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PRESENTED BY
GODEBERTA A. P.
c111 10 101
Advisor :
dr. Nurjalaludin Djawie
dr. Anak Agung Gede Putra
Supervisor:
dr. Henry Yurianto, M.Phil, Ph.D, SpOT
Name :Mr. A
Age :38 Years old
Sex : Male
Date of admission : August 20th 2015
Registry : 044958
HISTORY TAKING
Chief Complaint: Pain at Right Leg
History of Illness
1 day before admitted to the hospital he had an accident at
his workplace.
Mechanism of trauma:
The patient accidentally cut his right leg by a cutting
machine when cutting grass. History of fall (-). History of
unconciousness (-).
History of treatment:
The patient was sutured in Luwuk Banggae Hospital and
referred to Wahidin Sudirohusodo Hospital.
Patient working as labor.
Physical Examination
Generalized Status:
Compos mentis GCS 15/ Well nourished
Vital Sign:
Blood Preassure: 120/70 mmHg
Heart Rate: 74x/minutes
Respiratory Rate: 18x/minutes
Temperature: 36,5 C (axilla)
Numeric Rate Scale: 4/10
Localized Status:
Right Cruris Region:
Look: Stitched wound size 1 cm at anteromedial
aspect of right cruris as levels distal part,
Deformity (+), swelling (+), hematoma (+).
Feel: Tenderness (+), sensibility is good, pulsation
of the dorsalis pedis artery is palpable, Capillary
refill time < 2
Move: Active and passive movement of the knee
joint are limited due to pain. Active and passive
movement of the ankle joint are limited due to
pain
R L
ALL 87 cm 86 cm
TLL 83 cm 82 cm
LLD 1 cm
Clinical Picture
X-ray (Right Cruris AP + Lateral)
Laboratory Findings
WBC 20.4 103/mm3
RBC 3.37 106/mm3
HGB 13.8 g/dL
HCT 35 %
PLT 324 103/mm3
HbsAg Non Reactive
BT 3
CT 8
RESUME
Male, 38 y.o, was admitted to the hospital with the chief complaint
pain at his right leg. The onset of this complaint was 1 day before
admission.
The mechanism of trauma: The patient accidentally cut his right leg
by a cutting machine when cutting grass. The patient was sutured in
Luwuk Banggae Hospital and referred to Wahidin Sudirohusodo
Hospital.
From Physical examination, at right leg region from look there was
stitched wound size 1 cm at anteromedial aspect of right cruris as
levels distal part, there is deformity, there is swelling, there is
hematome. From feel, there is tenderness. Neurovascular distal are
within normal limits.
The R.O.M of Knee and Ankle joint cannot be evaluated due to pain
From radiologic finding, theres fracture at one third distal of right
tibia and theres fracture at one third distal of right fibula.
Diagnose
IVFD RL
Analgesic
Antibiotic
Tetanus Toxoid
Debridement
Plan for Open Reduction Internal Fixation
Discussion
INTRODUCTION
Solomon L, et all. Apleys System of Orthopaedics and Fractures. Ninth Edition. London :
Hodder Arnold. 2010; p.687, 772-5.
OPEN FRACTURE CLASSIFICATION
(GUSTILO AND ANDERSON)
a) Segmental fractures, farmyard injuries, fractures occuning in a highly contaminated environment, shotgun wounds,
or high-velocity gunshot wounds automatically result in classification as type lll open fractures.
Egol KA, Koval KJ, Zuckerman JD. Handbook of Fracture. 4th Edition. Philadelphia:Wolters Kluwer. 2010.
Anatomy
Bucholz,W. Tibia and Fibula Fracture in Rockwood and Green in Adults.7th ed. Lippincott Williams & Wilkins. 2010.
MECHANISM OF TRAUMA
DIRECT INDIRECT
Solomon L, et all. Apleys System of Orthopaedics and Fractures. Ninth Edition. London : Hodder Arnold. 2010.
Egol KA, Koval KJ, Zuckerman JD. Tibia and Fibula Fracture. In Handbook of Fracture. Philadelphia:Wolters Kluwer. 2010.
DIAGNOSIS
Solomon L, et all. Apleys System of Orthopaedics and Fractures. Ninth Edition. London : Hodder Arnold.
2010.
TREATMENT
Conservative Operative
Antibiotic Debridement
Anti tetanus External fixation
Stabilization with long leg Internal Fixation
back slab
Egol KA, Koval KJ, Zuckerman JD. Tibia and Fibula Fracture. In Handbook of Fracture. Philadelphia:Wolters Kluwer. 2010.
Solomon L, et all. Apleys System of Orthopaedics and Fractures. Ninth Edition. London : Hodder Arnold. 2010.
COMPLICATION
Solomon L, et all. Apleys System of Orthopaedics and Fractures. Ninth Edition. London : Hodder Arnold.
2010.
THANK YOU
Indication for External Fixation