Fraktur Humerus Sepertiga Distal

  • View
    229

  • Download
    0

Embed Size (px)

Text of Fraktur Humerus Sepertiga Distal

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    1/26

    Arsyi Adliah Anwar

    C11109266

    Advisor :

    dr. Helmiyadi Kuswardhana

    dr. Wendelin

    Supervisor :

    dr. M. Ruksal Saleh, Ph.D, Sp.OT (K)

    Closed Fracture One third Distal

    of The Left Humerus

    CASE REPORT

    Department of Orthopaedic and Traumatology

    Faculty of Medicine Hasanuddin University 2013

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    2/26

    Patient Identity

    Name : G

    Gender : Boy

    Date of birth : June 11th2011

    Medical Record : 635528

    Date of admission : November 4th2013

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    3/26

    History Taking

    Chief Complaint: Pain at left arm

    suffered since 10 hours before admission to the hospital

    after got a traffic accident.

    Mechanism of trauma :

    The patient was walking at roadside when suddenly got

    hit by a car from the back and the patient fell on the

    asphalt with the left side of the body.

    History of unconscious (-), nausea (-), vomit (-)

    Prior treatment in Hospital of Barru.

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    4/26

    Primary Survey

    Airway

    Patent, clear

    Breathing

    Spontaneous, symmetric, thoracoabdominal type

    RR : 22x/minute

    Circulation

    BP : 90/60 mmHg

    HR : 88x/minute, regular, adequate

    Disability

    GCS 15 (E4M6V5), pupils isochoric 2,5mm /2,5 mm, LR +/+

    Environment

    Temperature 36,8o

    C

    Physical

    Examination

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    5/26

    Head and neck region : No abnormality was found

    Thoracal region : No abnormality was found

    Abdominal Region : No abnormality was found

    Back Region : No abnormality was found

    Urogenitalia region : No abnormality was found

    Upper extremity Region

    Lower Extremity Region : No abnormality was found

    Physical Examination

    Secondary Survey

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    6/26

    Upper Extremity

    Left arm region

    Inspection : multiple excoriation wounds on posterolateral of

    hand, deformity (+), Swelling (+), hematoma (+)

    Palpation : Tenderness (+)ROM : active and passive motion of shoulder joints could not be

    examined due to pain. Active and passive motion of elbow

    joints could not be examined due to pain..

    NVD :sensibility is difficult to be identified, radial artery is

    palpable, Capillary Refill Time

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    7/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    8/26

    Additional Examination

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    9/26

    TEST RESULT

    WBC 18,69 x 103/uL

    RBC 3,26 x 106 /uL

    HGB 9,6 mg/dL

    HCT 26,5 %

    PLT 169 x 103/Ul

    GDS 92

    GOT 54 U/LGPT 20 U/L

    Ureum 26 mg/dL

    Creatinine 0,4 %

    HbsAg Negative

    Additional Examination

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    10/26

    A 2 years old boy admitted with pain at the left arm suffered

    since 10 hours ago due to traffic accident. The patient was

    walking at roadside and got hit by a car from the back and the

    patient fell to the left side.

    On physical examination of the left arm region was found

    ultiple excoriation wounds, deformity, swelling and hematoma,

    with tenderness. Active and passive motion of shoulder and elbow

    joints couldntbe examined due to uncooperative patient.

    On radiological imaging there was a closed fracture at the

    one-third distal of the left humerus.

    Resume

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    11/26

    CLOSED FRACTURE ONE

    -THIRD

    DISTAL OF THE LEFT HUMERUS

    Diagnosis

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    12/26

    Analgesic

    Apply slab

    Plan for ORIF

    Treatment

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    13/26

    Discussion

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    14/26

    Fracture is a break in the

    structural continuity of

    bone

    Fracture of the humeral

    shaft is 10% of all

    humeral fractures in

    children and 2-5.4% of all

    childrensfracture

    shaft

    Proximal

    Distal

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    15/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    16/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    17/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    18/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    19/26

    Direct

    Direct blow to the arm

    Transverse/comminuted

    fracture

    Indirect

    A fall on an outstrechedarm

    Spiral/oblique fracture

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    20/26

    HistoryTaking

    PhysicalExamination

    X-rayImaging

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    21/26

    ANAMNESIS

    Chief complaint

    Mechanism of injury

    Prior Treatment

    IMAGING

    X-ray examination

    PHYSICAL EXAMINATION

    Inspection

    Palpation

    Range of motion

    Neurovascular Distal

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    22/26

    Non Operative

    Cast immobilization

    Sling immobilization

    Coaptation splint

    Shoulder spica cast

    Functional bracing

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    23/26

    INDICATION FOR SURGERY

    Multiple fracture

    Inadequate closed reduction

    Open fracture

    Segmental fracture

    Bilateral humeral fracture

    Displaced intra-articular

    extension of the fracture

    Neurovascular compromise

    Unstable fracture fragment

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    24/26

    SURGICAL TECHNIQUES

    Open Reduction and Plate Fixation

    Percutaneous Pinning

    External Fixation

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    25/26

  • 8/11/2019 Fraktur Humerus Sepertiga Distal

    26/26

    Thank You