Hasnah Ortho

8/9/2019 Hasnah Ortho

1/28

PRESENTED BY:

JOEL GUNTER SINURAT, MD

ADVISORDR.FELIX BATUNADR.ARIEF FAISAL

SUPERVISORdr. Henry Yurianto, M.Phil, Ph.D, Sp.OT (K)

Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin University

Makassar

201


2/28

IDENTITY

!ame " !y#H

$ge " %& years old

'e( " Female

$dmission " !ovem)er *th+ 201 at 1*",

-egistration " *. .0 20


3/28

HISTORY TAKING

Chief Complaint: wound at the left leg

Hitory of illne

Suffered since 12 hours before admitted to

Wahidin Sudirohusodo General Hospital. Thepatient was riding a motorcycle and got hit by

another motorcycle from opposite direction.

History of unconsciousness (-! "ausea (-!

#omiting (-.$rior Treatment at Ta%alar Hospital


4/28

PRIMARY SURVEY

$ " /lear

" -- 22 (min+ spontaneous+ thoracoa)dominaltype

/ " 110,0 mmHg+ H- ..(min strong+regular

D " 3/' 14 56M*748+ upil isochoric+ diameter2#4mm2#4mm+ light refle( 99

6 " T" %,o/


5/28

SECONDARY SURVEY

:eft :eg -egion

:ook " 'titched ;ound at anteromedial aspect 1% middle si

Move "$ctive and passive motion of the knee ?oint not )e evaluateddue to pain

$ctive and passive motion of the ankle ?oint not )e evaluateddue to pain


6/28

LEG LENGTH DISCREPANCY

Right L!t

ALL "# $% "& $%

TLL '( $% ') $%

LLD #


7/28

CLINICAL FINDINGS


8/28

CLINICAL FINDINGS


9/28

RADIOLOGIC FINDINGS

/ruris $:ateral5!ovem)er &th+ 2018


10/28

LABORATORY FINDINGS

*BC 1+1 +00@10+0

RBC 12#4 12+0@1*+0

HCT %.#0 %,+0@.+0

PLT 2%0 140@00

GOT 21 = %.

GPT 1* = 1

CT ,A00 @10

BT 2A00 1@,

N+ 12 1%*@14

K +0 %+4@4+1

C 10* &,@111

H-Ag !on -eactive !on -eactive


11/28

DIAGNOSIS

Open !ra"ture #$% middle left ti&ia 'rade a

Open !ra"ture #$% middle left fi&ula 'rade a


12/28

RESUME

& ' years old female was admitted to theWahidin Sudirohusodo General Hospital due to

)ehicular accident.

*n physical e+am! there was Stitchedwound at anteromedial aspect 1,' middle left leg

sie ' cm! deformity! hematome! Swelling and

tenderness! acti)e and passi)e motion of %nee

and an%le oint cannot be e)aluated due to pain.

There is no neuro)ascular compromised.

*n radiologic finding! there is an fracture 1,'

middle left tibia-fibula.


13/28

MANAGEMENT

I/t0+1/23 !3i4 40i5

A/ti-i2ti$

A/+gti$

Tt+/3 T262i4

D-0i4%/t

P+/ !20 O5/ R43$ti2/ I/t0/+ Fi6+ti2/

7ORIF8


14/28

FRACTURE OFFRACTURE OF

THE TIBIATHE TIBIA

AND FIBULAAND FIBULA


15/28

INTRODUCTION

$ fracture is a )reak in thestructural continuity of )one#

/lassification of fractures"

1# open vs close

2# /omplete B transverse+o)liCue+ spiral+ comminuted

ncomplete B greenstick+)uckle or torus

Salomon L., Warwick D., Nayagam S. Apleys System of Orthopaedics and Fractres !thed. "#.$%&%.$'()**


16/28

ANATOMY

+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%


17/28

COMPARTMENT

OF LEG

$nteriorcompartment



18/28

COMPARTMENT

OF LEG

:ateralcompartment



19/28

COMPARTMENT

OF LEG

'uperficialposterior

compartment



20/28

COMPARTMENT

OF LEG

Deep posterior

compartment



21/28

EPIDEMIOLOGY

Fractures of the ti)ia and fi)ula shaft are the mostcommon long )one fractures#

n an average population+ there are a)out 2* ti)ialdiaphyseal fractures per 100+000 population per year#

Men are more commonly affected than ;omen+ ;ith themale incidence )eing a)out 1 per 100+000 per year andthe female incidence a)out 12 per 100+000 per year#

The average age of a patient sustaining a ti)ia shaftfracture is %, years+ ;ith men having an average age of %1years and ;omen 4 years#


22/28

CLASSIFICATION OFFRACTURE

Clinical types:open fracture / close fractureEtiology :

traumatic fracture/ stress fracture/pathologic fractureConfguration classifcation:



23/28

G3ti2 9 A/402/ C+i!i$+ti2/ 2! O5/F0+$t30

G0+4 *23/

4 i

C2/t+%i/

+ti2/

S2!t ti3 B2/ i/;30<

=1cm /lean Minimal @'imple 5transverse+ shorto)liCue8@minimal comminution

E1cm Moderate Moderate @moderate comminution5transverse+ short o)liCue8

$ E10 cm High @e(tensive soft tissuelaceration@ $deCuate softtissue coverage

@minimal periostealstripping@soft tissue coverage of )oneis possi)le

E10 cm Massive @6(tensive soft tissuein?ury@ !eed soft tissuereconstruction

@moderate to severecomminution@poor )one coverage

/ E10cm Massive @severe loss of softtissue@need !7reconstruction

@poor )one coverage@moderate to severecomminution


24/28

MECHANISME OF INJURY


25/28

TREATMENT

#enneth . #oal, oseph D. /ckerman 0 1and2ook of Fractre 'rd edition,


26/28

D$3!O''

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9thEdition. New York

Arnold. !"#"


27/28

COMPLICATION

E+0

Hasnah Ortho

Documents