ulmi fadillah - case report (open fracture tibia fibula) revisi 2
TRANSCRIPT
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Ulmi Fadillah Juniar
C111 10 156
OPEN FRACTURE OF THE LEFT TIBIA 1/3 PROXIMAL gradeIII AOPEN FRACTURE OF THE LEFT FIBULA 1/3 PROXIMALgrade III A
SUPERVISOR:dr. M. Andry Usman Ph.! S".O#
DEPARTMENT OF ORTHOPAEDIC ANDTRAUMATOLOGY
MEDICAL FACULTY OF HASANUDDIN UNIVERSITYMAKASSAR
!1"
CASE PRESENTATIONOCTOBER 2015
A!VISOR:
dr. Ari$s %u&a'ara&
dr. (ur Rahmansyah
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PATIENT IDENTITY
Na#e $ Mr% AR
Age $ &ear' ()d
Med*+a) re+(rd $ ,-.,3
Ad#*''*( da0e $ O+0(er 1.02 !1"
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C2*e4 +(#5)a*0
6(7d a0 02e r*g20 )eg
H*'0(r& Ta8*g
S79ered '*+e 1 2(7r e4(re ad#*00ed 0( 6a2*d*S7d*r(27'(d( H('5*0a) d7e 0( 0ra:+ a++*de0
Me+2a*'# (4 0ra7#a
Pa0*e0 ;a' r*d*g a #(0(r+&+)e ad g(0 2*0 &
a(02er #(0(r+&+)e 4r(# r*g20 '*de 02e 4a)) ;*022*' r*g20 )eg ?
@(#*0*g =>? H*'0(r& (4 5r*(r 0rea0#e0 =? a0 2('5*0a) E)*# *
0(raa ad g(0 '0*0+2 a0 02e ;(7d ( 02e r*g20 )eg
HISTORY TAKING
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PRIMARY SURVEY
Airway $ C)ear
Breathing $ Re'5*ra0(r& Ra0e ! /#0
'5(0ae(7' 02(ra+(ad(#*a) 0&5e
Circulation $ P7)'e /#0 reg7)ar '0r(g BP
11!/,! ##Hg
Disability$ GCS 1" =EM.V"? 575*) *'(+2(r d*a#e0er 3
## )*g20 ree /Environment $ 3., !C =a*))ar&?
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SECONDARY SURVEYLeft Leg Region
Look $ )a+era0ed ;(7d a0 02ea0er*(r a'5e+0 (4 +r7r*' +# ada0 02e a0er()a0era) a'5e+0 1 +# de4(r#*0& =? ';e))*g =?
2e#a0(#a =?
Feel :Tedere'' =?
NVD $ 'e'**)*0& (4 dee5 5er(ea)
er@e ad '75er
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CLINICAL PICTURES
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RADIOLOGICAL FINDINGSX-Ray AP/lateral (Cruris
Sinistra)
X-Ray AP/lateral (Genu
Sinistra)
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LABORATORY FINDINGS
Ea#*a0*( Re'7)0' N(r#a)
6BC !%!!! / 7) !!>1!!
RBC 3 X 1!. !!>.!!
HGB 1!" gr/d) 1!>1.!
HCT 3! J 3,!>!
PLT .-%!!!/7) 1"!>!!
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Male, 22 years old was admitted to the WahidinSudirohusodo Hospital with pain at the left leg sufferedsince 5 hours before admitted to the hospital due to trafficaccident.
Physical examination on left leg region were foundlacerated wound at the anterior aspect of cruris 2x2 cm,and at the anterolateral aspect x! cm , hematom, swelling,and tenderness, "#M acti$e and passi$e mo$ement of %nee
&oints can't be e$aluated due to pain (rom the radiological examinationcommuniti$e fracture
!)* proximal os tibia sinistra, obli+ue fracture 1/3
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OPEN FRACTURE OF THE LEFT TIBIA 1/3 PROXIMALgrade III AOPEN FRACTURE OF THE LEFT FIBULA 1/3 PROXIMALgrade III A
DIAGNOSIS
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IVFD
A0**(0*+'
Te0a7' 5r(52&)a*'
Aa)ge'*+A55)& )(g )eg a+8 ')a
P)a 4(r Der*de#e0
P)a 4(r E8'0era) F*a0*(
TREATMENT
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D*'+7''*(
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INTRODUCTION
A 4ra+07re *' a rea8 * 02e '0r7+07ra)+(0*7*0& (4 (e%
C)**+a) 0&5e'$ (5e 4ra+07re / +)('ed 4ra+07re%
I4 02e (@er)&*g '8* re#a*' *0a+0 *0 *' a+)('ed 4ra+07re ad *4 02e '8* (r (e (4 02e(d& +a@*0*e' *' rea+2ed *0 *' a (5e4ra+07re )*a)e 0( +(0a#*a0*( ad
*4e+0*(% U'7a))& d7e 0( 0ra:+ a++*de0 '5(r0'
*7r&
Apleys System of Orthopaedics and fracture, Chapter 23: Principle of fracture
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ANATOMY
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CONFIGURATION OF FRACTURE
Spiral pattern(twisting
Short o!li"ue
pattern
(compression
#riangular $!utterfly
fragment (!ending
#ran%erse pattern
(tension
Apleys System of Orthopaedics and fracture, Chapter 23: Principle of fracture
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GUSTILO AND ANDERSONCLASSIFICATION OF FRACTURE
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&n this patient had high energy trauma from direct hit in a motor %ehicle
accident which results in fracture of ti!ia and fi!ula
MECHANISM OF INURY
Apleys System of Orthopaedics and fracture, Chapter 23: Principle of fracture
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Anane!i!
"i!to#$ of illne!!% e&hani! of t#a'a
Ph$!i&al e(aination
LOO)% *EEL% MOVE% NVD
La+o#ato#$ e(aination
,- #a$% .ith AP an/ late#al ie.
ith #'le of 23: 2 ie.% 2 li+% 2 4oint% 2 o&&a!ion% 2 in4'#ie!
DIAGNOSIS
Solomon' ' et al' &n)urys of the *nee and eg in Apleys System of Orthopaedics and +ractures th -dition' .*: Arnold' 2/0/'
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CLINICAL FEATURES
Oe/ea
"eatoa
Ten/e#ne!! at the f#a&t'#e !iteDeea!e/ #ange of otion at
the 4oint
Che& ne'#oa!&'la# /i!tal
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MANAGEMENT
N(>(5era0*@e
Id*+a0*( $
1 Ud*'5)a+ed (r #**#a) d*'5)a+ed
1 C)('ed 4ra+07re'
1 L(; eerg& 0ra7#a
1 M**#a) '(40 0*''7e da#age
1 S0a)e 4ra+07re 5a00er
iller , Stephen 4, 5ennifer A et al' #rauma: ower -6tremity 7 Pel%is'&n: 4e%iew of Orthopedics, 8 th edition'
Philadelphia' -lse%er Saunder
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GOALS OF FRACTURE MANAGEMENT
4ecogni9e
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Id*+a0*(' $O5e 4ra+07re%U'0a)e 4ra+07re' +(##*70ed 4ra+07r ad
a''(+*a0ed ;*02 @ar&*g degree' (4 '(40>0*''7e
0ra7#aA''(+*a0ed @a'+7)ar *7r&%Fra+07re' a''(+*a0ed ;*02 +(#5ar0#e0
'&dr(#e%
Solomon. . et al. -pley's System of #rthopaedics and (ractures th/dition. 0ew 1or% -rnold. 23!3
O5era0*@e Trea0#e0
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COMPLICATION
Solomon. . et al. -pley's System of #rthopaedics and (ractures th/dition. 0ew 1or% -rnold. 23!3
Early comlplication :
0eoro$ascular 4n&ury
ompartment Syndrom
Late Complication :
Malunion, delay union, non union, 4nfection
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