case report fr shaft humerus

8/13/2019 Case Report Fr Shaft Humerus

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BY:

Andi sandra faro

C111 06 180

ADVISOR:

Dr.Ihsan kitta

Dr. Fadil Mula putra

SUPERVISOR:

Dr.M.Ruksal Saleh,Ph.D,Sp.OT

Orthopaedic and Traumatology Department

Medical Faculty of Hasanuddin University

Makassar

2012


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PATIENT IDENTITY

Name : I

Age : 14 years old

Gender : Male

Date of admission : September 20th 2012

Medical Record : 569723


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History talking Chief complaint:

Decrease of consciousness, suffered since 8 hours beforeadmission to Wahidin General Hospital due to trafficaccident.

Mechanism of Trauma : The patient was riding amotorcycle and suddently fell by himself .

Prior treatment from Takalar Hospital .History of unconscious (+), nausea (-), vomit (-)


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A : Patent, airway obstruction(-) Clear

B : RR = 23 x/min, spontaneous,

thoracoabdominal type.C : BP 110/80 mmHg, PR = 88 x/min regular

D : GCS 14 (E3V5M6), pupil isochor 2,5mm /2,5mm, light reflex +/+

E : T = 36,60C (axilla)

PRIMARY SURVEY


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Maxillofacial Region :

I : wound (+) at mandibula region, deformity (-)

,swelling at the left chik (+), hematoma (-),

P : Tenderness dificult to evaluated due to decreased ofconsciousness.

SECONDARY SURVEY


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CLINICAL APPEARANCE


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Left arm region :

I : Deformity(+), swelling (+), hematoma (+),wound(-)

P : Tenderness (+)

ROM : Active and passive motions of shoulderand elbow joint are difficult to evaluatedbecause of decrease consciousness.

NVD : Sensibility is difficult to evaluated becouse of

decrease consciousness. Radial artery and ulnarartery are palapable, CRT


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Clinical appearance


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Ct scan


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CERVICAL LATERAL


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Chest X-ray


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Radiology finding


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Pelvis AP


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Laboratory findingWBC 14,00 x 103 /uL PT 14,4

RBC 4,20 x 106 /uL APTT 25,9

HGB 12 g/dL UREUM 21 mg/dl

PLT 296 x 103 /uL CREATININ 0,6 mg/dl

CT 3,00 SGOT 83 u/l

BT 8,00 SGPT 47u/l


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summary A boy,14 years old ago admitted to hospital with chief

complain decrease of consciosness due to traffic accidentsince 8 hours before being admitted.

On physical examination : Deformity(+), swelling (+),hematoma (+),Tenderness (+) of left arm region.ROM : Active and passive motions of shoulder and elbow

joint are difficult to evaluated because of decreaseconsciousness.

NVD : Sensibility is difficult to evaluated becouse ofdecrease consciousness. Radial artery and ulnarartery are palapable, CRT


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Diagnosis Mild Trauma Capitis GCS 14 (E4M6V5)

Closed fracture 1/3 middle left of humerus


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ManagementIVFD RL

Analgesic

H2 receptor agonistApply U Slab at the left forearm

Neuro surgery dept : conservatif

Planning:

1. ORIF


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IntroductionFracture is break in the structural of the boneinvolving surrounding soft tissue

Different from fractures in adults

Pediatric bone has a higher water content andlower mineral content per unit volume than adultbone.

Pediatric bone has a lower modulus of elasticity(less brittle) and a higher ultimate strain-to-failure

than adult bone.

periosteum is thicker and stronger in children


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FRACTURE

CLOSED (SIMPLE)FRACTURE

SKIN INTACT

OPEN(COMPOUND)

FRACTURE

SKIN OR ONE OFTHE BODYCAVITIES ISBREACHED

Contamination andinfection

FRACTURE is a break in the structural of bone.

Sorurce: Principles of Fracture, Appleys


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Anatomy


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Epidemiology

3 % of 5% of allfracture

Fracture rate is 2 per10,000 per year

From the ages of 0 to 16years, 42% of boys willsustain at least one

fracture compared with27% of girls.

Midshaft fractures

comprise 40% of allhumerus fractures

In children, humerus

fractures cause 17% ofadmissions for fracture


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EtiologiAccidental trauma

Nonaccidental injury

Patologic condition


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Mechanism of fracture the most common cause is a

motorcycle accident transverse, comminuted,

displaced fractures commonlyoccurDirect

Lower injury

spiral or long oblique fracture

Indirect

Apleys, System of Orthopaedics and Fractures, NinthEdition


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TschernesClassification of skin

lesion in closed fracturesGrade 0 Injury from indirect forces with negligible soft tissue damage

Grade I Closed fracture caused by low-moderate energy mechanisms,with superficial abrasions or contusions of soft tissues overlyingthe fracture

Grade II Closed fracture with significant muscle contusion, with possibledeep, contaminated skin abrasions associated with moderate tosevere energy mechanisms and skeletal injury; high risk forcompartment syndrome

Grade III Extensive crushing of soft tissues, with subcutaneous deglovingor avulsion, with arterial disruption or established compartmentsyndrome


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AO classification of humeral diaphysealfractures

Type A: Simple fractureA1: Spiral

A2: Oblique (>30)

A3: Transverse (


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Diagnosis

AnamnesisPhysical

examination Xray


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Management

imobilization Hanging cast over the upper arm and forearm U slab

Functional cast brace Collar and cuff bandage

Nonoperativetreatment

A compression plate and screws using a

broad 4.5mm plate External fixation with a conventional or ring

fixator

nailing is increasingly favoured

Operatiftreatment


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non operative treatmentCuff and collar sling Hanging cast


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Treatment


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ComplicationRadial nerve injury

Vascular injury

Nonunion

Malunion


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case report fr shaft humerus

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