CASE REPORTCLOSED COMMINUTIVE FRACTURE 1/3 MIDDLE RIGHT TIBIA By: FRACTURE RIGHT CLOSED SEGMENTAL Fanny Ayu Permatasari CFIBULA 111 09 259 Advisors: dr. M. Rustam Noertika dr. Syarif Hidayatullah Supervisor: dr. Wilhelmus Supriyadi, Sp.OT Department of Orthopaedic dan Traumatology Faculty of Medicine Hasanuddin University Makassar 2014 IDENTITY Name Age :D : 56 years old / Male Admission : June 4th, 2014 at 18.00 Registration : 666521 .No history of unconscious. . .Anamnesis : suffered since 30 minutes before admitted to the hospital due to traffic accident. no history of nausea and vomit.HISTORY TAKING Chief Complain : pain at right leg .Mechanism of trauma : The patient was crossing the street when suddenly hit by a motorcycle from the right side. symmetrical B C BP 120/70 mmHg HR = 84 x/min regular.50 C (axillary) D .5 mm. pupil isochors. light reflex +/+ E T = 36. spontaneous thoracoabdominal type.5 mm/2. strong GCS 15 (E4V5M6). Ø : 2.PRIMARY SURVEY A Patent RR 18x/min regular. swelling (+).SECONDARY SURVEY Right leg region: I : Deformity (+). Capillary refill time < 2” . wound (-) P : Tenderness (+) ROM : Active and passive movement of the knee and ankle joints are limited due to pain NVD : Sensibility is good. hematoma (+). pulsation of the dorsalis pedis & tibialis posterior arteries are palpable. CLINICAL PICTURES . 15 x 106 /mm3 : 12.LABORATORY FINDINGS ◦WBC ◦RBC ◦HGB ◦HCT ◦PLT ◦HbsAg ◦BT 2’ ◦CT 6’ : 17.6 g/dL : 37 % : 222 x 10 3 /mm3 Non Reactive .4 x 103 /mm3 : 4. RADIOLOGICAL FINDINGS Rigth Cruris X-Ray AP / Lateral View . there are comminutive fracture 1/3 middle right tibia and segmental fracture right fibula.RESUME A male. I found deformity (+). swelling (+). was admitted to the hospital with chief complain pain at right leg due to traffic accident. hematoma (+). with tenderness. On radiologic examination (right cruris X-Ray AP / Lateral view). Active and passive movement of the knee and ankle joints are limited due to pain. . 56 years old. On physical examination. DIAGNOSIS Closed comminutive fracture 1/3 middle right tibia Closed segmental fracture right fibula . MANAGEMENT IVFD RL Analgesic Apply long leg back slab at right lower limb Plan for ORIF . DISCUSSION FRACTURE OF TIBIA AND FIBULA . Usually due to traffic accident & sports injury SOLOMON. L.INTRODUCTION A fracture is a break in the structural continuity of bone. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. UK: ARNOLD. ET AL. Fractures of the tibia and fibula shaft are the most common long bone fractures. liable to contamination and infection. Clinical types: open fracture / closed fracture. If the overlying skin remains intact it is a closed fracture and if the skin or one of the body cavities is breached it is an open fracture. . 2010. LEG/KNEE .ANATOMY NETTER’S CONCISE ORTHOPAEDIC ANATOMY. 2ND EDITION. CHAPTER. LEG/KNEE . 2ND EDITION. CHAPTER.NETTER’S CONCISE ORTHOPAEDIC ANATOMY. CHAPTER.NETTER’S CONCISE ORTHOPAEDIC ANATOMY. 2ND EDITION. LEG/KNEE . UK: ARNOLD. . ET AL. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. 2010.MECHANISM OF INJURY Spiral pattern (twisting) Short oblique pattern (compression) Triangular ‘butterfly’ fragment (bending) Tranverse pattern (tension) SOLOMON. L. . ZUCKERMAN. JOSEPH D.MECHANISM OF INJURY In this patient had high energy trauma from direct hit in a motor vehicle accident which results in comminutive tibia fracture and segmental fibula fracture KOVAL. 4 TH EDITION . HANDBOOK OF FRACTURES. KENNETH J. ET AL. L.MULLER’S CLASSIFICATION SOLOMON. UK: ARNOLD. . 2010. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. TYPES OF FRACTURE R NETTER’S CONCISE ORTHOPAEDIC ANATOMY. LEG/KNEE . CHAPTER. 2ND EDITION. ray. FEEL. 2010. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. UK: ARNOLD. . MOVE (examine the good limb → the bad limb) Laboratory examination X. mechanism of trauma Physical examination LOOK. with AP and lateral view With rule of ‘2’: 2 view. 2 joint. 2 occasion. 2 limb. 2 injuries SOLOMON. ET AL. L.DIAGNOSIS Anamnesis History of illness. CLINICAL FEATURES Oedema Hematoma Tenderness at the fracture site Decreased range of motion at the ankle or knee Check neurovascular distal SOLOMON. . INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. UK: ARNOLD. 2010. ET AL. L. ET AL.GOALS OF FRACTURE MANAGEMENT SOLOMON. L. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. . UK: ARNOLD. 2010. UK: ARNOLD. 2010. L. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION.TREATMENT Conservative (Non-operative) Indication : • Closed fracture with minimal displacement • Children SOLOMON. ET AL. . • Compartment syndrome. • Neurovascular injury. UK: ARNOLD. • Open fractures. ET AL. L. SOLOMON. 2010. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION. • Major bone loss. .TREATMENT Operative The indications for operative : Definite: • Associated intra-articular and shaft fractures. INJURY’S OF THE KNEE AND LEG IN APLEY’S SYSTEM OF ORTHOPAEDICS AND FRACTURES 9TH EDITION.COMPLICATIONS Early complications Late complication Neurovascular injury Malunion. ET AL. delay union. L. non. UK: ARNOLD. . 2010.union Compartment syndrome Joint stiffness infection SOLOMON. THANK YOU .