Case Report - Closed Fracture Middle of the R Femur-2

8/9/2019 Case Report - Closed Fracture Middle of the R Femur-2

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Presented by:Zulkarnain Hasyim

Advisor :

dr. Arnold Darmawandr. Muhammad Arief Faisal

Supervisor:

dr. Petrus ohan! M."es!Sp #$

Orthopaedic and Traumatology Dept

Medical Faculty of Hasanuddin University

Makassar, 20!


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PATIENT IDENTITY

• Name : D

• Age :19 years old• Sex : Female

• Date of admittance : September 18th, !1"

• #$ : %81!&!


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HISTORY TAKING

"hief "omplaint# Pain at the right thigh

History of illnessSuffered since 3o minutes before admitted to thehospital due to traffic accident.

Mechanism of trauma#

Patient was ride a motorcycle and hit by anothermotor on the right side of the right thigh of thepatient

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


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PRIMARY SURVEY


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SECONDARY SURVEY$O"%$&'(D )T%TU) #

Right femur region

&nspection# deformity (!), swelling (!) , haematoma (!), shortenedright lower limb compared to opposite, , wound (-)

*alpation# "enderness (!)

+OM# $ctive and passive motion of hip and %nee &oints are notevaluated due to pain.

-D# Sensibility is good, dorsalis pedis artery palpable and 'apillaryrefill time *

+ight $eft

$++

"++ /

++0 cm


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CLINICAL PICTURE (September 18TH,

2014


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2014


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2014


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LA!ORATORY "INDIN# 12' # !./00mm3

H2 # 4, mg5dl 62' # 3.7.5mm3

P+" # 3/4.5mm3

'" # 8*

2" # 38*

Hbs$g # non reactive


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$%RAY September 18TH, 2014


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RESUME9 $ female 47 years Suffered since 3o minutes before

admitted to the hospital due to traffic accident.

• :rom the physical e;amination vital sign is normal and atthe right femur

&nspection# deformity (!), swelling (!) , haematoma (!), shortened right lowerlimb compared to opposite, swelling (!), haematoma (!), wound (-)

*alpation# "enderness (!) +OM# $ctive and passive motion of hip and %nee &oints are can not be evaluated

due to pain. -D# Sensibility is good, dorsalis pedis artery palpable and 'apillary refill time

*

•


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DIA#NOSIS

9 'losed fracture 453 middle of the right femur


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MANA#EMENT

9 =>:0 6+

9 $nalgesic

9 $pply s%in traction 3 %g

9 Plan for ?6=:


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Femur )haft Fracture


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I&tr')*t+'&

9 "he femoral shaft is circumferentially

padded with large muscles.

9 $ femoral shaft fracture is a fracture of

the femoral diaphysis occurring between @ cmdistal to the lesser trochanter and

@ cm pro;imal to the adductor tubercle.

9 :racture patterns are clues to the type offorce that produced the brea%.

1' Solomon (o)is, *ar+ic Da-id, Nayagam Sel-ad)rai : Apley.s System of /rthopaedics and Fract)res 9th 0dition

' o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd edition'


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A&t'm- '. "em)r


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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'


18/277hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'


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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st

edition'


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De.'rm+&/ m)*e .'r*e '&

te .em)r

o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd 0dition


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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'


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Me*&+m '. I&3)r-


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PHYSICAL E$AMINATION

9 =nspection# deformity, swelling, hematoma.

9 Present with tenderness9 Decreased range of motion at the hip or knee,depending on the location of the fracture

9 A>0 evaluation

Solomon (o)is, *ar+ic Da-id, Nayagam Sel-ad)rai : Apley.s System of /rthopaedics and Fract)res 9th 0dition

7hompson, 2on ' Netter.s oncise /rthopaedics Anatomy nd 0dition

Hip

Flexion 0-120°

Extend 20-30 °

Abduct 40-50 °

Adduct 20-30 °

Internal

rotate

30 °

External

rotate

50 °

Knee

Flexion 125 - 135

°

Extend 5 - 15 °


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TREATMENT9 Aonoperative

S%in "raction

S%eletal traction 'asting

9 ?perative

=ntramedullary Aailing

B;ternal :i;ation Plate and Screw :i;ation

o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd 0dition


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COMPLICATION

Cenneth Coval, et al. Handboo% of fractures third edition. D. +ippincott 1illiams and wil%ins. ES$

9 Falunion

9 Aonunion

9 Fuscle wea%ness

9 ++0 ?vergrowth

Shortening


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THANK YOU

Case Report - Closed Fracture Middle of the R Femur-2

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