CLOSED FRACTURE RIGHT NECK FEMUR

G. P. Januar R. A. TehupeioryAdvisor :

dr. Andhikadr. Putra

Supervisor :dr. Supriadi, Sp. OT

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin UniversityMakassar

CASE REPORTMARCH 2016

PATIENT IDENTITY

• Name : Mr. N

• Number Register : 747786

• Sex : Man

• Age : 76 years old

• Date of Admission : March 21st, 2016

Chief Complain : Pain on the right groin Suffered since 16 days before admitted to

Wahidin sudirohusodo hospital Mechanism 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 pain

After falling, patient cannot stand by his feets anymore and patient taken to his house. He didn’t take any medication in 16 days

HISTORY TAKING(HETEROANAMNESIS)

Before fall patient still can walk by himself History of Ca. Prostate and hernia

operation 5 years ago.• History of numbness, cramps, and limb

weakness • No history of chronic headache• No history of HHD and DM• Prior treatment : UNHAS hospital (1 days)

GENERAL STATUS• General condition: well-nourished, compos mentis (GCS 15)

• Vital signs :BP = 150/90 mmHg; HR = 80x/minutes, reguler, palpable RR = 20x/minute T =37,1

Right Thigh RegionLook : Deformity (+), swelling (-), hematoma

(-), wound (-), shortening and external rotation

Feel : 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 REGION

LEG LENGTH DISCREPANCY

R LALL 86 cm 88 cmTLL 75 cm 77 cmLLD 2 cm

LATERAL MEDIAL

CLINICAL FINDINGS

Result Normal Level

WBC 8,1 4,00-10,0

RBC 1,99 4,50-6,50

HGB 6,1 14,0-18,0

HCT 18,5% 40,0-54,0

PLT 453 150-400

CT 7,30’ 4-10

BT 3,00’ 1-7

HBsAg Non Reactive Non Reactive

LABORATORY FINDINGS

RADIOLOGICAL IMAGING• Pelvis AP (12/03/2016)

FRACTURE

RADIOLOGICAL IMAGING• Right Femur AP/Lat (12/03/2016)

FRACTURE

RESUME

• Man, 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..

DIAGNOSIS

•Closed fracture right neck of femur

MANAGEMENT•IVFD RL •Analgesic•Apply skin traction load 3 kg•Plan for right hemiarthroplasty

DISCUSSIONFEMORAL NECK FRACTURE

Fracture of proksimal femur, intracapsular fracture

NECK FEMUR FRACTURE

ARTERIES

Netter Concise Orthopedic, 2nd edition, 2002

GERIATRIC PEOPLE PROBLEMS which increases risk of falls

• HEALTH 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 HAZARDS

1. poor lighting2. unsafe stairways3. irregular floor/ road surface4. Slippery floor/ road surface5. slippery shoes/ slipper

• Subcapital• Transcervical• Basicervical

Classification by Anatomic Location

Garden Classification

Pauwels Classification

anatomical classification

gardenclassification

pauwelsclassification

Ganti gambar ->

Fracture of Right Neck Femur

EVIDENCES LEADING TO DIAGNOSIS

PATIENT EVALUATION

- Hip Deformity & Tenderness at right groin- Pain on movement

PHYSICAL EXAMINATION

-Pain on left groin-history of fall on sitting position-Risk of fall (+)

HISTORY

X- Ray showsfracture right neck of femur

RADIOLOGICAL EXAMINATIONS

TREATMENT GOALS

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

Goals

Minimize patient discomfort

Restore hip function

Rapid mobilization

Treatment

SurgeryInitial treatment

Apley’ s System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

HemiarthroplastySkin traction

Elderly patient with displaced fracture

Pain alleviationTo minimize soft –tissue injuryTo hold fracture alignment

MANAGEMENT

Cannulated Screw Fixation Hemiarthroplasty

MANAGEMENT

Total Hip Arthroplasty

FUNDAMENTALS OF MUSCULOSKELETAL F. A. DAVIS COMPANY • Philadelphia IMAGING

Early Complication :- DVT- PE- Ulcus decubitus- Orthosatic pneumonia

Late Complication :- Osteonecrosis Avascular Necrosis of femoral head- Non union - Secondary Osteoarthritis

COMPLICATIONS

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