 Name : Mr.

B
 Age : 72 y.o
 Address : Jl. Hasanuddin Gowa
 MR Number : 780236
 Admission : 25 November 2016
 Chief complain : pain at the right groin

 Suffered since 6 months before admitted to

RSWS after felt down while walking home from
mosque. After felt down , patient couldn’t walk
again due to pain. There is no history of
medication before.There was no history of loss
of conciousness. There was no prior history of
diabetes or hypertension.

 Mechanism of trauma : patient went to outside

of the mosque and slipped off and felt down
with his right side of the body
 Well nourish/ Mild illness/ Compos Mentis

 Blood pressure : 120/70 mmHg

 Heart rate : 86 bpm
 Respiratory rate : 20 rpm
 Temperature : 36,8 0 C (Axilla)
 NRS score : 4/10
 Left Femur Region

o Look : Deformity (+), swelling (-), hematom (-), wound (-)

o Feel : Tenderness (+)
Active and passive motion of hip joint cannot be
o Move :
evaluated due to pain.
Sensibility is good
Pulsation of dorsalis pedis artery and tibialis
o NVD :
posterior artery are palpable
CRT < 2”
Leg Length Discrepancy (LLD)

Right Left
ALL 87 cm 89 cm
TLL 82 cm 84 cm
LLD 2 cm
Anterior view

Lateral view
Pelvis AP 23/11/16
Right femur AP/Lat (23/11/16)
JENIS PEMERIKSAAN HASIL NILAI RUJUKAN
WBC 10.2 x 103 4 - 10 x 103/uL
RBC 4.81x106 4.50-6.50 /mm3
HGB 13.9 12 - 16 g/dL
HCT 43.6% 40-54%
MCH 28.9 27.0 – 34.0 pg
MCV 91 80.0 – 100.0 fL
MCHC 31.9 31.0-36.0 g/dl
PLT 357x103 150 - 400 x 103/uL
CT 8.00” 4 – 10 mnt
BT 3.00” 1 – 7 mnt
SGOT 23 <35 U/L
SGPT 15 <45 U/L
Ureum 25 10-50 mg/dL
Creatinin 1.59 <1.3 mg/dL
GDS 93 80-180 mg/dl
 A male, 72 years-old admitted to the hospital
because of pain in the right groin, suffered since
6 months before admission, due to slipped.
 Physical examination, swelling, and hematoma
were not present, but there’s tenderness in the
right thigh region. Active and passive motions of
the hip joint cannot be evaluated due to pain.
NRS 4/10. LLD 2 cm.
 Laboratory findings showing increased of LED.
 X-Ray of pelvis and right femur showed
Fracture Right Neck of Femur.
Closed Fracture Right Neck of
Femur
 IVFD RL
 Analgetic
 Apply to skin traction load 3 kg at right lower
limb
 Plan: Hemiarthoplasty
FEMORAL NECK FRACTURE
 DEFINITION o A break in the structural
EPIDEMIOLOGY continuity of bone
ANATOMY o If overlying skin is intact :
MECHANISM Closed fracture
TYPE OF o If skin is not intact : Open
FRACTURE fracture
DIAGNOSIS

TREATMENT

PROGNOSIS
 DEFINITION
o 80% occur in ♀ , doubles every 5
EPIDEMIOLOGY to 6 years in age >30 years
ANATOMY o Incidence; younger patients low;
MECHANISM older patient high
TYPE OF o Mostly patient has fallen history as
FRACTURE
the caused of the trauma. In 2-3%
DIAGNOSIS
traumatic accident doesn’t exist,
TREATMENT like patologic fracture and stress
PROGNOSIS fracture
DEFINITION
EPIDEMIOLO
GY
ANATOMY

MECHANISM

TYPE OF
FRACTURE

DIAGNOSIS

TREATMENT

PROGNOSIS
 HIP JOINT

Thompson, J. Netter’s Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 BLOOD SUPPLY

Thompson, J. Netter’s Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 BLOOD SUPPLY

Thompson, J. Netter’s Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 ROM

Thompson, J. Netter’s Concise Orthopaedic Anatomy 4nd Edition. Kansas : Elsevier.

 MECHANISM OF INJURY
DEFINITION
EPIDEMIOLOG
Y Injury/ Repetitive Pathological
Trauma stress fracture
ANATOMY
Normal bone, Bone
MECHANISM Direct Indirect repeated weakened by
heavy a change in
TYPE OF loading. its structure
FRACTURE Breaks at the
Bone breaks
at a distance Typically in Osteoporosis,
point of where the force athletes, tumor,
DIAGNOSIS impact is applied dancers or congenital
military. anomalies,
TREATMENT infection

PROGNOSIS

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

 DEFINITION
 Complete fractures  the bone
EPIDEMIOLOGY
is completely broken into two or
ANATOMY more fragments. Ex : transverse,
MECHANISM oblique, spiral, comminutive,
TYPE OF
impacted
FRACTURE  Incomplete fractures  the
DIAGNOSIS bone incompletely divided and
TREATMENT
the periosteum remains in
continuity, ex : greenstick
PROGNOSIS
fractures
 Tissue destruction and haematoma
formation
 Inflamattion and cellular proliferation
 Callus formation
 Consolidation
 Remodelling
 DIAGNOSIS
DEFINITION
EPIDEMIOLO
GY
ANATOMY
HISTORY PHYSICAL IMAGING
MECHANISM TAKING EXAMINATION • Xray shows
• Pain on the groin • Swelling, fracture left neck
TYPE OF • Simple, low- Hematome & of femur
FRACTURE energy fall  Tenderness at
history of fall on groin region
the region position • Pain on movement
DIAGNOSIS

TREATMENT

PROGNOSIS

Campbell Operative Orthopedics 12th Edition.

Rockwood and Green's Fractures in Adults (7Ed. 2010)
 CLASSIFICATION

Classification by
Anatomic Location
• Subcapital
• Transcervical
• Basocervical

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

Campbell Operative Orthopedics 12th Edition.
 CLASSIFICATION

Pauwels
Classification
Type I <30 degrees
Type II 30 to 70 degrees
Type III >70 degrees

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

Sivananthan S, Femoral neck Fracture; Mercer’s Textbook of Orthopaedics and Trauma, 10th Ed.
 GARDEN CLASSIFICATION

(a) Stage I: incomplete (impacted) (b) Stage II: complete without displacement
(c) Stage III: complete with partial displacement (d) Stage IV: complete with full displacement
 Pauwels classification

anatomical
classification garden
classification
 TREATMENT GOALS
DEFINITION
EPIDEMIOLO
GY
ANATOMY

MECHANISM

TYPE OF
FRACTURE

DIAGNOSIS

TREATMENT

PROGNOSIS

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

 MANAGEMENT
DEFINITION
EPIDEMIOLO
GY Non • External Reduction
ANATOMY • Gradual mobilization
Operative
MECHANISM

TYPE OF
FRACTURE • Cannulated screw fixation
Operative
• Sliding hip screw
DIAGNOSIS  • Hemiarthroplasty
TREATMENT preferred • Total Hip Arthroplasty

PROGNOSIS

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

 MANAGEMENT

Cannulated Screw Fixation

• Garden I & II fracture in the elderly
• Displaced transcervical fracture in young
patient

Sliding Hip Screw

• Basicervical fracture
• Vertical fracture pattern in a young patient
 MANAGEMENT

Hemiarthroplasty
• Elderly with poor bone quality

Total Hip Arthroplasty

• Eldery with high functional demands and
good bone density
• Garden III & IV fracture in patient > 85 years
 COMPLICATIONS

Early Complication : Late Complication :

• DVT • Osteonecrosis  Avascular
• PE Necrosis of femoral head
• Non union
• Secondary Osteoarthritis

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 4th

 DEFINITION  The incomplete (nondisplaced or
impacted) fracture can be treated
EPIDEMIOLOGY either non operatively or with
internal fixation with good result
ANATOMY
and a low rate of avascular
MECHANISM necrosis.
 The complete (displaced) fracture
TYPE OF
FRACTURE
needs either internal fixation
complicated by non-union and
DIAGNOSIS avascular necrosis, requiring
reoperation in up to 47% of the
TREATMENT patients, or prosthetic
PROGNOSIS
replacement.