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CLOSE FRACTURE1/3 MIDDLE LEFT HUMERUS
By
Icha Marissa Sofyan
(C 111 08 318)
Advisor
dr. Lutfi
dr. Dhedi P.sam
Supervisor
dr. JAINAL ARIFIN, M. KES, SP.OT (K)
DEPARTMENT OF ORTHOPAEDIC AND TRAUMATOLOGY
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
MAKASSAR2013
Case Report
July 2013
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General Status
Moderate illnes/Wellnourished/Composmentis
Vital SignsT : 130/70 mmHg
N : 82x/minutes, reguler
P : 20x/minutes, simetris, spontan, tipethoracolabdominal
S : 37,3 c
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LOCALIZED STATUSLeft Upper Arm Region
Look: deformity (+), swelling (+), hematoma (-),
open wound (-)Feel: tenderness (+)
ROM: Active and passive motion of shoulder
elbow joint limited due to painNVD: Sensibility is good, radialis artery palpable,
capillary refill time
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Clinical Pictures
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Radiologic Findings
AP and lateral
radiograph of upper
arm
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Laboratory Findings
Leukocyte 15,0 103/L 4,0-10.0
Eritrocyte 4,57 103
/L 4,0-6,0Hemoglobin 14,4 g/dL 12,0-16,0
Hematocrit 43,9% 37,0-48,0
Trombocyte 411 103
/L 150-400MCV 96,0 fl 80-97
MCH 31,4 pg 26,5-33,5
MCHC 32,7g/dL 31,5-35,0
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Laboratory Findings
Na+ 145 mmol/L 136-145
K+ 4,2 mmol/L 3,5-5,1Cl- 110 mmol/L 97-111
GDS 103 mg/dL
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Diagnosis
Closed fracture 1/3 middle left humerus
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Management
Immobilization
Analgetics
apply U slab
Plan ORIF
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DISCUSSIONFracture of Shaft Humerus
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EPIDEMIOLOGY
Common injury, representing 3% to 5% of all
fractures.
Brinker et al
mean age 28.9 years 13.1 per 100,000
persons per year.
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
Bucholz, Robert W.; Heckman, James D.; Court-Brown, Charles M. Rockwood & Green's Fractures in
Adults, 6th Edition. 2006
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ANATOMY (1)
Putz R. and Pabs R. Sobotta Atlas of Human Anatomy. Volume 1 Head, Neck, Upper Limb. 2006
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ANATOMI (3)
Thompson JC. Arm. In: Netters Concise Orthopaedic Anatomy. Second edition.
muscle : brachialis,biceps brachii, dancoracobrachialis.
Neurovascular :brachial a.,musculocutaneus n.,media n., and radial n
Anterior
compartments:
muscle : tricepsbrachii.
Neurovascular : radial
n.and ulnar n.,radialrecurrent arteries
Posterior
compartments:
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AO Clasificcation
W.M MURPHY , D. LEU. In AO PRINPCLES Of FRACTURE MANAGEMENT. EDITION 2000
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CLASSIFICATION
Open vs. closed.
Location: proximal third, middle third, distal
third.
Degree: nondisplaced, displaced.
Direction and character: transverse, oblique,
spiral, segmental, comminuted.
Articular extension.
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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MECHANISM OF INJURY (2)
Fracture pattern depends on the type of force applied:
Compressive: proximal or distal humeral fractures
Bending: transverse fractures of the humeral shaft
Torsional: spiral fractures of the humeral shaft Torsional and bending: oblique fracture, often
accompanied by a butterfly fragment
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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CLINICAL EVALUATION
pain, swelling, deformity, and shortening
neurovascular examination
radial nerve function
compartment pressures
instability
Soft tissue abrasions and minor lacerationsmust be differentiated from open fractures.
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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RADIOLOGICAL EXAMINATION
The site of the fracture,its line (transverse,
spiral or comminuted)
and any displacement
are readily seen.
The possibility that the
fracture may be
pathological should beremembered.
Solomon L, Warwick DJ, Nagayam S. Apley's system of orthopaedics and fractures2001.
Closed transverse fracture with moderate displacement.
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TREATMENT (1)
Humeral
Fracture
NonOperative
Operative
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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TREATMENT (3)
OPERATIVE Indications are:
Multiple trauma
Inadequate closed
reduction orunacceptable malunion
Pathologic fracture
Associated vascular injury
Floating elbow
Segmental fracture
Intraarticular extension
Bilateral humeral
fractures
Open fracture
Neurologic loss
following penetrating
trauma
Radial nerve palsy after
fracture manipulation
(controversial)
Nonunion
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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TREATMENT (4)
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
Operative
OPEN REDUCTION AND PLATE FIXATION INTRAMEDULLARY FIXATION EXTERNAL FIXATION
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TREATMENT (5)
Fractured humerus and other methods of fixation. (a,b) Compression plating, and
(c,d,e) external fixation.
Solomon L, Warwick DJ, Nagayam S. Apley's system of orthopaedics and fractures2001.
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Postoperative Rehabilitation
Range-of-motion exercises for the hand and
wrist should be started immediately after
surgery; shoulder and elbow range of motion
should be instituted as pain subsides.
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition 2006
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Thankyou
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Radiologic ORIF