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PATIENTS IDENTITY
Name
: Mr. A
Register no.
: 73 55 97
Sex
: Male
Age
: 30 years old
Date of admission : 4th December 2015
HISTORY TAKING
Chief complain
Anamnesis
PRIMARY SURVEY
Airway
Breathing
Circulation
Disabilty
Exposure
Patent, clear
20x/min, thoracoabdominal,
spontaneous, symetric.
BP 110/70mmHg, HR 88x/min, regular,
strong on palpation
GCS 15(E4M6V5), light reflex +/+ ,
pupil isochors, : 2.5mm/2.5mm,
SECONDARY SURVEY
LEFT LEG REGION
Look
Feel
Tendernes (+)
Move
NVD
Sensibility is good,
Pulsation of the dorsalis pedis artery and
tibialis posterior artery are palpable.
CRT <2
ALL
TLL
LLD
Right (cm)
Left (cm)
98
97
93
92
1 cm
CLINICAL FINDINGS
LABORATORY FINDINGS
WBC
RBC
HGB
HCT
PLT
: 20,3 X 103/UI
: 4,13 X 106/UL
: 12,5 GR/DL
: 38 %
: 415 X 103/UL
RADIOLOGY FINDINGS
RESUME
Male, 30 years old, admitted with open fracture
left cruris, suffered since 2 hours before
admission. From the physical examination there is
pin point wound at anteromedial aspect at 1/3
middle left cruris, deformity (+), hematoma (+),
swelling (+). tenderness (+). from the radiology
finding, there are oblique fracture at 1/3 middle
left tibia and fibula.
DIAGNOSIS
OPEN FRACTURE 1/3 MIDDLE LEFT TIBIA GRADE I
OPEN FRACTURE 1/3 MIDDLE LEFT FIBULA GRADE I
MANAGEMENT
IVFD
Antibiotic
Analgesic
Tetanus prophylaxis
Apply long leg back slab at left lower limb
Plan for ORIF elective
DISCUSSION
TIBIAAND FIBULA SHAFT
FRACTURE
INTRODUCTION
Fracture a break in the structural continuity of
bone
If overlying skin remains intact
: Closed
fractured
If skin not intact
: Open fractured
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York:
Lippincott Williams & Wilkins. 2006.
EPIDEMIOLOGY
Fractures of the tibia and fibula shaft are the
most common long bone fractures.
Male: incidence being about 41 per 100,000
per year.
Female: incidence about 12 per 100,000 per
year.
Usually due to traffic accident & sports injury.
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York: Lippincott
Williams & Wilkins. 2006.
Anterior Compartment
Lateral Compartment
Diagnosis
Physical
Examination
Radiological
Examination
History
Open
Fracture
oblique 1/3
middle left
cruris
Deformity
Pain
Swelling
Bruising
Decrease
range of
motion
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York:
Lippincott Williams & Wilkins. 2006.
Restore function
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.
Initial Treatment
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.
Treatment
Operative
The indications for operative :
Open fractures.
Multiple fracture
Neurovascular compromize.
Unstable fracture
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.
COMPLICATION
EARLY COMPLICATION
LATE COMPLICATION
Neurovascular injury
Delayed Union
Compartment Syndrom
Non Union
Malunion
Infection
Joint Stifness
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New
York : Arnold. 2010
THANK YOU
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY