CLOSED FRACTURE

1/3 MIDDLE OF THE

LEFT FEMUR
Presented by:
Juliet C G Umbas
Advisor :
dr. Salman Al Wahaby
dr. Syarif Hidayatullah
Supervisor:
dr. Notinas Horas, M. Kes, Sp. OT

Orthopaedic and Traumatology Dept

Medical Faculty of Hasanuddin University
Makassar, 2013

Patient Identity

Name
Age
Sex
Date of admittance
MR

: Mr. M
: 16 years old
: Male
: 24th June 2013
: 615468

History Taking
Chief Complaint: Pain at the left thigh
History of illness
Suffered since 6 hours before admitted to
hospital due to a traffic accident.

the

History of unconsciousness (-), nausea (-) vomiting (-)

History of previous illnesses (-)
Mechanism of trauma:The patient was a passenger
of a motorcycle an then suddenly got hit by
a car from behind, fell down, and then rolled
on the road.

Primary Survey
A
B

Patent
RR 20x/min regular, spontaneous
thoracoabdominal type, symmetrical

BP 120/80 mmHg
HR = 88 x/min regular.

GCS 15 (E4V5M6),
isochoric pupil, : 2.5 mm, light reflex +/+

T = 36,70 C (axilla)

Secondary Survey
LOCALIZED STATUS :
Left femur region
Inspection: deformity (+), swelling (+), haematoma (-)
Palpation: Tenderness (+)
ROM: Active and passive motion of hip joint and knee joint are limited
due to pain.
NVD: Sensibility is good,
dorsalis pedis artery and
tibialis posterior artery palpable,
Capillary refill time <2
Right

Left

ALL

98

96

TLL

93

91

LLD

2 cm

Clinical Picture

Laboratory Findings

WBC
HGB
RBC
PLT
Ur
Cr

: 10.000/mm3
: 13,5 mg/dl
: 5.260.000/mm3
: 259.000/mm3
: 30
: 0,9

GOT : 61
GPT : 60
CT
: 800
BT
: 200
HbsAg : non reactive
GDS : 72
Elektrolit
Na : 136
K : 5,0
Cl : 102

X-ray :
Femur (S)
AP/Lateral view
24th June 2013
Fracture 1/3
middle (L) femur

Pelvic X-ray
24th June 2013
Within normal
limit

Resume
A 16 years old boy came with closed fracture 1/3 middle of
the left femur.
From the physical examination vital sign is normal and at
the left femur there are deformity, swelling, hematoma,
tenderness.
ROM is limited and NVD is normal
X-Ray examination is confirm the fracture
Laboratorium findings within normal limit

Diagnosis
Closed fracture 1/3 middle of the left femur

Management

IVFD RL
Analgesic
Skin traction
Plan for ORIF

Femur Shaft Fracture

Anatomy of Femur

Thompson, Jon C. Netters Concise Orthopaedics Anatomy 2nd Edition

MUSCULATURE COMPARTMENT OF THE

THIGH

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition

Introduction
A fracture is a break in the structural continuity of
bone
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.
Fracture patterns are clues to the type of
force that produced the break.

1. Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition
2. Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd edition.

Principles of Fracture
Classification of Fracture

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

Fractures result from

Injury
Repetitive stress
Pathological fracture
Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

Mechanism of Injury

Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

PATHOLOGY ANATOMY
Fracture displacement often follows a
predictable pattern dictated by the pull of
muscles attached to each fragments.
In proximal shaft fracture the proximal fragment is
flexed, abducted and externally rotated because
of gluteus medius and iliopsoas pull, the distal
fragment is frequently adducted.
In mid-shaft fracture the proximal fragment is
again flexed and externally rotated but abduction
is less marked.
In lower third fractures the proximal fragments is
adducted and the distal fragment is tilted by
gastrocnemius pull.
Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

PHYSICAL EXAMINATION
Inspection: deformity, sweling, haematoma.
Present with tenderness
Decreased range of motion at the hip or knee,
depending on the location of the fracture
Hip :
Flexion 120-135
Extend 20-30
Abduct 40-50
Adduct 20-30
Internal rotate 30
External rotate 50

- Knee :
Flexion : 125 - 135
Extend : 5 - 15

NVD evaluation
Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition
Thompson, Jon C. Netters Concise Orthopaedics Anatomy 2nd Edition

TREATMENT
Nonoperative
Skin Traction
Skeletal traction
Casting
Splint

Operative
Intramedullary Nailing
External Fixation
Plate and Screw Fixation
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition

COMPLICATION
Early

Shock
Vascular injury
Nerve Injury
Fat embolism
Thromboembolism
Infection

Late

Non union or delayed

union
Malunion
Joint stiffness
Refracture and
implant failure

Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

Thank You