CASE REPORT:

Close Fracture Antebrachii

Sarah Marsa Tamimi
132011101012

SMF/ LAB RSD dr. Soebandi Jember

Fakultas Kedokteran Universitas Jember
2018
INTRODUCTION

Definition Epidemiology
• Fracture is a break in the structural continuit Most injuries occur in men and the
y of bone. cause of injury is transportation ac
• Most fracture are caused by sudden and exc cidents
essive force
• The forearm is a complex anatomical struct
ure that has an important role in upper limb
function.
• The bone in the forearm connect to the two
condyle joints, the radioulnar joint distal an
d proximal,

2
ANATOM
Icon

Y
ANATOMY

Radius

Ulna

Radio-Ulnar Articular

Movement

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 Icon

CLASSIFICATION
 CLASSIFICATION
Based on the caused

HIGH-ENERGY TR
LOW-ENERGY TR
AUMA
AUMA
• External:
Repeatedly of low-energy trauma and depend of these conditio
Car or motor vehicle accident, or fall from a significant n:
height • Direct‘/indirect injury
• Internal • Age
• Location
Overwhelm muscle forces (ex: on epylepsi, tetanus, ele
• Patological fracture (ex: myeloma multiple, osteosarkoma, an
ctrical shock) d osteomyelitis)
• Stress fracture: March fracture on metatharsal, tibia fracture
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Complete Fracture
 Add an image
ICON ICON

Smith Fracture Monteggia

Called reverse colles. Bec fracture of the proximal
ause of the mechanical of i third of the ulna with disl
njury when palmarflexio ocation of the proximal he
n of hand. ad of the radius

ICON ICON ICON

Colles Fracture Galeazzi Fracture

Most often on fall with out Fracture of the distal thir
stretched hand, pronation, d of the radius with disloc
and dorsoflexion. Caused ation of the distal radiouln
distal fracture and displac ar joint.
ed fragments on radius

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RADIOGRAPHY
Analyze the Xray With ABCs

A: ALIGNMENT (structure)
Length, bone surface, discontinuity, displaced, fracture

B: BONE DENSITY
Changes in bone density (opaque or lucent)

C: CARTILAGE SPACE
Width of joint gap: wide or narrow

S: SOFT TISSUE
Muscle, articular capsule (normal: invisible), and the other ma
nifestion of abnormality

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Add an image

Icon

TREATMEN
T
 PRINCIPLE of TREATMENT
With 4R

RECOGNITION
Diagnose the fracture. What kind of fracture to det
ermine what kind of therapy to that condition

Icon Icon
REDUCTION
Or reposition, restore the fragments of fractur to th
e anatomical position

REHABILITATION
Monitoring until patient is able to
Icon Icon
safely return to his or her previous lifestyle.

RETENTION
Or fixation/ imobilitation. Keeping the anatomical po
sition until healing process of bone is done

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 TREATMENT

CONCERVATIVE
- Protection from a high intense of activity (using
crutch)
- Imobilitation (using splint) without reduction
SURGICAL INTER
VENTION
Close or open reduction with external or internal
fixation are available for this fracture.

- Close reduction

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 COMPLICATIONS

MALUNION Incorrect fuse because of incorrect reposition

NON-UNION Failed to fuse because of imobilititaion ineffective

Generally on elder patient because of decreasing of osteoblast, deficienc

DELAYED UNION y of vitamin D, pathological factors, ect

INFECTION On open fracture

AVASCULAR NECROSIS Discontinuity of vascularization on bone

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CASE REPORT
 Patient identity

Name : Mrs. Titin Sumarni

Birth Date/Age : 18-11-1965/ 53 years old
Address : Gebang, Jember
MR Number : 224353
Hospitalized : August 8th, 2018
Operation’s Date : August 8th, 2018
Unhospitalized : August 17th, 2018

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 Clinical Anamnesis

Main Problem: pain on the right forearm

Patient feel pain on the right forearm post a single motor vehicle accident at 06.30
am 8/8/2018. Patient wore helmet and remembered the accident. Headache (-), bl
eeding on forearm and head (-), nausea and vomit (-) .

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 Past Illness History

Hypertension : Denied
DM : Denied
Asthma :-
Allergic :-
Other Heart Disease : -

Family Illness History : denied

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 General Status

General condition : Good

Level of conciusness : Compos Mentis (GCS  4-5-6)
Vital Sign :
Blood pressure: 164/71 mmHg
Pulse Rate : 88 x/minute, regular, adequate
Respiratory Rate : 18 x/minute
Axilla Temperature : 36,3 0C
Remarks : General condition, consciousness  . Blood pressure abnormal

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 General Status

Cranial/ colli : anemic conjunctiva / icteric sclera/ cyanosis/ dyspnea = -/-/-/-

Thorax : I : Symmetrical, retraction (-), wound (-), Ictus Cordis  not visible
P: Fremitus tactile  normal, ictus cordis  palpated in ICS V MCL,
crepitation (-)
P: Sonor  in all of lung fields, Cor  normal in normal margin
A: Vesicular (+) in all of lung fields, Cor  S1S2 single, e/g/m -/-/-
Abdomen : I : Flat, Wound (-)
A : Bowel sound (+) normal range (15x/minute)
P : Tympanic
P : Supple

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 General Status

Extremities : Upper : Warm in distal for both right and left extremities, oedema (-)
Lower : Warm in distal for both right and left extremities oedema (-)
o Localized Status  Antebrachii Dextra :
Look : Deformity (+), oedema (+), active bleeding (-), laceration (-)
Feel : pain (+) score 5-6, crepitation (+), CRT <2 s
Movement : ROM limited et causa the pain

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Clinical Photos
X-Ray
Laboratorium (8-8-2018)

Hb 14,9 gr/dl

Leukosit 19,1 x 109 /L

HCT 44,1%

Trombosit 326 x109/L

SGOT 35 U/L

SGPT 37 U/L

Glukosa Sewaktu 117 mg/dL

Kreatin Serum 0,9 mg/dL

BUN 14 mg/dL

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Assesment Planning
Close fracture antebrachii third me Therapy Planning
dial Inj. Antrain 3x1amp
Inj. ranitidin 2x50 mg
pro ORIF
Consult to cardiologist get:
p/o concor 2,5 mg 1-0-0
p/o amlodipine 5mg 1-0-1
p/o valsartan 80mg 0-0-1

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OPERATION
REPORT
August 14th, 2018

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Operation Date : 8-14-2018
Pre-op diagnosis : CF antebrachii dextra third medial
Post-op diagnosis : CF antebrachii dextra third medial + Post ORIF Plating
Operation : ORIF Plating
Anasthesia : GA
Preparation : Informed consent and profilactive antibiotic ceftriaxone 2 gr

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Position : Supine with hand table
Description : supine position  deep incision until m. pronator teres  reduction radius  fix
ation with plate  dorsal incision  reduction ulna  fixation with plate hecting  ORIF Plati
ng
Complication : Bleeding about 100cc
Closure : subcuticular/ intradermal hecting

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Assesment Planning
Close fracture antebrachii third medial + p Therapy Planning
ost ORIF plating Inf. RL 15 dpm p/o concor 2,5 mg 1-0-0
Inj. Ceftriaxone 2x1 gr p/o amlodipine 5mg 1-0-1
Inj. ranitidin 2x50 mg p/o valsartan 80mg 0-0-1
Inj. Ketorolac 3x30mg

Monitoring Education
General condition, vital sign, right forearm Educates the patient and family how to ma
 pain, ROM, Swelling nage the wound after patient unhospitaliz
ed 

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FOLLOW
UP
August 16th, 2018

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 SOAP

S) the patient said surgical pain is decrease with scoring 1-2

O) Generalized Status :
General Condition : Good
Level of conciusness : compos mentis (4-5-6)
Vital sign :
Blood pressure : 120/70 mmHg
Pulse : 80 x/minute
RR : 16 x/minute
Tax : 36,60C
2
 SOAP

Cranial/Colli : a/i/c/d : -/-/-/-

Thorax :
Cor : Ictus cordis not visible, palpated at ICS V MCL Sinistra, cor in normal margin, S1S
2 single e/g/m = -/-/-
Pulmo : symmetrical, tactile fremitus normal, sonor, Vesikuler +/+
Abdomen : flat, bowel sound (+) normal, timpani, soepel, nyeri tekan (-)
Extremities : warm, oedema (-)

2
 SOAP

Localized Status (antebrachii dextra)

L : dressing (+), blood stain (-), oedema (-)
F : pain (+) scoring 1-2
M : ROM limited

2
X-Ray Post Op
Assesment
Close fracture antebrachii dextra thir
d medial + post ORIF plating Day-2
Planning
Therapy Planning
Inf. RL 15 dpm p/o concor 2,5 mg 1-0-0
Inj. Ceftriaxone 2x1 gr p/o amlodipine 5mg 1-0-1
Inj. ranitidin 2x50 mg p/o valsartan 80mg 0-0-1
Inj. Ketorolac 3x30mg Unhospitalized
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 Prognosis

Quo ad vitam : ad bonam

Quo ad functionam : dubia ad bonam
Quo ad sanationam : dubia ad bonam

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THANK YOU