slide ortho tibia and fibula ppt

7/25/2019 Slide Ortho Tibia and Fibula PPT

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PATIENT IDENTITY

Name : B

Age : 44 years old

Sex : Male

Date of Admission:August 23rd, 2015 at16.30

RM number : 723290


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HISTORY TAKING

Chief Complaint:Pain at right leg

Suffered since 22 hours before being admitted toWahidin General Hospital

Patient was riding a motorcycle when he fell down

due to loss of balancePatients right leg first came into contact with theground.

Vomitting (-) nausea (-)Prior treatment : Pangkep Hospital


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PRIMARY SURVEY

Airway :Clear

Breathing:RR = 20x/min, regular, spontaneous,

thoracoabdominal type, symmetrical.

Circulation:BP = 120/70 mmHg,HR = 80 x/min regular,strong.

Disability :GCS 15 (E4V5M6),isochoric pupil, : 2,5 mm,light reflex +/+

Exposure :T = 36,70C (axilla)


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SECONDARY SURVEY

Localized status :

Right Leg region

Look:Deformity (+), swelling (+), hematoma (+),Wound (-)

Feel :tenderness (+)

Move:Active and passive motions of the knee arelimited due to pain

Active and passive motions of the ankle arelimited due to pain

NVD :Good sensibility, dorsalis pedis and tibialisanterior pulses are palpable, CRT


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CLINICAL FINDINGS


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LEG LENGTH DISCREPANCY

Right Left

ALL 86 87

TLL 82 83

LLD 1 cm


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LABORATORY FINDINGS

WBC : 15.400/ ulRBC : 5.000.000/ ul

HBG : 14.7 g/dl

HCT : 43 %

PLT : 233.000/mm3

CT : 730

BT : 230

HBsAg : Non reactive


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X-RAY RIGHT CRURIS

AP View Lateral View


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DIAGNOSIS

Closed fracture 1/3 distal right tibia

Closed fracture 1/3 distal right fibula


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MANAGEMENT

IVFD RL

Analgesic

Report to Orthopaedic senior, advice:Apply boot slab left lower limb

Plan for ORIF Tibia & Fibula


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RESUME

A Boy 44 years old came to the hospital with chiefcomplaint pain at the left leg,sufered since 22 hoursbeore admitted to Hospital.

At the anterolateral aspect, there is haematom and edema.The

region was tenderness on palpation, with unknown active and

passive motion of knee joint and ankle joint due to pain.

Sensibility is good and dorsalispedis artery is palpable, !T "#$ .

laboratory findings are within normal limit, From radiology finding (X-Ray cruris dextra AP/Lateral)

there is closed fracture 1/3 distal of right tibia and fibula.


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Discussion


13/25Thompson, J.Netters Concise Orthopaedic Anatomy, 2ndEd. Elsevier Saunders, 2010.

TIBIA AND

FIBULA


14/25NETTERS CONCISE ORTHOPAEDIC ANATOMY, P. 316


15/25NETTERS CONCISE ORTHOPAEDIC ANATOMY, P. 317


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NETTERS CONCISE ORTHOPAEDIC ANATOMY, P.318


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TYPES OF FRACTURES

Thompson, J.Netters Concise Orthopaedic Anatomy, 2ndEd. Elsevier Saunders, 2010.


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Diagnosis Clinical features

Anamnesis Physical examination

X- ray, with anteriorposterior and lateral view

Laboratory examination

Oedema

Hematoma

Tenderness at the fracture

site. Decreased range of motion

at the ankle or knee,

depending on the location

of the fracture

If fracture is displaced, adeformity may be noted

Appleys . Sistem Of orthopaedis & fracture,8thedition.


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TSCHERNES CLASSIFICATION OF SKIN

LESION IN CLOSED FRACTURES

Grade 0 Injury from indirect forces with negligible soft tissue

damage

Grade I Closed fracture caused by low-moderate energy

mechanisms, with superficial abrasions or contusions ofsoft tissues overlying the fracture

Grade II Closed fracture with significant muscle contusion, with

possible deep, contaminated skin abrasions associated with

moderate to severe energy mechanisms and skeletal injury;

high risk for compartment syndrome

Grade III Extensive crushing of soft tissues, with subcutaneous

degloving or avulsion, with arterial disruption or

established compartment syndrome


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TREATMENT

Conservative

Closed reduction

Apply long leg cast

Functional bracing with Early weight-bearing

Pain medication if needed


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TREATMENT

Operative Internal Fixation

External Fixation


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DEFINITIVE TREATMENT

Open Reduction Internal FixationIndication of ORIF in this patient is :

ORIF Tibia

Acceptable fracture reduction is not indicated anymore inthis patient

ORIF FibulaTheres fracture at 3 cm from syndesmosis at X-Rayfindings

AdvantageAdequate reduction

Early movementDisadvantage

Increase risk of infection, skin problemA high degree of surgical technique and facilities areessential


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COMPLICATIONS

Early complications Late complication

Neurovascular injury Malunion, delay union, non-

union

Compartment syndrome Joint stiffness

infection


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slide ortho tibia and fibula ppt

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