CLOSED COMMUNITIVE FRACTURE 1/3 PROXIMAL OF THE RIGHT FEMUR

NAME Ahmad Sharizal C111 07 313 ADVISORS Dr. Arnold Dr. Hendrian SUPERVISOR Dr. W.Supriyadi, Sp.OT

PATIENT IDENTITY

Name : Mr. A Age : 20 y/o, Sex : Male Admission : January 3rd 2013 Registration : 587062

HISTORY TAKING

Chief complaint Pain at the right thigh History of illness Suffered since 8 hours prior admission to the Wahidin Hospital Mechanism of trauma Patient was riding a motorcycle and got hit by another 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 General Hospital

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)

SECONDARY SURVEY
RIGHT THIGH REGION I : Deformity (+), swelling (+), hematom (+), wound (-) P : Tenderness (+) ROM : Limited active and passive movement of the hip join and knee joint due to pain NVD : sensibility is good, pulsation of dorsalis pedis artery is palpable, capillary refill time <2

LEG LENGTH DISCREPANCY

R 80 cm 74 cm
3 cm

ALL TLL LLD

L 83 cm 77 cm

CLINICAL PICTURE

CLINICAL PICTURE

CLINICAL PICTURE

LABAROTORY FINDINGS

WBC RBC HGB HCT PLT CT BT HBsAg

: : : : : :

12,41 x 103 /uL : 3,32x 106 /uL 13,8 gr/dL 37,0 % : 332 x 103 /Ul 730 230 Negative

RADIOLOGY FINDING

RADIOLOGY FINDING

RADIOLOGY FINDING

RESUME

A 20 years old man came to the hospital with chief complaint of pain at the right thigh due to traffic accident. He got hit by a motorcycle from his right side and fell down with right thigh hit the ground first. From the physical examination of the right thigh : deformity (+), hematoma (+), tenderness (+), active and passive motion of the hip and knee joint due to the pain. From radiologic finding, there is communitive fracture at the 1/3 proximal of the right femur

DIAGNOSIS

Closed communitive fracture at 1/3 proximal of the right femur

TREATMENT
Analgetic Apply skin traction with load 3 kg Plan for ORIF ( Open reduction internal fixation )

DISCUSSION

Fracture of shaft femur

DEFINITION
A femoral shaft fracture is a fracture of the femoral diaphysis occurring between 5 cm distal to the lesser trochanter and 5 cm proximal to the adductor tubercle.

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

EPIDEMIOLOGY
Femoral shaft fractures occur most frequently in young men after high-energy trauma and elderly women after a low-energy fall.
Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

ANATOMY

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier

ANATOMY

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

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

ANTERIOR COMPARTMENT
1.

2. 3.

Quadriceps femoris - Rectus Femoris - Vastus Intermedius - Vastus Medial - Vastus Lateral Sartorius Psoas major and iliacus
Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA: Lippincott Williams & Wilkins. 2002

ANTERIOR COMPARTMENT

MEDIAL COMPARTMENT
1.

2.
3. 4.

Gracilis Pectoneus Adductor longus, brevis, magnus Obturator externus

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA: Lippincott Williams & Wilkins. 2002

MEDIAL COMPARTMENT

POSTERIOR COMPARTMENT
1.

2.
3.

Biceps femoris Semitendinosus Semimembranosus

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA: Lippincott Williams & Wilkins. 2002

POSTERIOR COMPARTMENT

ARTERY OF THE THIGH

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.p189

CLASSFICATION OF WINGUIST AND HANSEN

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA: Lippincott Williams & Wilkins. 2002

MECHANISM OF INJURY
In adults are almost always the result of high-energy trauma, result from motor vehicle accident, gunshot injury, or fall from a height Pathologic fractures, especially in the elderly, commonly occur at the relatively weak metaphysealdiaphyseal junction

Stress fractures occur mainly in military recruits or runners

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

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. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

RADIOLOGIC EXAM

Anteroposterior (AP) and lateral views of the femur, hip, and knee as well as an AP view of the pelvis should be obtained

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

TREATMENT
EMERGENCY
Shock should be treated and the fracture splinted before the patient is moved.

NON OPERATIVE

Traction and Bracing

Intramedullary Nailing External Fixation Internal Fixation

OPERATIVE

Koval KJ, Zuckerman JD. In : Handbook of Fractures Third Edition. USA : Lippincott Williams & Wilkins. 2002

COMPLICATION

Early complication Shock Fat embolism and ARDS Thromboembolism infection

Solomon. L. et al. Apleys System of Orthopaedics and Fractures 9th Edition. New York : Arnold. 2010

COMPLICATION

Late complication Delayed union Non-union Malunion Joint stiffness

Solomon. L. et al. Apleys System of Orthopaedics and Fractures 9th Edition. New York : Arnold. 2010

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