IDENTITY

Name:HAge:70 years old / femaleAdmission:March 29 th, 2015 at 11:44Registration :70 64 61

AUTOANAMNESIS

Chief Complain : Pain at left thighSuffered since 25 days before admitted to Wahidin General Hospital.Patient was going into the bathroom then she slipped and fell with her left thigh hitting the floor.History of loss of conciousness (-), vomiting (-).History of hypertension (-),diabetes (-)Prior treatment at Haji Hospital.

GENERAL STATUS

Conscious / Well-nourished / AnemicVital Signs:Blood pressure: 130/70 mmHgPulse rate: 80 x/minRespiratory rate: 18 x/minTemperature: 36,8 0C

LOCAL STATUS

Left Thigh RegionLook:Wound (-), deformity (+) ,hematome (-), Swelling (+), Feel:Tenderness (+)NVD: sensibility is good, pulsation of dorsalis pedis artery and tibialis posterior artery are palpable, CRT < 2Move:Active and passive motions of hip joint are difficult to be evaluated due to painActive and passive motions of knee joint are difficult to be evaluated due to pain

RLALL87 cm86 cmTLL83 cm82 cmLLD1 cm

RLALL87 cm86 cmTLL83 cm82 cmLLD1 cm

CLINICAL FINDINGS

RADIOLOGIC FINDING

LABORATORY FINDINGS

WBC: 10.500/ ulRBC: 2.330.000/ ulHGB: 6,6 g/dlHCT : 20 %PLT: 164.000/ ulCT: 700BT: 300HBsAg: Non-ReactiveAlbumin: 2,8 gr/dL

RESUMEFemale 70 y.o admitted to hospital with chief complain pain at the left, there is deformity, and posterolateral displacement. From X-Ray finding,supracondylar fracture of left femur.

DIAGNOSISClosed Fracture Left Supracondylar FemurAnemiaHypoalbuminemia

MANAGEMENTIVFD RLAnalgesicApply Skin Traction load 3 kgs at left lower limbTransfusion 2 bags of Packed Red Cell Plan for Open Reduction Internal Fixation

DISCUSSIONClose fracture Left Supracondylar femur

Fracture is a break in the structural continuity of the boneClosed fracture if the overlying skin remain intact

Type of fracturesComplete : the bone is completely broken into two or more fragments tranverse, oblique, spiral, comminutedIncomplete : incompletely divided and the periosteum remains in continuity greenstick

Anatomy of thigh

Bones

Compartments

InnervationsThe sciatic nerve innervates muscles in the posterior compartment of thighthe femoral nerve innervates muscles in the anterior compartment of thighand the obturator nerve innervates most muscles in the medial compartment of thigh.

VascularisationThe major artery, vein, and lymphatic channels enter the thigh anterior to the pelvic bone and pass through the femoral triangle inferior to the inguinal ligament. Vessels and nerves passing between the thigh and leg pass through the popliteal fossa posterior to the knee joint.

Mechanism of injuryMost common severe axial load with a varus,valgus, or rotational forceIn young adults tipically high energyIn the elderly minor slip or fall onto a flexed knee

Deforming forceThe deforming forces from muscular attachment cause caracteristic dispalacement patterns gastrocnemius : flexes the distal fragment posterior displacement and angulationQuadriceps and hamstring : exert proximal traction shortening lower extremity

Clinical evaluationPatient typically are unable to ambulate with pain,swelling, and variable deformity in the lower thigh and kneeAssest of neurovascular usual sign of pallor and lack of pulse rupture of a major vessel

TreatmentNon Operatif treatment Indication :Patient with nondisplaced fractureSignificant medical comorbiditiesRelatif indication : nonambulatory patients,significant underlying medical diseases,infected fracture and lack of internal fixation devices

Non operatif treatment for distal femur fracture include :Close reduction with skeletal traction with or without cast-bracing

Operative treatmentIndications :Close reduction failsLarge articular fragmentAvulsion fracturesAssociated injuries

Complications

EarlyLateLocal Visceral InjuryMalunionVascular InjuryNon-unionCompartment SyndromeAvascular NecrosisNerve InjuryMusculare ContractureInfectionJoint InstabilityGas GangreneRegional Pain

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