Orthopaedic and Traumatology Department

1. CLOSED FRACTURE 1/3
MIDDLE FEMUR SINISTRA
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT
Presented by:
Faradhillah A Suryadi C11108340
Advisor:
dr. Naharudin Imo
dr. M. Luthfi Muammar
dr. M. Rustam
Supervisor:
dr. M. Ruksal Saleh, Ph.D,Sp.OT
Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar, 2011

2. • Name : Mr. M
• Age : 16 y.o
• Admission : 23th June 2013
• RM number : 615465
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
PATIENT IDENTITY

3. Chief Complaint : Pain at the left thigh
History of illness : suffered since 3 hours before admitted to
hospital due to traffic accident.
Mechanism of trauma:
Patient was a passenger of a bike when he fell down and rolled on
the road as the rider was trying to avoid car from opposite
direction.
History of unconscious (-), nausea (-), vomiting (-)
Prior treatment at Pangkep hospital.
HISTORY TAKING

4. GENERAL STATUS
• General Appearance :
Moderate illness /Well Nourished/compos mentis
• Vital sign
• Bp : 110/70 mmHg
• Hr : 84x/min regular, strong
• RR : 18x/min, spontaneous, thoracoabdominal
• Temp : 36.7 oC (axilla)
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

5. LOCALIZED STATUS
Left Thigh Region
• I : deformity (+), swelling (+), hematoma (+) wound (-)
• P : tenderness (+)
• RoM : active and passive motion on hip and knee, joints can not
be evaluated
• NVD : sensibility is good, dorsalis pedis artery was palpable, CRT
< 2”
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

6. Leg length
Right leg Left leg
ALL 98 cm 96 cm
TLL 93 cm 91 cm
LLD 2 cm
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

7. CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

8. LABORATORY FINDINGS
• RBC :
5.260.000/mm3
• HGB : 13,5 mg/dl
• HCT : 42,9 %
• PLT : 259.000/mm3
• WBC : 10.000/mm3
• CT : 8’
• BT : 2’
• HbsAg : non reactive
• Elektrolit
Na : 136
K : 5,0
Cl : 102
• GDS : 72
• Ureum : 30
• Kreatinin : 0,9
• GOT/GPT : 61/60
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

9. RADIOGRAPHIC FINDINGS
PELVISXRAY(24.06.2013)

10. RADIOGRAPHIC
FINDINGS
XRAY
AP/LAT
Femur S
(24.06.20
13)
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

11. DIAGNOSIS
Closed fracture 1/3 middle of the left
femur
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

12. IVFD
Analgetics
Skin Traction
Plan for ORIF
MANAGEMENT
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

13. RESUME
A 16y.o boy was admitted to the hospital with pain at the left
femur which was suffered since 3 hours ago due to traffic
accident. Patient was a passenger of a bike when he fell down
and rolled on the road as the rider was trying to avoid car from
opposite direction.
At the anterior aspect of the femur, there is no wound,
deformity (+) oedem (+) hematom (+) . The region was tender
on palpation, with active and passive motion of hip and knee
joint can not be eavaluated due to pain. Sensibility good, a.
dorsalis pedis was palpable, CRT < 2”
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

14. FRACTURE FEMORAL SHAFT
DISCUSSION
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

15. ANATOMI
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

16. Muscles of the thigh are arranged in three compartments
separated by intermuscular septa.
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

17. ANTERIOR Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
MUSCLE ORIGIN INSERTION
Sartorius ASIS Prox. med.
tibia (pes
anserius)
Rectus
femoralis
1.AIIS
2.Sup. acetab.
rim
Patella/tibia
tubercle
Vastus lateralis Gtr. trochanter,
lat. linea aspera
Lat.
patella/tibia
tubercle
Vastus
intermedius
Proximal
femoral shaft
Patella/tibia
tubercle
Vastus medialis Intertrochant.
line, med. linea
aspera
Medial
patella/tibia
tubercle
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

18. MEDIAL Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
MUSCLE ORIGIN INSERTION NERVE
Obturator
externus
Ischiopubic
rami, obturator
memb
Piriformis fossa Obturator
Adductor
longus
Body of pubis
(inferior)
Linea aspera (mid 1/3) Obturator
Adductor
brevis
Body and
inferior pubic
ramus
Pectineal line, linea
aspera
Obturator
Adductor
magnus
1.Pubic ramus
2. Isxhial tub.
Linea aspera, add.
tubercle
1.Obturator
2.Sciastic
Gracilis Body and
inferior pubic
ramus
Prox. med. tibia (pes
anserius)
Obturator
Pectineus Pectineal line
of pubis
Pectineal line of femur Femoral
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

19. POSTERIOR
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
MUSCLE ORIGIN INSERTION NERVE
Semitendinosus Ischial
tubersity
Proximal
medial tibia
(pes anserius)
Sciastic
(tibial)
Semimembranosus Ischial
tubersity
Posterior
medial tibial
condyle
Sciastic
(tibial)
Biceps femoris :
Long head
Ischial
tubersity
Head of
fibula
Sciastic
(tibial)
Biceps femoris
:Short head
Linea
aspera,
supracon
dylar line
Fibula, lateral
tibia
Sciastic
(peroneal)
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

20. Classification of Fracture
Descriptive
 Open versus closed
 Level of fracture: proximal, middle, distal third
 Fracture pattern: transverse, spiral, or oblique
 Comminuted, segmental or butterfly fragment
 Shortening, angulation or rotation deformity
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

21. Winquist& HansenClassification
Stable
0 : No comminution
I : Minimal comminution
II : Comminuted > 50% of cortices intact
Unstable
III : Comminuted < 50% of cortices intact
IV : Complete comminution, no intact cortex
Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.
Stable
0 : No comminution
I : Minimal comminution
II : Comminuted > 50% of cortices intact
Unstable
III : Comminuted < 50% of cortices intact
IV : Complete comminution, no intact cortex
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

22. MECHANISM OF INJURY
Solomon, L, Warwick D.L, Nayagam,S. Apley’s system of orthopedic and fractures. 8th editions. 2008.
•Direct trauma:
•Motor vehicle accident
•Fall
•child abuse
•Indirect trauma
•Rotational injury.
•Pathologic fractures
•osteogenesis imperfecta
•nonossifying fibroma
•bone cysts
•tumors
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

23. • The diagnosis of femoral shaft fracture is usually obvious, with
the patient present with pain, deformity, swelling, and
shortening of the affected extremity
• The effect of blood loss and other injuries, some of which can
be life-threatening, may dominate the clinical picture.
Solomon, L, Warwick D.L, Nayagam,S. Apley’s system of orthopedic and fractures. 8th editions. 2008.
CLINICAL FEATURE
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

24. • Anteroposterior and lateral views of the femur should be
obtained.
• Radiographs of the hip and knee should be obtained to rule
out associated injury
Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.
RADIOLOGIC EXAM
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

25. • Non operative: skeletal traction and skin traction
• Operative:
External fixation
Plate fixation
Intramedulary nailing
Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.
TREATMENT
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

26. • Multiple trauma
• Open fracture
• Vascular injury
• Pathologic fracture
• Uncooperative patient
Koval, KJ, Zuckerman, JD. Hand book of fractures .3rd editon.2006.p349-53
OPERATIVE INDICATION
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ORTHOPAEDIC AND TRAUMATOLOGY

27. • Early
• Shock
• Fat embolisme
• Compartment syndrome
• Late
• Delayed / non union
• Malunion
• Joint stiffness
• Refracture
COMPLICATION
CASE REPORT
ORTHOPAEDIC AND TRAUMATOLOGY

28. THANK
YOU
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ORTHOPAEDIC AND TRAUMATOLOGY