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CASE REPORT CLOSED FRACTURE 1/3 MIDDLE (R) FEMUR

By Zulkifli DamisC111 08 010

ADVISORdr. Umar Abdullah Alhadar

dr. Helmiyadi us!ardha"a

SU#$RVISORDr. %&'i"as H&ras( ). es. S*.O+

Or'h&*edi, a"d +rauma'&l&-ya,ul'y &f )edi,i"e Hasa"uddi" U"i/ersi'y

)akassar

01

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P"isy$a' E*a%ination

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Se$ondary S+r,eyFemur region (D)

I def&rmi'y ;:( s!elli"- 9:( !&u"d 9:( hema'&ma 9:.# 'e"der"ess 9: .RO) A,'i/e a"d *assi/e a' hi* a"d k"ee ?&i"'s arelimi'ed due '& def&rmi'y.

%VD Se"sibili'y is -&&d( *ulsa'i&" d&rsalis *edisar'ery is *al*able( CR+ is @ .

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C'ini$a' Pi$t+re

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Le! Len!t" Dis$re&an$y

R L

ALL 89cm 91 cmTLL 84 cm 86 cm

LLD 2 cm

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Radio'o!y Findin!

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Radio'o!y Findin!

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La-oratory #indin!sBC 5(50 > 10 7 3u

RBC (E2 > 10 6 3uH

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Dia!nose

Neglected Closed fracture 1/3 middle(R) femur.

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Mana!e%ent

Plan ORIF

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Res+%eA male( 2 years &ld ,ame '& ahidi" H&s*i'al !i'h ,hief

,&m*lai" lim*i"- -ai' a' ri-h' 'i-h'. +his ,&m*lai" has bee"suffered si",e 7 !eeks a-& due '& 'raffi, a,,ide"'. #a'ie"' is ridi"-m&'&r,y,le( a"d 'ha" ,rush a 'ree. His'&ry &f medi,i"e 9:( his'&ry

b&"e se''er ;:O" #hisi,al e>ami"a'i&"( her /i'al si-"s !ere s'able. O" 'he

ri-h' 'i-h' 'here are def&rmi'y ;:( S!elli"- 9:( 'e"der"ess 9:.O" G ray e>ami"a'i&" femur de>'ra A#3 a'erl Cl&sed

ra,'ure 137 middle femur D:G9ray e>ami"a'i&" #el/is A# %&rmal >9ray

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Dis$+ssion

FRACTURE SHAFT FEMUR

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Anato%y o# #e%+r

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M+s$'es Co%&art%ent o# t"e Fe%+r

A.TERIOR COMPARTME.T

MUSCLE ORIGIN INSERTION NERVE

Sartorius A I Pro!. med.ti"ia (#esanserius)

Femoral

Rectusfemoralis

1.AII$. u#. aceta".Rim

Patella/ti"iatu"ercle

Femoral

Vastuslateralis

%tr. troc&anter'lat. lineaas#era

at.#atella/ti"iatu"ercle

Femoral

Vastusintermedius

Pro!imalfemoral s&aft

Patella/ti"iatu"ercle

Femoral

Vastusmedialis

Intertroc&ant.line' med. lineaas#era

edial#atella/ti"iatu"ercle

Femoral

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M+s$'es Co%&art%ent o# t"e Fe%+r

MEDIAL COMPARTME.T

MUSCLE ORIGIN INSERTION NERVE

Obturatorexternu

s

Isc&io#u"icrami' o"turatormem"

Piriformis fossa O"turator

Adductor lon us

*od+ of #u"is(inferior)

inea as#era(mid 1/3)

O"turator

Adductor bre!is

*od+ andinferior #u"icramus

Pectineal line'linea as#era

O"turator

Adductorma nus

1.Pu"ic ramus$. Is!&ial tu".

inea as#era'add. tu"ercle

1.O"turator

$. ciastic

Gracilis *od+ andinferior #u"icramus

Pro!. med.ti"ia (#esanserius)

O"turator

"ectineus

Pectineal lineof #u"is

Pectineal lineof femur

Femoral

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M+s$'es Co%&art%ent o# t"e Fe%+r

POSTERIOR COMPARTME.T

MUSCLE ORIGIN INSERTION NERVE

Semitendinos

us

Isc&ial

tu"ersit+

Pro!imal

medial ti"ia(#es anserius)

ciastic

(ti"ial)

Semimembranosus

Isc&ialtu"ersit+

Posteriormedial ti"ialcond+le

ciastic(ti"ial)

#ice$sfemoris %Lon &ead

Isc&ialtu"ersit+

,ead of -"ula ciastic(ti"ial)

#ice$sfemoris%S&ort &ead

ineaas#era'su#racond+lar line

Fi"ula' lateralti"ia

ciastic(#eroneal

)

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C'assi#i$ation o# Fra$t+reDes$ri&ti,e

O#en / closede el of fracture #ro!imal' middle' distal

Fracture #attern trans erse' s#iral' or

o"li0ueComminuted' segmental or "utter +fragmentAngulation or rotation deformit+Dis#lacement s&ortening or translation

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in0+ist Hansen C'assi#i$ation

ta"le2 No comminutionI inimal comminutionII Comminuted 425 of cortices intact

6nsta"leIII Comminuted 7 425 of cortices intactI8 Com#lete comminution' no intactcorte!

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Me$"anis% o# In2+ry Trauma % &ig&9energ+ trauma from motore&icle accident' guns&ot in:ur+' or fall from a

&eig&t.

"at&olo ic fractures % ;ea< meta#&+seal9dia#&+seal :unction in t&e elderl+

Stress fractures % in militar+ recruits or

runners.

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C'ini$a' E,a'+ationVariable -r&ss def&rmi'y( sh&r'e"i"- &f 'heaffe,'ed e>'remi'y.

A ,areful "eur&/as,ular e>ami"a'i&" is esse"'ial.

$>ami"a'i&" &f 'he i*sila'eral hi* a"d k"ee sh&uld be *erf&rmed( i",ludi"- sys'emi, i"fe,'i&" a"d *al*a'i&".

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Treat%ent Conser,ati,e

Ski" +ra,'i&" imi'ed f&r,e ,a" be a**lied 9 -e"erally "&' '& e>,eed 2

lbs

)&re ,&mm&"ly used i" *edia'ri, *a'ie"'s Ca" ,ause s&f' 'issue *r&blems es*e,ially i" elderly &r

rheuma'&id *a'ie"'s %&' as *&!erful !he" used duri"- &*era'i/e *r&,edure

f&r b&'h le"-'h &r r&'a'i&"al ,&"'r&l

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Treat%ent O&erati,eIndication %

ulti#le trauma' including &ead traumaO#en fracture

8ascular in:ur+Pat&ological fracture6ncoo#erati e #atientFail to conser ati e treatment

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Co%&'i$ationsEarly Late

1. Fat embolism 1. Delayed union and non-union

2. T romboembolism 2. !al union". # oc$ ". %oint sti&&ness

4. Re&racture and im'lant &ailure

(. )n&ection

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THANK YOU