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Slide Fraktur Femur

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Text of Slide Fraktur Femur

FRACTURE NECK OF FEMUR

CLOSED FRACTURE RIGHT NECK FEMURG. P. Januar R. A. TehupeioryAdvisor :dr. Andhikadr. PutraSupervisor :dr. Supriadi, Sp. OT

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin UniversityMakassar

CASE REPORTMARCH 2016PATIENT IDENTITYName: Mr. N

Number Register: 747786

Sex: Man

Age: 76 years old

Date of Admission: March 21st, 2016

Chief Complain : Pain on the right groinSuffered since 16 days before admitted to Wahidin sudirohusodo hospitalMechanism of Trauma : this occurs in the time when patient was go to bank and suddenly slipped, patient hit the ground with sit position.The patient felt pain at the area of the hip and spread at the back and groin.History of nausea and vomiting worsen especially increase of back painAfter falling, patient cannot stand by his feets anymore and patient taken to his house. He didnt take any medication in 16 days

HISTORY TAKING(HETEROANAMNESIS)Before fall patient still can walk by himselfHistory of Ca. Prostate and hernia operation 5 years ago.History of numbness, cramps, and limb weakness No history of chronic headacheNo history of HHD and DMPrior treatment : UNHAS hospital (1 days)

GENERAL STATUSGeneral condition: well-nourished, compos mentis (GCS 15)

Vital signs:BP = 150/90 mmHg; HR = 80x/minutes, reguler, palpable RR = 20x/minute T =37,1Right Thigh RegionLook:Deformity (+), swelling (-), hematoma (-), wound (-), shortening and external rotationFeel:Tenderness (+)Move:

Active and pasive motion of hip joint cannot be evaluated due to painNVD:Sensibility is good, dorsalis pedis artery is palpable, capillary refill time < 2

LOCAL REGIONLEG LENGTH DISCREPANCY RLALL86 cm88 cmTLL75 cm77 cmLLD2 cmLATERALMEDIALCLINICAL FINDINGSResult Normal LevelWBC8,14,00-10,0RBC1,994,50-6,50HGB6,114,0-18,0HCT18,5%40,0-54,0PLT453 150-400CT7,304-10BT3,001-7HBsAgNon ReactiveNon ReactiveLABORATORY FINDINGSRADIOLOGICAL IMAGINGPelvis AP (12/03/2016)FRACTURERADIOLOGICAL IMAGINGRight Femur AP/Lat (12/03/2016)FRACTURERESUMEMan, 76 years old, was admitted to Hospital because of pain in the right groin, suffered since 16 days before admission, the patient was slipped and hit the ground with sit position.Based on physical examination, deformity, swelling & tenderness is present in the right hip region. Active and passive motions of the hip joint cannot be evaluated due to pain

X- ray of pelvic and right femur (ap and lateral views) showed a..DIAGNOSISClosed fracture right neck of femur

MANAGEMENTIVFD RL AnalgesicApply skin traction load 3 kgPlan for right hemiarthroplasty

DiscussionFEMORAL NECK FRACTURE

Fracture of proksimal femur, intracapsular fracture

NECK FEMUR FRACTURE

ARTERIESNetter Concise Orthopedic, 2nd edition, 2002LFC ; LATERAL FEMORAL CIRCUMFLEX ARTERYbecause of there is abundant blood supply in intertrochateric region, so non union and osteonecrosis are not major problemsGERIATRIC PEOPLE PROBLEMS which increases risk of fallsHEALTH PROBLEMS1. Muskuloskeletal problems (osteoporosis, muscle weakness)2. Impairment of special senses (Visual and auditory impairment)3. Cardio vascular disease, postural hypotension4. Diabetes 5. CNS disorder, syncope, epilepsy6. Certain drugs (sedatives, hypoglycemic drugs, etc)

Psychological problems 1. Suicidal tendency2. Senile dementia

EXTRINSIC ENVIROMENTAL HAZARDS1. poor lighting2. unsafe stairways3. irregular floor/ road surface4. Slippery floor/ road surface5. slippery shoes/ slipper17

SubcapitalTranscervicalBasicervicalClassification by Anatomic LocationGarden Classification

Pauwels Classification

anatomical classificationgardenclassification

pauwelsclassificationGanti gambar ->Fracture of Right Neck Femur EVIDENCES LEADING TO DIAGNOSIS PATIENT EVALUATION Hip Deformity & Tenderness at right groin Pain on movement

PHYSICAL EXAMINATIONPain on left groinhistory of fall on sitting positionRisk of fall (+)HISTORYX- Ray showsfracture right neck of femurRADIOLOGICAL EXAMINATIONS20TREATMENT GOALSKoval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd EditionGoals Minimize patient discomfortRestore hip functionRapid mobilization

Apley s System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.HemiarthroplastySkin tractionElderly patient with displaced fracturePain alleviationTo minimize soft tissue injuryTo hold fracture alignment

MANAGEMENT

Cannulated Screw Fixation

HemiarthroplastyMANAGEMENT

Total Hip ArthroplastyFUNDAMENTALS OF MUSCULOSKELETAL F. A. DAVIS COMPANY Philadelphia IMAGINGEarly Complication :DVTPEUlcus decubitusOrthosatic pneumonia

Late Complication :Osteonecrosis Avascular Necrosis of femoral headNon union Secondary Osteoarthritis

COMPLICATIONSKoval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition