case report fr femur and patella

7/30/2019 Case Report Fr Femur and Patella

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Closed Fracture 1/3 Distal of The Left Radius

and Left Ulna

Closed Fracture 1/3 Distal of The Right RadiusClosed Comminuted Fracture 1/3 Middle of the

Left Femur

Presented by :

Hasmia

Advisor

dr. Bennydr. Jacky

Supervisor

dr. M.Ruksal Saleh, Ph.D, Sp.OT


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Patient Identity

Name : Mr. E

Age : 16 years old

Sex : MaleAdmittance : 3rd July 2012

Address : Parigi, Maros

Occupation : Student RM number : 55 51 42


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History Taking

Chief complaint : wound at the left light Anamnesis : suffered since + 4 hours before

admitted to Wahidin Sudirohosodo hospitaldue to traffic accident.

Injury mechanism : He was riding amotocycle, and then hit the tree.

History of unconsciousness (-), nausea (-),vomit (-)

History of prior treatment at SoppengHospital


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A : Patent

B : RR = 20 x/min, simetris,

spontaneous, thoracoabdominal

type.

C : PR= 88 x/min regular, strong.

D : GCS 15 (E4V5M6), pupil isochors

2,5mm/2,5 mm, light reflex +/+

E : T = 36,5 0 C (axillar)

Primary Survey


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Secondary Survey

Right Antebrachii region :

I : Deformity (+), swelling (+), hematoma (-

),

wound (-)

P : Tenderness (+)

ROM :Active and passive motion at elbow and

wrist joints are limited due to pain.NVD : Sensibility is good , radial

artery pulse is palpable, capillary refill

time is


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Left Antebrachii region :

I : Deformity (+), swelling (+),hematoma (+), wound (-)

P : Tenderness (+)

ROM:Active and passive motion at elbowand wrist joints are limited due to pain.

NVD: Sensibility is good , radial

artery pulse is palpable, capillaryrefill

time is


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Femoral region :

I : Deformity (+), swelling (+), hematoma (-),wound (-)

P : Tenderness (+)

ROM:Active and passive motion at hip and knee

joints are limited due to pain.

NVD: Sensibility is good , dorsalis pedis

arterypulse is palpable, capillary refill time is


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Leg Length Discrepancy

R L

ALL 78 cm 77 cm

TLL 76 cm 75 cm

LLD 1 cm


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The Right Forearm


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The Left Forearm


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The Lower Limb


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WBC 8,92 x 103/uL

RBC 5,14 x 106/uL

HGB 14,9 g/dL

PLT 236 x 103 /uL

Ureum 16 mg/dl Creatinin 0,7 mg/dl

SGOT 20 u/l

SGPT 27 u/l

CT 800

BT 200

PT 12,7 control 13,6

APTT 22,2 control 26,3


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Radiological Findings

X-Ray AP/Lat

of The Right

Antebrachiu

m


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X-Ray AP/Latof The Left

Antebrachium


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X-Ray

AP/Lat ofLeft Femur


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Closed Fracture 1/3 Distal of the Left Radiusand Left Ulna

Closed Fracture 1/3 Distal of The Right

Radius Closed Comminuted Fracture 1/3 Middle of

The Left Femur


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Management

IVFD RL

Analgesic

Immobilization

Plan for ORIF


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Resume

A 13 years old with Deformity (+) edema

(+) and tenderness at the antebrachii region,limited active and passive motion of elbow and

wrist joint due to pain. Deformity (+) edema (+)

and tenderness at the femoral region andlimited active and passive motion of hip joint

and knee joint due to pain. Sensibility is good,

dorsalis pedis artery palpable, Capillary refill

time < 2. Radiological finding with distal

fracture of left radius and left ulna, distal

fracture of right radius, and comminuted

fracture of left femur shaft.


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The diagnosis are Closed Fracture 1/3distal of the Left Radius and Left Ulna,

Closed Fracture 1/3 distal of the right

Radius, and Closed comminutedfracture 1/3 middle of the Left Femur.


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Fracture in Pediatrics


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Distal Forearm Fracture in

Children


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Introduction

Fractures of the forearm is common inchildren, accounting for 30% to 40% of all

fractures in children.

Most forearm fractures occur in children olderthan 5 years. The location of the fracture

advances distally with increasing age of the

child, probably because of the anatomic

changes in the metaphyseal-diaphysealjunction that occur with maturity

The distal forearm is the site of 70% to 80% of

fractures of the radius and ulna.


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BONE ANATOMY IN CHILDREN

Bone in Children:

- Less mineralized.

- Have more vascularchannels than the

bones of adults.

- Periosteal is thick

- Elastis of ligament

- There are Growth

plate (physis)


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ANATOMY OF RADIUS ULNA


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MECHANISM OF INJURY

Indirect: The mechanism is a fall onto anoutstretched hand. Forearm rotation

determines the direction of angulation:

Pronation: flexion injury (dorsal angulation) Supination: extension injury (volar

angulation)

Direct: Direct trauma to the radial orulnar shaft.


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Classification of The Distal

Forearm Fractures Buckle or torus fracture

Greenstick fracture

Metaphyseal fracture

Physeal fracture

Galleazzi fracture


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Greenstick Fracture


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Buckle or Torus Fracture


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CLINICAL EVALUATION

Wrist deformity and displacement ofthe hand in relation to the wrist. The

wrist is typically swollen with

ecchymosis, tenderness, and painfulrange of motion.


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DIAGNOSIS

Anamnesis Physical examination

X- ray, with AP and lateral view


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MANAGEMENT

NonOperatif

Simple Closed

reduction

Immobilization

long arm casting

Operative

External Fixation

ORIF


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COMPLICATIONS

Malunion Re-fracture

Growth arrest

Peripheral nerve injury

Compartement syndrome

Non-union, cross union

Reflex sympathetic dystrophy.


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Femur Shaft

Fracture inChildren


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Introduction

Fracture of the femur are quite commonand are usually due to direct violence or

a fall from high.

Between 1 and 4 years of age, 30 % offemoral shaft fracture are attributed to

abuse.

In the adolescent age group, highvelocity motor vehicle accidents are

more often the mechanism of injury and

account for up to 90% of all femoral shaft

fractures.


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ANATOMY

OF

FEMUR

Muscles Compartment of the


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Femur

ANTERIOR COMPARTMENTMUSCLE ORIGIN INSERTION NERVE

Sartorius ASIS Prox. med. tibia

(pes anserius)

Femoral

Rectus

femoralis

1.AIIS2.Sup. acetab. rim

Patella/tibiatubercle

Femoral

Vastus

lateralis

Gtr. trochanter, lat.

linea aspera

Lat. patella/tibia

tubercle

Femoral

Vastus

intermedius

Proximal femoral

shaft

Patella/tibia

tubercle

Femoral

Vastus

medialis

Intertrochant. line,

med. linea aspera

Medial

patella/tibiatubercle

Femoral



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Femur

MEDIALCOMPARTMENT

MUSCLE ORIGIN INSERTION NERVE

Obturator

externus

Ischiopubic rami,

obturator memb

Piriformis fossa Obturator

Adductor

longus

Body of pubis

(inferior)

Linea aspera

(mid 1/3)

Obturator

Adductor

brevis

Body and inferior

pubic ramus

Pectineal line,

linea aspera

Obturator

Adductor

magnus

1.Pubic ramus

2. Isxhial tub.

Linea aspera,

add. tubercle

1.Obturator

2.Sciastic

Gracilis Body and inferiorpubic ramus

Prox. med. tibia(pes anserius)

Obturator

Pectineus Pectineal line of

pubis

Pectineal line of

femur

Femoral



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Femur

POSTERIOR COMPARTMENT

MUSCLE ORIGIN INSERTION NERVE

Semitendinosus Ischial

tubersity

Proximal medial

tibia (pes

anserius)

Sciastic

(tibial)

Semimembrano

sus

Ischial

tubersity

Posterior medial

tibial condyle

Sciastic

(tibial)

Biceps femoris :

Long head

Ischial

tubersity

Head of fibula Sciastic

(tibial)

Biceps femoris

:Short head

Linea aspera,

supracondylar

line

Fibula, lateral

tibia

Sciastic

(peroneal)


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Classification of Fracture

Descriptive Open versus closed

Level of fracture: proximal, middle, distal

third Fracture pattern: transverse, spiral, or

oblique

Comminuted, segmental or butterflyfragment

Angulation or rotation deformity

Displacement : shortening or translation

Stable


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Winquist & Hansen

Classification

Stable0 : No comminutionI : Minimal comminutionII : Comminuted > 50% of cortices intact

UnstableIII : Comminuted < 50% of cortices intactIV : Complete comminution, no intact cortex


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Mechanism of Injury

Direct trauma: Motor vehicle accident,pedestrian injury, fall, and child abuse

are causes.

Indirect trauma: Rotational injury. Pathologic fractures: Causes include

osteogenesis imperfecta, nonossifying

fibroma, bone cysts, and tumors.


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Clinical Evaluation

Patients with a history of high-energy injuryshould undergo full trauma evaluation as

indicated.

The presence of a femoral shaft fractureresults in an inability to ambulate, with

extreme pain, variable swelling, and variable

gross deformity.

A careful neurovascular examination is

essential.


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Radiologic Evaluation

Anteroposterior (AP)and lateral views of the

femur should be

obtained.

Radiographs of the hipand knee should be

obtained to rule out

associated injuries


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TreatmentGuideline Age

0 to 6 Months : Pavlik Harness

7 Months to 5 Years : Closed Reduction

with Spica Cast Application, Skin or

Skeletal Traction, Flexible Intramedullary

Rods.

6 to 10 Years : Open Reduction with

Flexible Rods.

11 Years to Skeletal Maturity : Flexible

Intramedullary Rodding, Submuscular

Plate Fixation, Rigid Intramedullary


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Complication

Common

Limb Length Inequality

Unacceptable Angulation

Rotational Deformities

Non-union and Delayed Union

Rare

Compartment Syndrome Infection

Inflamation

Vascular Injury


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case report fr femur and patella

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