Closed Fractur 1/3 Middle Femur Sinistra

CLOSED FRACTURE 1/3 MIDDLE FEMUR SINISTRA

CASE REPORT ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

Presented by:Faradhillah A Suryadi C11108340

Advisor:dr. Naharudin Imo

dr. M. Luthfi Muammardr. M. Rustam

Supervisor:dr. M. Ruksal Saleh, Ph.D,Sp.OT

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin University

Makassar, 2011

• Name : Mr. M• Age : 16 y.o• Admission : 23th June 2013• RM number : 615465

CASE REPORT ORTHOPAEDIC AND TRAUMATOLOGY

PATIENT IDENTITY

Chief Complaint : Pain at the left thigh

History of illness : suffered since 3 hours before admitted to hospital due to traffic accident.

Mechanism of trauma: Patient was a passenger of a bike when he fell down and rolled on the road as the rider was trying to avoid car from opposite direction. History of unconscious (-), nausea (-), vomiting (-)Prior treatment at Pangkep hospital.

HISTORY TAKING

GENERAL STATUS• General Appearance : Moderate illness /Well Nourished/compos mentis• Vital sign

• Bp : 110/70 mmHg• Hr : 84x/min regular, strong• RR : 18x/min, spontaneous, thoracoabdominal• Temp : 36.7 oC (axilla)


LOCALIZED STATUSLeft Thigh Region• I : deformity (+), swelling (+), hematoma (+) wound (-)• P : tenderness (+)• RoM : active and passive motion on hip and knee, joints can not

be evaluated• NVD : sensibility is good, dorsalis pedis artery was palpable, CRT

< 2”


Leg length

Right leg Left leg

ALL 98 cm 96 cm

TLL 93 cm 91 cm

LLD 2 cm



LABORATORY FINDINGS• RBC :

5.260.000/mm3• HGB : 13,5 mg/dl• HCT : 42,9 %• PLT : 259.000/mm3• WBC : 10.000/mm3• CT : 8’• BT : 2’• HbsAg : non reactive

• ElektrolitNa : 136K : 5,0Cl : 102

• GDS : 72• Ureum : 30• Kreatinin : 0,9• GOT/GPT : 61/60


RADIOGRAPHIC FINDINGSPELVIS XRAY (24.06.2013)

RADIOGRAPHIC FINDINGS

XRAY AP/LAT Femur S (24.06.2013)


DIAGNOSISClosed fracture 1/3 middle of the left femur


IVFD Analgetics Skin TractionPlan for ORIF

MANAGEMENT


RESUMEA 16 y.o boy was admitted to the hospital with pain at the left femur which was suffered since 3 hours ago due to traffic accident. Patient was a passenger of a bike when he fell down and rolled on the road as the rider was trying to avoid car from opposite direction. At the anterior aspect of the femur, there is no wound, deformity (+) oedem (+) hematom (+) . The region was tender on palpation, with active and passive motion of hip and knee joint can not be eavaluated due to pain. Sensibility good, a. dorsalis pedis was palpable, CRT < 2”


FRACTURE FEMORAL SHAFT

DISCUSSION


ANATOMICASE REPORT

ORTHOPAEDIC AND TRAUMATOLOGY

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Muscles of the thigh are arranged in three compartments separated by intermuscular septa.



ANTERIORThompson,JD. Netter's concise atlas of orthopedic anatomy.2004.


MUSCLE ORIGIN INSERTION

Sartorius ASIS Prox. med. tibia (pes anserius)

Rectus femoralis

1.AIIS2.Sup. acetab. rim

Patella/tibia tubercle

Vastus lateralis Gtr. trochanter, lat. linea aspera

Lat. patella/tibia tubercle

Vastus intermedius

Proximal femoral shaft

Patella/tibia tubercle

Vastus medialis Intertrochant. line, med. linea aspera

Medial patella/tibia tubercle


MEDIALThompson,JD. Netter's concise atlas of orthopedic anatomy.2004.


MUSCLE ORIGIN INSERTION NERVE

Obturator externus

Ischiopubic rami, obturator memb

Piriformis fossa Obturator

Adductor longus

Body of pubis (inferior)

Linea aspera (mid 1/3) Obturator

Adductor brevis

Body and inferior pubic ramus

Pectineal line, linea aspera

Obturator

Adductor magnus

1.Pubic ramus2. Isxhial tub.

Linea aspera, add. tubercle

1.Obturator 2.Sciastic

Gracilis Body and inferior pubic ramus

Prox. med. tibia (pes anserius)

Obturator

Pectineus Pectineal line of pubis

Pectineal line of femur Femoral


POSTERIOR



MUSCLE ORIGIN INSERTION NERVE

Semitendinosus Ischial tubersity

Proximal medial tibia (pes anserius)

Sciastic (tibial)

Semimembranosus Ischial tubersity

Posterior medial tibial condyle

Sciastic (tibial)

Biceps femoris : Long head

Ischial tubersity

Head of fibula

Sciastic (tibial)

Biceps femoris :Short head

Linea aspera, supracondylar line

Fibula, lateral tibia

Sciastic (peroneal)


Classification of FractureDescriptive Open versus closed Level of fracture: proximal, middle, distal third Fracture pattern: transverse, spiral, or oblique Comminuted, segmental or butterfly fragment Shortening, angulation or rotation deformity


Winquist & Hansen Classification

Stable0 : No comminution

I : Minimal comminutionII : Comminuted > 50% of cortices intact

UnstableIII : Comminuted < 50% of cortices intact

IV : Complete comminution, no intact cortex


Stable0 : No comminutionI : Minimal comminutionII : Comminuted > 50% of cortices intact

UnstableIII : Comminuted < 50% of cortices intactIV : Complete comminution, no intact cortex


MECHANISM OF INJURY

Solomon, L, Warwick D.L, Nayagam,S. Apley’s system of orthopedic and fractures. 8 th editions. 2008.

•Direct trauma: • Motor vehicle accident • Fall• child abuse

•Indirect trauma• Rotational injury.

•Pathologic fractures• osteogenesis imperfecta• nonossifying fibroma• bone cysts• tumors


• The diagnosis of femoral shaft fracture is usually obvious, with the patient present with pain, deformity, swelling, and shortening of the affected extremity

• The effect of blood loss and other injuries, some of which can be life-threatening, may dominate the clinical picture.

Solomon, L, Warwick D.L, Nayagam,S. Apley’s system of orthopedic and fractures. 8 th editions. 2008.

CLINICAL FEATURE


• Anteroposterior and lateral views of the femur should be obtained.

• Radiographs of the hip and knee should be obtained to rule out associated injury

Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.

RADIOLOGIC EXAM


• Non operative: skeletal traction and skin traction

• Operative: External fixationPlate fixationIntramedulary nailing

Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.

TREATMENT


• Multiple trauma• Open fracture• Vascular injury• Pathologic fracture• Uncooperative patient

Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.p349-53

OPERATIVE INDICATION


• Early • Shock• Fat embolisme• Compartment syndrome

• Late• Delayed / non union• Malunion• Joint stiffness• Refracture

COMPLICATION


THANKYOU


Health & Medicine

Closed Fractur 1/3 Middle Femur Sinistra