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FRACTURE OF
LEFT FEMORAL NECK
Presented by :
SITI AISHAH BT KHAIRUDIN
C111 11 849
Advisors :
dr. HERBERT
dr. QARIAH M.
Supervisor :
dr. Henry , Yurianto, M.Phil , PhD, Sp.OT
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PATIENT IDENTITY
Name
: Mr. MF
Age
: 16 years old
Sex
: Male
Address
: Jl. Kumala
Occupation
: Student
Regist Number: 778129
Date of admission : November, 5th
2016
HISTORY TAKING
Chief Complain
: Pain at the left groin
Suffered since 1 month before admitted to Wahidin Hospital due to
falling down while painting wall. After falling down, the patient used
traditional therapy as alternative treatment for two weeks. After there
is no improvement and consistently feel the pain, patient went to
Labuang Baji Hospital and had treated with skin traction, operative
therapy and recommended to do joint replacement. There was no
history of loss of consciousness. There was no prior history of
diabetes or hypertension
Mechanism of trauma: Patient felt down from 3 meter high and fell
over his left side of the body
GENERAL STATUS
Well nourish/ Mild illness/ Compos Mentis
Blood pressure : 110/70 mmHg
Heart rate
: 88 bpm
Respiratory rate : 20 rpm
Temperature: 36,8 0 C (Axilla)
NRS score : 2/10
LOCALIZED STATUS
REGIO FEMORALIS SINISTRA
PHYSICAL EXAMINATION
Leg Length Discrepancy (LLD)
Right
Left
ALL
97 cm
95 cm
TLL
83 cm
81 cm
LLD
2 cm
CLINICAL FINDINGS
RADIOLOGIC FINDINGS
Pelvis AP (05/11/2016)
RADIOLOGIC FINDINGS
Left Femur AP/Lat (05/11/2016)
LABORATORY FINDINGS
JENIS
PEMERIKSAAN
HASIL
NILAI RUJUKAN
WBC
6.3 x 103
4 - 10 x 103/uL
HGB
11.1
12 - 16 g/dL
PLT
259x103
CT
7.00
4 10 mnt
BT
3.00
1 7 mnt
Na/K/Cl
144/4.7/ 102
Mmol/L
SGOT
23
<35 U/L
SGPT
26
<45 U/L
GDS
92
80-180 mg/dl
HBsAg
Non Reactive
Non Reactive
RESUME
A male, 16 years-old was admitted to the hospital because of
pain in the left groin, suffered since 1 month before admission,
due to fall.
Based on physical examination, wound incision present at
anterolateral left thight region, deformity and tenderness were
present. Active and passive motions of the hip joint cannot be
evaluated due to pain.
Laboratory findings showing anemia.
X-Ray of pelvis and left femur showed Fracture Left Basic Neck
of Femur.
DIAGNOSIS
MANAGEMENT
INITIAL
IVFD
Analgesic
Skin traction with load 3kg
DEFINITIVE
ORIF
Cannulated Screw Fixation
Discussion:
FEMORAL NECK
FRACTURE
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DEFINITION
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Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition
OVERVIEW
>250,000 hip
fractures occur in the
US each year (50%
involve the femoral
neck)
80% occur in ,
Incidence; younger
doubles every 5 to 6
patients low; older
years in age >30
patient high
years.
FEMUR BONE
BLOOD SUPPLY
MECHANISM OF INJURY
Direct
Breaks at the
point of impact
Indirect
Bone breaks at a
distance where the
force is applied
Repetitive stress
Normal bone,
repeated heavy
loading.
Typically in
athletes, dancers
or military.
Pathological
fracture
Bone weakened
by a change in its
structure
Osteoporosis,
tumor, congenital
anomalies
Injury/ Trauma
DIAGNOSIS
HISTORY
TAKING
PHYSICAL
EXAMINATION
Tenderness at left
groin
Pain on
movement
Xray shows
fracture left neck
of femur
IMAGING
CLASSIFICATION
Classification by
Anatomic Location
Subcapital
Transcervical
Basicervical
Pauwels classification
anatomical
classification
garden
classification
TREATMENT GOALS
Restore hip
function
Minimize
patient
discomfort
Rapid
mobilization
Goals
Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition
MANAGEMENT
Non Operative
External Reduction
Gradual mobilization
Operative preferred
MANAGEMENT
Cannulated Screw Fixation
Garden I & II fracture in the elderly
Displaced transcervical fracture in young patient
Basicervical fracture
Vertical fracture pattern in a young patient
MANAGEMENT
Hemiarthroplasty
Elderly with poor bone quality
COMPLICATIONS
Early Complication :
DVT
PE
Ulcus decubitus
Late Complication :
Osteonecrosis Avascular Necrosis of femoral head
Non union
Secondary Osteoarthritis
Thank You