/36
ARTERY OF THE THIGH
Thompson,JD. Netter's concise atlas of orthopedic
anatomy.2004.p189
-
7/30/2019 Case Sharizal
29/36
CLASSFICATION OF WINGUIST
AND HANSEN
Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA:L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
30/36
MECHANISM OF INJURY
In adults are almost always
the result of high-energy
trauma, result from motor
vehicle accident, gunshotinjury, or fall from a height
Pathologic fractures,
especially in the elderly,
commonly occur at the
relatively weak metaphyseal-diaphyseal junction
Stress fractures occur mainly in militaryrecruits or runners
Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA :
L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
31/36
DIAGNOSIS
History Taking
high-energy trauma, a full trauma survey is
indicated
pain
Physical Examination
deformity, swelling, hematoma, tenderness
range of motion hip joint and knee joint limited neurovascular examination
examination of the ipsilateral hip and knee
Koval KJ, Zuckerman JD. I n : Handbook of F ractures Thi rd Edition. USA :
L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
32/36
RADIOLOGIC EXAM
Anteroposterior (AP) and lateral
views of the femur, hip, and knee
as well as an AP view of thepelvis should be obtained
Koval KJ, Zuckerman JD. I n : Handbook of F ractures Thi rd Edition. USA :
L ippincott Wil li ams & Wil kins. 2002
-
7/30/2019 Case Sharizal
33/36
TREATMENT
Shock should be treated and thefracture splinted before thepatient is moved.
EMERGENCY
Traction and BracingNON
OPERATIVE
Intramedullary Nailing External Fixation
Internal Fixation
OPERATIVE
Koval KJ , Zuckerman JD . In : Handbook of F ractures Third Edition. USA : Li ppincott Will iams & Wilki ns. 2002
-
7/30/2019 Case Sharizal
34/36
COMPLICATION
Early complication
Shock
Fat embolism and ARDS Thromboembolism
infection
Solomon. L . et al. Apleys System of Orthopaedics and F ractures 9thEditi on. New
York : Arnold. 2010
-
7/30/2019 Case Sharizal
35/36
COMPLICATION
Late complication
Delayed union
Non-union Malunion
Joint stiffness
Solomon. L . et al. Apleys System of Orthopaedics and F ractures 9thEditi on. New
York : Arnold. 2010
-
7/30/2019 Case Sharizal
36/36
THANK YOU