case report supracondylar fracture of right femur

8/11/2019 case report supracondylar fracture of right femur

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Sri Mahtufa Riski C 111 09 759

Advisor :

dr. Dwi Indra | dr. Herbert Y.

Supervisor :

dr. Muhammad Sakti, M.Kes. Sp.OT

Closed Fracture

Supracondylar Right Femur

Department Of Orthopaedic and Traumatology

Faculty Of Medicine Hasanuddin University

Makassar 2014


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Identity

Mr. EName

14 years oldAge

August, 19th2014Addmision

084733

Registration Number

Perum. Mangga III, DayaAddress

StudentJob

BPJSPayment


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History Taking

Chief complaint: Pain on the right tight

Suffered since 1 hour before admitted to Wahidin General Hospital dueto traffic accident.

Mechanism of trauma:

History of Fainting (-), nausea (-), vomiting (-), dizziness (-)

Prior treatment (-)


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Past history of disease

Frequent fractures with or without trauma denied.

Family history of disease

No family members have a history of frequent fractures with

or without trauma.

History habits

He denied drinking alcoholic beverages and smoking. He also

admitted to rarely exercise.History of allergies

He denies any drug or food allergies


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Physical Examination

Primarysurvey

Secondarysurvey


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Deformity (+) is shortening, Swelling (+),Hematome (+), wound (-)

L

Tenderness (+)F

Active and passive motions of hip joint can not be evaluated due topain.

Active and passive motions of knee joint can not be evaluated due topain.

M

Sensibility is good,

pulsation of artery dorsalis pedis is palpable

Capillary Refill Time (CRT) < 2 Second

NVD

Localized status : Regio Femoris Dextra

Secondary Survey


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R

ALL 90 cm 92 cm

TLL 83 cm 85 cmLLD 2 cm

Leg LengthDiscrepancies(LLD)


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Clinical Findings

Photo 1 Lower Extrimity from anterior aspect


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Photo 2. lower limb from lateral aspect

Photo 3. lower limb from medial aspect


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Laboratory Findings

19/8/2014

WBC 9.2 x 10/Ul GDS 82 mg/dL

RBC 4.84x 10/uL Ur 22 mg/dL

HB 13.8 g/dL Cr 0.50 mg/dL

HCT 40.2 % SGOT 39 u/L

PLT 288 x 10/uL SGPT 20 u/L

CT 600 Na 140 mmol/L

BT 300 K 4.2 mmol/L

HbsAg Negative Cl 107 mmol/L


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Radiology Findings

Photo 4 Plain photo of Pelvic AP

Result : no

visualization

of abnormality

in this pelvis

plain photo.


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Result :

oblique

fracture of

distal Os.Femur dextra

Photo 5Plain photo of femur dextraAP + Lateral


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Photo 6Plain photo of Genu dextra AP + Lateral


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Resume

A boy, 14 years old came with chief complaints of pain on the

right thigh after motorcycle accident 1 hour prior

hospitalization.

On physical examination, we found at the right tight region :

Look : Deformity (+) shortening, Swelling (+), Hematome (+), Feel :Tenderness (+). Move : Active and passive motions of hip joint and kneejoint cant be evaluated due to pain.NVD :Sensibility is good, CapillaryRefill Time (CRT) < 2 Second, pulsation of artery dorsalis pedis is

palpable. On radiological finding: oblique fracture 1/3 distal Os.Femur dextra


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Diagnose

Closed

FractureSupracondylarRight Femur


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Management

IVFD RL

Analgesic

Apply Skin traction at right lower extremity

Plan for Open Reduction Internal Fixation (ORIF)


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Discusion


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Anatomy

Os. FemurNetter, Frank H. Netters Concise Orthopaedic Anatomy 2ndedition. Saunders Elseiver.


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Arteries of thigh

Netter, Frank H. Netters Concise Orthopaedic Anatomy 2ndedition. Saunders Elseiver.


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Introduction

If overlying skin remains intact : Closed fractured If skin not intact : Open fractured

Fracture is a break in the structural continuity ofbone

Solomon, L, Warwick D.L, Nayagam,S. Apleys system of orthopedic and fractures. 8theditions. 2008Beaty, James H.; Kasser, James R. Rockwood and WilkinsFractures in Adult. 6thEdition. 2006.


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Supracondylar fracture is a fracture at area of thefemur at the zone between the femoral condyles

and the junction of the metaphysis with thefemoral shaft.


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Epidemology

Supracondylar fracture of the femur in adultsoccurs in 7% of cases of all cases of femurfractures.

Fracture incidence is increasing in frequency dueto the modern lifestyle and high driving transport.

Accidents are the main cause of this trauma at theage of 17-30 years.

Bucholz Robert W, Heckman James D.Rockwood and Greens Fractures in Adult. 7thEd. 2010

Solomon, L, Warwick D.L, Nayagam,S. Apleys system of orthopedic and fractures. 8theditions. 2008.

Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H. 5-Minutes Orthopaedic Consult, 2nd Edition. 2007


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Mechanismof

Injury

In young adults,

this force is typicallythe result of high-energy trauma such asmotor vehicle collisionor fall from a height.

In the elderly

the force may resultfrom a minor slip or

fall onto a flexed knee.

Robert, W Bucholz. Heckman, James. Rockwood and WilkinsFractures in Adult. 7

th

Edition. 2010.


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How to Diagnose ?

Chief complaint

(Pain,swelling,

bruising, &

inability to

walk)

Anamnesis

Look,

Feel,

Move

Clinicalmanifestation X- ray, with

AP and lateral

view

Laboratory

examination

Additionalexam


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Tscherne Classification of Closed Fractures

This classifies soft tissue injury in closed fractures and takes into

account indirect or direct injury mechanisms.

Egol, Kenneth A, etc. Handbook of Fracture 4thEd. USA. 2010

Grade 1 Injury from indirect forces with negligiblesoft tissue damage

Grade 2 Closed fracture caused by low-moderate energy mechanisms, withsuperficial abrasions or contusions of soft tissues overlying

the fractureGrade 3 Closed fracture with significant muscle contusion, with

possible deep, contaminated skin abrasions associatedwithmoderate to severe energy mechanisms and skeletal injury; highrisk for compartment syndrome

Grade 4 Extensive crushing of soft tissues, with subcutaneous deglovingor avulsion, with arterial disruption or established compartmentsyndrome

Cl ifi i


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Classification

I : minimally displaced < 1 cm

II : medial displacement of the condyles > 1 cm

III : lateral displacement of the condyles > 1 cm

IV : conjoined supracondylar and shaft fracture

Neer classification.

This classification is based on the direction of the shift of the distal fragment. It isstructured to be able to identify the mechanisms and patterns of soft tissuedamage and therapy will be provided.

Kamel Kasem. Management of Supracondylar Fracture of The Femur. Department of Orthopaedic Surgery &Traumatology Faculty of Medicine Minia University. 2004.


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AO (Muller and colleagues)

Classification

Group A: extra-articular fractures A1: simple

A2: metaphysical slices

A3: metafisial complex (comminuted)

This classification is the most widely used in cases of supracondylar fracture.In this classification, identified three types of supracondylar fractures withthree subtypes based on the radiological picture.

Kamel Kasem. Management of Supracondylar Fracture of The Femur. Department of Orthopaedic Surgery &

Traumatology Faculty of Medicine Minia University. 2004.


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Group B:

partial articular fractures

B1: condylus lateral(sagittal)

B2: condylus medial(sagittal)

B3: condylus lateral ormedial (coronal)

Group C:

total articular fractures

C1: articular simple,simple metaphysical

C2: articular simple,metaphysical

multifragment

C3: articularmultifragment

Kamel Kasem. Management of Supracondylar Fracture of The Femur. Department of Orthopaedic Surgery &

Traumatology Faculty of Medicine Minia University. 2004.

Addi i l E i i


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Additional Examination

Radiology examination

Radiological examination should show the overall femur on the AP andlateral

Including pelvic and knee joints associated injury.

x-ray of fracture supracondylar of femur

Alan Graham Appley. Appleys System of Orthopedics and Fracture 9th edition. Butterworths Medical Publications.

2010.

M


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Management

Indication non-operative

Non-displaced / incompletefractures

Acceptable angulation in childrenpatients

impacted stable fractures inelderly patients

severe osteopenia

advanced underlying medicalconditions

select gunshot injuries

Indication Operative

Multiple trauma

Segmental or comminuted type

Open fractureNeurovascular injury

Articular fractures

Pathologic fracture

In elderly patients with severeosteopenia or those withcontralateral amputation

Egol, Kenneth A.MD, etc.Handbook of Fracture 4thEd. 2010. USA


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Non-operative

Treatment is mobilization of the extremity in ahinged knee brace

Non-operative treatment entails a 6 to l2 weeksperiod of castingwith acceptance of resultantdeformity followed by bracing.

Egol, Kenneth A.MD, etc.Handbook of Fracture 4thEd. 2010. USA


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Operative Technique

Screw fixation

Frontal view of the definitivelag screw fixation of the

articular fragments.

Condylar plate/dynamic

condylar screw (DCS)

Colton, C. L., etc. AO Principles of Fracture Management. Thieme Stuttgart. New York. 2000

Retrograde nailing


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Complication

Early

Damage to the vessels

Late

Non union

Malunion

Stiffness of the kneejoint

Warwick D.L, Nayagam,S. Apleys system of orthopedic and fractures. 8theditions. 2008.


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Documents

case report supracondylar fracture of right femur