Ulmi Fadillah - Case Report (Open Fracture Tibia Fibula) Revisi 2

7/25/2019 Ulmi Fadillah - Case Report (Open Fracture Tibia Fibula) Revisi 2

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Ulmi Fadillah Juniar

C111 10 156

OPEN FRACTURE OF THE LEFT TIBIA 1/3 PROXIMAL gradeIII AOPEN FRACTURE OF THE LEFT FIBULA 1/3 PROXIMALgrade III A

SUPERVISOR:dr. M. Andry Usman Ph.! S".O#

DEPARTMENT OF ORTHOPAEDIC ANDTRAUMATOLOGY

MEDICAL FACULTY OF HASANUDDIN UNIVERSITYMAKASSAR

!1"

CASE PRESENTATIONOCTOBER 2015

A!VISOR:

dr. Ari$s %u&a'ara&

dr. (ur Rahmansyah


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PATIENT IDENTITY

Na#e $ Mr% AR

Age $ &ear' ()d

Med*+a) re+(rd $ ,-.,3

Ad#*''*( da0e $ O+0(er 1.02 !1"


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C2*e4 +(#5)a*0

6(7d a0 02e r*g20 )eg

H*'0(r& Ta8*g

S79ered '*+e 1 2(7r e4(re ad#*00ed 0( 6a2*d*S7d*r(27'(d( H('5*0a) d7e 0( 0ra:+ a++*de0

Me+2a*'# (4 0ra7#a

Pa0*e0 ;a' r*d*g a #(0(r+&+)e ad g(0 2*0 &

a(02er #(0(r+&+)e 4r(# r*g20 '*de 02e 4a)) ;*022*' r*g20 )eg ?

@(#*0*g =>? H*'0(r& (4 5r*(r 0rea0#e0 =? a0 2('5*0a) E)*# *

0(raa ad g(0 '0*0+2 a0 02e ;(7d ( 02e r*g20 )eg

HISTORY TAKING


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PRIMARY SURVEY

Airway $ C)ear

Breathing $ Re'5*ra0(r& Ra0e ! /#0

'5(0ae(7' 02(ra+(ad(#*a) 0&5e

Circulation $ P7)'e /#0 reg7)ar '0r(g BP

11!/,! ##Hg

Disability$ GCS 1" =EM.V"? 575*) *'(+2(r d*a#e0er 3

## )*g20 ree /Environment $ 3., !C =a*))ar&?


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SECONDARY SURVEYLeft Leg Region

Look $ )a+era0ed ;(7d a0 02ea0er*(r a'5e+0 (4 +r7r*' +# ada0 02e a0er()a0era) a'5e+0 1 +# de4(r#*0& =? ';e))*g =?

2e#a0(#a =?

Feel :Tedere'' =?

NVD $ 'e'**)*0& (4 dee5 5er(ea)

er@e ad '75er


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CLINICAL PICTURES


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RADIOLOGICAL FINDINGSX-Ray AP/lateral (Cruris

Sinistra)

X-Ray AP/lateral (Genu

Sinistra)


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LABORATORY FINDINGS

Ea#*a0*( Re'7)0' N(r#a)

6BC !%!!! / 7) !!>1!!

RBC 3 X 1!. !!>.!!

HGB 1!" gr/d) 1!>1.!

HCT 3! J 3,!>!

PLT .-%!!!/7) 1"!>!!


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Male, 22 years old was admitted to the WahidinSudirohusodo Hospital with pain at the left leg sufferedsince 5 hours before admitted to the hospital due to trafficaccident.

Physical examination on left leg region were foundlacerated wound at the anterior aspect of cruris 2x2 cm,and at the anterolateral aspect x! cm , hematom, swelling,and tenderness, "#M acti$e and passi$e mo$ement of %nee

&oints can't be e$aluated due to pain (rom the radiological examinationcommuniti$e fracture

!)* proximal os tibia sinistra, obli+ue fracture 1/3


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OPEN FRACTURE OF THE LEFT TIBIA 1/3 PROXIMALgrade III AOPEN FRACTURE OF THE LEFT FIBULA 1/3 PROXIMALgrade III A

DIAGNOSIS


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IVFD

A0**(0*+'

Te0a7' 5r(52&)a*'

Aa)ge'*+A55)& )(g )eg a+8 ')a

P)a 4(r Der*de#e0

P)a 4(r E8'0era) F*a0*(

TREATMENT


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D*'+7''*(


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INTRODUCTION

A 4ra+07re *' a rea8 * 02e '0r7+07ra)+(0*7*0& (4 (e%

C)**+a) 0&5e'$ (5e 4ra+07re / +)('ed 4ra+07re%

I4 02e (@er)&*g '8* re#a*' *0a+0 *0 *' a+)('ed 4ra+07re ad *4 02e '8* (r (e (4 02e(d& +a@*0*e' *' rea+2ed *0 *' a (5e4ra+07re )*a)e 0( +(0a#*a0*( ad

*4e+0*(% U'7a))& d7e 0( 0ra:+ a++*de0 '5(r0'

*7r&

Apleys System of Orthopaedics and fracture, Chapter 23: Principle of fracture


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ANATOMY


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CONFIGURATION OF FRACTURE

Spiral pattern(twisting

Short o!li"ue

pattern

(compression

#riangular $!utterfly

fragment (!ending

#ran%erse pattern

(tension



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GUSTILO AND ANDERSONCLASSIFICATION OF FRACTURE


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&n this patient had high energy trauma from direct hit in a motor %ehicle

accident which results in fracture of ti!ia and fi!ula

MECHANISM OF INURY



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Anane!i!

"i!to#$ of illne!!% e&hani! of t#a'a

Ph$!i&al e(aination

LOO)% *EEL% MOVE% NVD

La+o#ato#$ e(aination

,- #a$% .ith AP an/ late#al ie.

ith #'le of 23: 2 ie.% 2 li+% 2 4oint% 2 o&&a!ion% 2 in4'#ie!

DIAGNOSIS

Solomon' ' et al' &n)urys of the *nee and eg in Apleys System of Orthopaedics and +ractures th -dition' .*: Arnold' 2/0/'


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CLINICAL FEATURES

Oe/ea

"eatoa

Ten/e#ne!! at the f#a&t'#e !iteDeea!e/ #ange of otion at

the 4oint

Che& ne'#oa!&'la# /i!tal


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MANAGEMENT

N(>(5era0*@e

Id*+a0*( $

1 Ud*'5)a+ed (r #**#a) d*'5)a+ed

1 C)('ed 4ra+07re'

1 L(; eerg& 0ra7#a

1 M**#a) '(40 0*''7e da#age

1 S0a)e 4ra+07re 5a00er

iller , Stephen 4, 5ennifer A et al' #rauma: ower -6tremity 7 Pel%is'&n: 4e%iew of Orthopedics, 8 th edition'

Philadelphia' -lse%er Saunder


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GOALS OF FRACTURE MANAGEMENT

4ecogni9e


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Id*+a0*(' $O5e 4ra+07re%U'0a)e 4ra+07re' +(##*70ed 4ra+07r ad

a''(+*a0ed ;*02 @ar&*g degree' (4 '(40>0*''7e

0ra7#aA''(+*a0ed @a'+7)ar *7r&%Fra+07re' a''(+*a0ed ;*02 +(#5ar0#e0

'&dr(#e%

Solomon. . et al. -pley's System of #rthopaedics and (ractures th/dition. 0ew 1or% -rnold. 23!3

O5era0*@e Trea0#e0


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COMPLICATION

Solomon. . et al. -pley's System of #rthopaedics and (ractures th/dition. 0ew 1or% -rnold. 23!3

Early comlplication :

0eoro$ascular 4n&ury

ompartment Syndrom

Late Complication :

Malunion, delay union, non union, 4nfection


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THANKYOU

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Ulmi Fadillah - Case Report (Open Fracture Tibia Fibula) Revisi 2