CASE REPORT

CASE REPORTBy:Fanny Ayu PermatasariC 111 09 259

Advisors:dr. M. Rustam Noertikadr. Syarif Hidayatullah

Supervisor:dr. Wilhelmus Supriyadi, Sp.OT

CLOSED COMMINUTIVE FRACTURE 1/3 MIDDLE RIGHT TIBIA CLOSED SEGMENTAL FRACTURE RIGHT FIBULADepartment of Orthopaedic dan TraumatologyFaculty of Medicine Hasanuddin University Makassar 2014

IDENTITYName : DAge: 56 years old / MaleAdmission : June 4th, 2014 at 18.00 Registration : 666521

HISTORY TAKINGChief Complain : pain at right leg- Anamnesis : suffered since 30 minutes before admitted to the hospital due to traffic accident.- Mechanism of trauma : The patient was crossing the street when suddenly hit by a motorcycle from the right side. - No history of unconscious, no history of nausea and vomit.PRIMARY SURVEYPatentARR 18x/min regular, spontaneous thoracoabdominal type, symmetricalBBP 120/70 mmHg HR = 84 x/min regular, strongC GCS 15 (E4V5M6), pupil isochors, : 2.5 mm/2.5 mm, light reflex +/+DT = 36,50 C (axillary) ERight leg region:I : Deformity (+), swelling (+), hematoma (+), wound (-) P : Tenderness (+) ROM : Active and passive movement of the knee and ankle joints are limited due to painNVD: Sensibility is good, pulsation of the dorsalis pedis & tibialis posterior arteries are palpable. Capillary refill time < 2SECONDARY SURVEY5CLINICAL PICTURES

LABORATORY FINDINGSWBC : 17,4 x 103 /mm3RBC : 4,15 x 106 /mm3 HGB : 12,6 g/dLHCT : 37 %PLT : 222 x 10 3 /mm3HbsAg Non ReactiveBT 2CT 6

7RADIOLOGICAL FINDINGSRigth Cruris X-Ray AP / Lateral View

RESUMEA male, 56 years old, was admitted to the hospital with chief complain pain at right leg due to traffic accident. On physical examination, I found deformity (+), swelling (+), hematoma (+), with tenderness. Active and passive movement of the knee and ankle joints are limited due to pain.On radiologic examination (right cruris X-Ray AP / Lateral view), there are comminutive fracture 1/3 middle right tibia and segmental fracture right fibula. DIAGNOSIS Closed comminutive fracture 1/3 middle right tibiaClosed segmental fracture right fibula

MANAGEMENTIVFD RLAnalgesicApply long leg back slab at right lower limbPlan for ORIF

11DISCUSSIONFRACTURE OF TIBIA AND FIBULA

INTRODUCTION A fracture is a break in the structural continuity of bone. Fractures of the tibia and fibula shaft are the most common long bone fractures. 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, liable to contamination and infection. Usually due to traffic accident & sports injury

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

ANATOMYNetters concise orthopaedic anatomy, 2nd edition, chapter, leg/knee

Netters concise orthopaedic anatomy, 2nd edition, chapter, leg/knee

Netters concise orthopaedic anatomy, 2nd edition, chapter, leg/knee MECHANISM OF INJURYSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

Spiral pattern (twisting)Short oblique pattern (compression)Triangular butterfly fragment (bending)Tranverse pattern (tension)In this patient had high energy trauma from direct hit in a motor vehicle accident which results in comminutive tibia fracture and segmental fibula fractureMECHANISM OF INJURYKoval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4th editionMULLERS CLASSIFICATION

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.TYPES OF FRACTURE

RNetters concise orthopaedic anatomy, 2nd edition, chapter, leg/knee AnamnesisHistory of illness, mechanism of trauma Physical examinationLOOK, FEEL, MOVE (examine the good limb the bad limb) Laboratory examination X- ray, with AP and lateral viewWith rule of 2: 2 view, 2 limb, 2 joint, 2 occasion, 2 injuriesDIAGNOSISSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.CLINICAL FEATURES Oedema Hematoma Tenderness at the fracture site Decreased range of motion at the ankle or knee Check neurovascular distalSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.GOALS OF FRACTURE MANAGEMENTSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.Conservative (Non-operative)Indication: Closed fracture with minimal displacement Children

TREATMENTSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.Operative The indications for operative :Definite:Associated intra-articular and shaft fractures. Open fractures. Major bone loss. Neurovascular injury. Compartment syndrome. TREATMENTSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.Early complications

Late complicationNeurovascular injuryMalunion, delay union, non- unionCompartment syndromeJoint stiffnessinfection

COMPLICATIONSSolomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.THANK YOU