CBD

1. STASE BEDAH Orthopaedi I
PPDS BEDAH FAKULTAS KEDOKTERAN UNIVERSITAS RIAU
RSUD ARIFIN ACHMAD
PEKANBARU - RIAU

2. Trauma, Alert response
Primary Survey
Objective Assessment Action
Airway maintenance
with restriction of
cervical spine motion
Snoring (-), gurgling (-), stridor (-), saturation
99 %. Tracheal deviation (-), Wound (-),
Emphysema (-), Laryngeal Tenderness /
crepitus (-), Venous Distension (-),
Oesophageal injury (-), Carotid Bruits / swelling
(-)
Patent airway (+) Monitoring airway
Cervical Control with
Neck Collar
Breathing and
ventilation
RR 20 x/minute, Bruise (-), Wound (-),
symmetrical chest wall movement, jugular
venous distention (-), trachea in the middle,
Emphysema / Crepitus (-), Chest wall
tenderness (-), normal heart sound, normal
breath sound R = L, resonance percussion,
saturation 99 %
Breathing and ventilation clear Monitoring breath
rhythm and O2
saturation
Circulation and
hemorrhagic control
warm (+), cyanotic (-), pulse 108 bpm, regular
adequate, CRT < 2’s, BP 174/110 mmHg
Hemodynamic Stable IVFD RL 1500 cc/24
hours
Disability (neurology
evaluation)
GCS 15 E4M6V5, round pupils, equal 2/2 mm,
pupillary light direct & indirect reflex +/+,
lateralization (-)
Decrease of consciousness (-) Observation level of
consciousness, repeat
the examination
Mrs. TM/ 47 years old/ 00876039/ BPJS
Attending: dr. Adri Yandra, Sp.OT

3. Mrs. TM/ 47 years old/ 00876039/ BPJS
Attending: dr. Adri Yandra, Sp.OT
Secondary Survey:
• The patient came with complaints of pain at left elbow since 6 hours
before admission.
• the mechanism of trauma previously she was walking around his house
then she tripped over the mound in front of his house and fell with his left
hand supporting the body, decreased consciousness (-), seizures (-),
nausea (-), vomiting (-). Complaints of other other limbs were denied.
• Because of these complaints, she was initially taken to Awal Bros
Panam Hospital, due to limited facility, she was taken by the family to
Arifin Achmad Hospital for further treatment.

4. Mrs. TM/ 47 years old/ 00876039/ BPJS
Attending: dr. Adri Yandra, Sp.OT
History of past illness
• A : History of an allergic (-)
• M: Medication (amlodipin, not taking regular medication)
• P : History of past illnesses (+) hypertension since 5 years ago, uncontrolled
• L : Last meal about 10 hours before admission
• E : Falls at home

5. Physical Examination
• Awareness : compos mentis GCS 15
• Vital sign
• VAS : 2-3 out of 1-10 scale
• BP : 174/100 mmHg
• HR : 108 x/minute
• RR : 20 x/minute
• Temp : 36.8 oC
• SpO2 : 99 % room air

6. Head to Toe Examination
• Head: Normocephal
• Eyes : anemic conjunctiva (-/-), icteric
sclera (-/-), round pupil, direct and indirect
pupil reflex (+/+) normal equal, hematoma
palpebra (-/-)
• Neck: normal
• Chest:
- I : Symmetric movement of chest walls,
- P : Fremitus right and left are normal
- P : Resonance (+/+)
- A : Vesicular sounds (+/+), rales (-/-),
wheezing (-)
• Heart: Normal heart sound regular, no
gallop, no murmur
• Abdomen:
• I : Distended (-) , bruise (-), scar (-)
• A : Bowel sounds (+) normal
• P : Firm, Tenderness (-)
• P : Tympany, shifting dullness (-)
• Extremity: CRT < 2”, warm (+),
cyanotic (-), swelling (-/-)

7. Localized Status of Left Upper Arm
- Look: swelling (+) distal shaft of upper arm , lacerated
wound (-), deformity (+)
- Feel: Crepitation (+), tenderness (+), crt <2 sec, warm
acral, SpO2 98-99%, sensation was normal, pulsation
a.radialis/ulnaris (++), Movement:
Active: limited adduction and Abduction of elbow joint.

8. End Brachialis Examination
Brachial Nerve Examination :
• Musculocutanous N. : elbow flexion (+). Sensoric: upper arm (++)
• Axillary N. : shoulder abduction (+). Sensoric: deltoid (++)
• Radial N. :
• Motoric : Elbow extension (+), wrist extension (+), thumb extension (+)
• Sensoric: snuffbox (++)
• Ulnar N. :
• Motoric : Abduction and adduction finger (+)
• Sensoric: digiti 5 (++)
• Medianus N:
• Motoric : wrist flexion (+), flexor finger (+)
• Sensoric: digiti 3 (++)

9. Localized Status of Left Upper Arm
Left Side
Right Side

10. Localized Status of Left Upper Arm

11. Working Diagnosis
- Suspected Closed Fracture
Supracondylar Left Humerus
Performed
Emergency room at Arifin Achmad
Hospital :
- Ketorolac 30 mg iv
- Omeprazole 40 mg iv
Plan:
• Laboratory test
• Chest X-ray, Left Elobw joint X-ray
• Consult to Orthopaedic surgeon

12. Laboratory Result (December, 14th 2023)
Type Value Unit Normal Value
Haemoglobin 11.6 g/dL 13,0 - 16,0
Haematocrit 34.4 % 40,0 - 48,0
WBC 18.84 10^3/µl 5,00 - 10,00
Platelet 336 10^3/µl 150 – 400
PT 13.9 second 11-15
APTT 28.4 second 28-42
Type Value Unit Normal Value
Glucose 109 mg/dL < 140
AST 14 U/L 10 – 40
APT 18 U/L 10 – 40
Ureum 17 mg/L 17.1 – 49.2
Creatinine 8.65 mg/L 0.55 – 1.30
HIV Non-reactive Non-reactive
HBsAg Non-reactive Non-reactive

13. • Airway: trachea was at middle site
• Bone: No discontinuity
• Cardiac: Cardiomeghaly, (CTR >
50%)
• Diaphragm: Normal
• Field of the lung: Normal
Chest X-ray (November, 13th 2023)

14. Left Upper Arm X-Ray (December, 13th 2023)
Discontinuity of supracodylar of left
humerus
• Site : Diaphysis
• Extend : Complete
• Configuration : Transversal
• Displacement : Posterolateral

15. Diagnosis
- Closed Fracture Supracondylar Left
Humerus, Gartland type III
ICD X:
812.41 Supracondylar fracture of humerus closed
Consult to dr. Adri Yandra, Sp.OT, Advice :
- Inpatient
- IVFD RL 1500 cc / 24 hours
- Ceftriaxone 2 x 1 gr iv
- Ketorolac 3 x 30 mg
- Omeprazole 2 x 40 mg
- Install Posterior Splint
- CT Scan Left Elbow 3D
- ORIF Elective at the room
Performed

16. CT Scan 3D Left Elbow
Discontinuity of supracodylar of left
humerus
• Site : Diaphysis
• Extend : Complete
• Configuration : Transversal
• Displacement : Posterolateral

17. Posterior Splint

18. Gartland Classification

19. THANK YOU