Case Presentation February

2015

CLOSE FRACTURE NECK FEMUR

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY

HASANUDDIN UNIVERSITY

2015

PRESENTED BY:Fadilah Rezki Said

C 111 09 280

ADVISORS:dr. Alfa Januar

dr. Fahroni

SUPERVISOR:dr. Notinas Horas, M.Kes,

Sp.OT

IDENTITYName : Mrs. M

Age : 54 years old / Female

Admission : February 3rd, 2015 at 22:00

Registratio

n

: 69 97 84

Status : BPJS

AUTOANAMNESIS

Chief Complain : Pain at right thigh Since 2 days ago before admitted to

Wahidin General Hospital due to traffic accident. After that, patient can’t walk.

Mechanism of trauma : Patient was being a passenger and suddenly the motorcycle stopped and the patient fell to the right side with her right hip landed first.

History of loss of consciousness (-), vomit (-).

GENERAL STATUS

SG : Composmentis / Well Nouris

BP :120/80 mmHg

HR : 82 x/min strong, regular

RR : 20 x/min, symetric, thoracoabdominal type

T : 36,9 oC

NRS : 2

LOCALIS STATUS

Region Right Lower Extremity

Look : Deformity (+), swelling (+), hematome (+) and wound (-).

Feel : Tenderness (+)

Move : Active and passive movement of hip joint and knee joint are not evaluated due to pain

NVD: Sensibility is good , Capillary Refill Time < 2”, pulsation of dorsalis pedis artery is palpable.

LEG LENGTH DISCREPANCY

R L

ALL 83 cm 85 cm

TLL 77 cm 79 cm

LLD 2 cm

CLINICAL FINDINGS

CLINICAL FINDINGS

SUPPORTING MODALITIESLABORATORIUM :

Pemeriksaan Hasil

WBC 11.3 x 103

RBC 3.25 x 106

HB 11

HCT 33

PLT 316.000

GDS 110

Ureum 23

Kreatinin 1

GOT 23

GPT 11

Albumin 3.6

Na/K/Cl 138/3.4/101

CT/BT 8’00”/3’00”

HBsAg Non reactive

RADIOLOGY FINDINGS

X-RAY FINDING

• AP PEVIC• Fracture

Neck Femur Dextra

• Right Femur AP / Lateral

• Fracture Neck Femur Dextra

• Intra Venous Fluid Drips Ringer Lactat

• Analgesic• Pre-operatif traction: Apply Skin

Traction right lower limb load 3 kg

• Plan : Hemiarthoplasty

MANAGEMENT

DIAGNOSIS

Closed Fracture Right Neck Femur Garden Type III

DISCUSSION

INTRODUCTION

• A fracture is a loss of contuinuity of bone, joint cartilage, epiphyseal cartilage is both total or parsial

• Close fracture means the fracture that does not penetrate the skin

ANATOMY OF FEMUR

Thompson, Jon C. Netter’s Concise Orthopaedics Anatomy 2nd Edition

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

MECHANISM OF INJURY

• Direct : Fall into Greater Trochanter (valgus impaction)

• Indirect : Muscle forces overwhelm the strength of the femoral neck

Low-energy trauma

• Younger and older, such a motor vehicle accident or fall from a significant height

High-energy trauma

• Athletes, military recruits, ballet dancers;• Patient with osteoporosis and osteopenia are particulary risk

Cyclical loading- stress

fractures

Handbook of Fracture 3rd Edition.

CLINICAL FEATURESUsually, there is

history of trauma (a fall, motorcycle accident).

Pain in the hip, worsened with attempted ROM.

In displaced fracture, patient lies with the injured limb in shortened and externally rotated.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

CLASSIFICATION OF NECK FEMUR FRACTUREGARDEN

Type l : Incomplete/valgus impacted

Type ll : Complete and nondisplaced on AP and lateral views

Type lll : Complete with partial displacement

Type IV : Completel fracture with total displaced

Handbook of Fracture 3rd Edition.

CLINICAL EVALUATION

• Subtle findings: • anterior capsular tenderness• pain with axial compression• lack of deformity• maybe able to bear weight.

• Pain is evident on attempted range of hip motion, with pain on axial compression and tenderness to palpation of the groin.

• Obtaining a history of:• loss of consciousness• prior syncopal episodes• medical history, prior hip pain (pathologic fracture)• preinjury ambulatory status

Handbook of Fracture 3rd Edition.

EVIDENCE LEADING TO DIAGNOSIS

HISTORY TAKING

PHYSICAL EXAMINATION

ADDITIONAL EXAMINATION

1. Internal fixation : Multiple screw fixation Three parallel screws

2. Prosthetic replacement Unipolar hemiarthroplasty bipolar hemiarthroplasty total hip replacement

TREATMENT

COMPLICATION

• General : vein thrombosis, pulmonari embolism, pneumonia, decubitus

• Avascular Necrosis of Head Femur

• Non union

• Ostheoartritis

• Shortening of the extremity

• Mal unioin

• Mal rotation