Case Sharizal

7/30/2019 Case Sharizal

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PATIENT IDENTITY

Name : Mr. A

Age : 20 y/o,

Sex : Male

Admission : January 3rd 2013

Registration : 587062


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HISTORY TAKING

Chief complaint

Pain at the right thigh

History of illness

Suffered since 8 hours prior admission to theWahidin Hospital

Mechanism of trauma

Patient was riding a motorcycle and got hit byanother motorcycle from the right side and fell down

with his right thigh hit the ground first. History of unconscious (-), nausea (-), vommiting (-)

History of prior treatment at the Sinjai GeneralHospital


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PRIMARY SURVEY

A : Patent

B : RR = 20x/min, spontaneous,

thoracoabdominal

C : BP = 110/70 mm/Hg, PR = 86x/min,

reguler, strong pulse

D : GCS 15 ( E4M6V5), pupil isochor 2.5mm/2.5mm, light reflex +/+

E : T =36,50 C (axillar)


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SECONDARY SURVEY

RIGHT THIGH REGION

I : Deformity (+), swelling (+),hematom (+), wound (-)

P : Tenderness (+)

ROM : Limited active and passivemovement of the hip join and knee joint

due to pain NVD : sensibility is good, pulsation of

dorsalis pedis artery is palpable, capillaryrefill time


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LEG LENGTH DISCREPANCY

R L

ALL 80 cm 83 cmTLL 74 cm 77 cm

LLD 3 cm


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CLINICAL PICTURE


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CLINICAL PICTURE


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CLINICAL PICTURE


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LABAROTORY FINDINGS

WBC : 12,41 x 103 /uL

RBC : 3,32x 106 /uL

HGB : 13,8 gr/dL

HCT : 37,0 % PLT : 332 x 103 /Ul

CT : 730

BT : 230

HBsAg : Negative


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RADIOLOGY FINDING


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RADIOLOGY FINDING


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RADIOLOGY FINDING


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RESUME

A 20 years old man came to the hospital withchief complaint of pain at the right thigh due totraffic accident. He got hit by a motorcyclefrom his right side and fell down with rightthigh hit the ground first. From the physicalexamination of the right thigh : deformity (+),hematoma (+), tenderness (+), active andpassive motion of the hip and knee joint due tothe pain.

From radiologic finding, there is communitivefracture at the 1/3 proximal of the right femur


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DIAGNOSIS

Closed communitive fracture at

1/3 proximal of the right femur


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TREATMENT

Analgetic

Apply skin traction with load 3 kg

Plan for ORIF ( Open reductioninternal fixation )


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DISCUSSION

Fracture of shaftfemur


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DEFINITION

A femoral shaft fracture is a

fracture of the femoral diaphysis

occurring between 5 cm distal tothe lesser trochanter and 5 cm

proximal to the adductor tubercle.

Koval KJ, Zuckerman JD. In : Handbook of Fractures Thi rd Edition.

USA : L ippincott Wil li ams & Wil kins. 2002


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EPIDEMIOLOGY

Femoral shaft fractures occur

most frequently in young men

after high-energy trauma andelderly women after a low-energy

fall.

Koval KJ, Zuckerman JD. In : Handbook of Fractures Thi rd Edition.

USA : L ippincott Wil li ams & Wil kins. 2002


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ANATOMY

Thompson, J. Netters Concise Orthopaedic Anatomy 2ndEdi tion. Kansas : Elsevier


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ANATOMY

Muscles of the thigh are arranged in three

compartments separated by intermuscular septa.

Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA :

L ippincott Wil li ams & Wilki ns. 2002


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ANTERIOR COMPARTMENT

1. Quadriceps femoris

- Rectus Femoris

- Vastus Intermedius

- Vastus Medial- Vastus Lateral

2. Sartorius

3. Psoas major and iliacus

Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition.

USA: L ippincott Wil li ams & Wilkins. 2002


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ANTERIOR COMPARTMENT


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POSTERIOR COMPARTMENT

1. Biceps femoris

2. Semitendinosus

3. Semimembranosus

Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition.

USA: L ippincott Wil li ams & Wilkins. 2002


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POSTERIOR COMPARTMENT


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ARTERY OF THE THIGH

Thompson,JD. Netter's concise atlas of orthopedic

anatomy.2004.p189


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CLASSFICATION OF WINGUIST

AND HANSEN

Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA:L ippincott Wil li ams & Wil kins. 2002


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MECHANISM OF INJURY

In adults are almost always

the result of high-energy

trauma, result from motor

vehicle accident, gunshotinjury, or fall from a height

Pathologic fractures,

especially in the elderly,

commonly occur at the

relatively weak metaphyseal-diaphyseal junction

Stress fractures occur mainly in militaryrecruits or runners

Koval KJ, Zuckerman JD. In : Handbook of F ractures Thi rd Edition. USA :

L ippincott Wil li ams & Wil kins. 2002


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DIAGNOSIS

History Taking

high-energy trauma, a full trauma survey is

indicated

pain

Physical Examination

deformity, swelling, hematoma, tenderness

range of motion hip joint and knee joint limited neurovascular examination

examination of the ipsilateral hip and knee

Koval KJ, Zuckerman JD. I n : Handbook of F ractures Thi rd Edition. USA :



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RADIOLOGIC EXAM

Anteroposterior (AP) and lateral

views of the femur, hip, and knee

as well as an AP view of thepelvis should be obtained

Koval KJ, Zuckerman JD. I n : Handbook of F ractures Thi rd Edition. USA :



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TREATMENT

Shock should be treated and thefracture splinted before thepatient is moved.

EMERGENCY

Traction and BracingNON

OPERATIVE

Intramedullary Nailing External Fixation

Internal Fixation

OPERATIVE

Koval KJ , Zuckerman JD . In : Handbook of F ractures Third Edition. USA : Li ppincott Will iams & Wilki ns. 2002


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COMPLICATION

Early complication

Shock

Fat embolism and ARDS Thromboembolism

infection

Solomon. L . et al. Apleys System of Orthopaedics and F ractures 9thEditi on. New

York : Arnold. 2010


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COMPLICATION

Late complication

Delayed union

Non-union Malunion

Joint stiffness

Solomon. L . et al. Apleys System of Orthopaedics and F ractures 9thEditi on. New

York : Arnold. 2010


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