8/9/2019 Case Report - Closed Fracture Middle of the R Femur-2
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Presented by:Zulkarnain Hasyim
Advisor :
dr. Arnold Darmawandr. Muhammad Arief Faisal
Supervisor:
dr. Petrus ohan! M."es!Sp #$
Orthopaedic and Traumatology Dept
Medical Faculty of Hasanuddin University
Makassar, 20!
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PATIENT IDENTITY
• Name : D
• Age :19 years old• Sex : Female
• Date of admittance : September 18th, !1"
• #$ : %81!&!
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HISTORY TAKING
"hief "omplaint# Pain at the right thigh
History of illnessSuffered since 3o minutes before admitted to thehospital due to traffic accident.
Mechanism of trauma#
Patient was ride a motorcycle and hit by anothermotor on the right side of the right thigh of thepatient
History of unconsciousness (-), nausea (-) vomiting (-)
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PRIMARY SURVEY
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SECONDARY SURVEY$O"%$&'(D )T%TU) #
Right femur region
&nspection# deformity (!), swelling (!) , haematoma (!), shortenedright lower limb compared to opposite, , wound (-)
*alpation# "enderness (!)
+OM# $ctive and passive motion of hip and %nee &oints are notevaluated due to pain.
-D# Sensibility is good, dorsalis pedis artery palpable and 'apillaryrefill time *
+ight $eft
$++
"++ /
++0 cm
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CLINICAL PICTURE (September 18TH,
2014
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CLINICAL PICTURE (September 18TH,
2014
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CLINICAL PICTURE (September 18TH,
2014
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LA!ORATORY "INDIN# 12' # !./00mm3
H2 # 4, mg5dl 62' # 3.7.5mm3
P+" # 3/4.5mm3
'" # 8*
2" # 38*
Hbs$g # non reactive
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$%RAY September 18TH, 2014
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RESUME9 $ female 47 years Suffered since 3o minutes before
admitted to the hospital due to traffic accident.
• :rom the physical e;amination vital sign is normal and atthe right femur
&nspection# deformity (!), swelling (!) , haematoma (!), shortened right lowerlimb compared to opposite, swelling (!), haematoma (!), wound (-)
*alpation# "enderness (!) +OM# $ctive and passive motion of hip and %nee &oints are can not be evaluated
due to pain. -D# Sensibility is good, dorsalis pedis artery palpable and 'apillary refill time
*
•
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DIA#NOSIS
9 'losed fracture 453 middle of the right femur
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MANA#EMENT
9 =>:0 6+
9 $nalgesic
9 $pply s%in traction 3 %g
9 Plan for ?6=:
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Femur )haft Fracture
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I&tr')*t+'&
9 "he femoral shaft is circumferentially
padded with large muscles.
9 $ femoral shaft fracture is a fracture of
the femoral diaphysis occurring between @ cmdistal to the lesser trochanter and
@ cm pro;imal to the adductor tubercle.
9 :racture patterns are clues to the type offorce that produced the brea%.
1' Solomon (o)is, *ar+ic Da-id, Nayagam Sel-ad)rai : Apley.s System of /rthopaedics and Fract)res 9th 0dition
' o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd edition'
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A&t'm- '. "em)r
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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'
8/9/2019 Case Report - Closed Fracture Middle of the R Femur-2
18/277hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'
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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st
edition'
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De.'rm+&/ m)*e .'r*e '&
te .em)r
o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd 0dition
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7hompson, on ' asic Science' ;n Netters oncise Atlas of /rthopedics Anatomy, 1st edition'
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Me*&+m '. I&3)r-
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PHYSICAL E$AMINATION
9 =nspection# deformity, swelling, hematoma.
9 Present with tenderness9 Decreased range of motion at the hip or knee,depending on the location of the fracture
9 A>0 evaluation
Solomon (o)is, *ar+ic Da-id, Nayagam Sel-ad)rai : Apley.s System of /rthopaedics and Fract)res 9th 0dition
7hompson, 2on ' Netter.s oncise /rthopaedics Anatomy nd 0dition
Hip
Flexion 0-120°
Extend 20-30 °
Abduct 40-50 °
Adduct 20-30 °
Internal
rotate
30 °
External
rotate
50 °
Knee
Flexion 125 - 135
°
Extend 5 - 15 °
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TREATMENT9 Aonoperative
S%in "raction
S%eletal traction 'asting
9 ?perative
=ntramedullary Aailing
B;ternal :i;ation Plate and Screw :i;ation
o-al, enneth 2'3 4)cerman, 2oseph D' 5andboo of Fract)res, 6rd 0dition
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COMPLICATION
Cenneth Coval, et al. Handboo% of fractures third edition. D. +ippincott 1illiams and wil%ins. ES$
9 Falunion
9 Aonunion
9 Fuscle wea%ness
9 ++0 ?vergrowth
Shortening
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THANK YOU
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