CLOSED FRACTURE LEFT NECK FEMUR

Nurul ShafiniC 111 09 869

Mentorsdr. Wendelin Widia

dr. Fahroni Cahyono Winata

Supervisordr.Zulfan Oktasatria Siregar, Sp.OT

Orthopaedic and Traumatology DepartmentHasanuddin University

2014

PATIENT’S IDENTITY Name : Mr. DH Age : 60 years old Sex : Male RM : 560144 Date of admission : 24/09/2014

HISTORY Chief complaint: Pain of the left hip Since 7 weeks before admitted to the

Wahidin Sudirohusodo hospital Mechanism of trauma: patient was walking

then suddenly fell down at the left side of the hip due to slippery floor at the bathroom

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

Prior treatment at wahidin Hospital History of bone setter (+)

PRIMARY SURVEYA : Patent

B : RR 20 x/min, symmetric, spontaneous, abdominal type

C : BP 120/80 mm/Hg, HR 98/min, regular, strong

D : GCS 15, pupil isochor, pupil diameter 2.5mm/2.5mm, light reflex (+/+)

E : 36.7 C (axillary)

SECONDARY SURVEYRegio Left Hip JointLook : Deformity (+), swelling (-), haematom (-), wound (-)Feel : Tenderness (+),

Move

: Active and passive movement of Hip joint cannot be evaluated due to pain

NVD : Sensibility is good, pulsation of the dorsalis pedis artery is palpable.Capillary refill time <2 second

LEG LENGTH DISCREPANCYR L

ALL 83 cm 81 cmTLL 77 cm 75 cmLLD 2 cm

CLINICAL PICTURE

CLINICAL PICTURE

LABORATORY FINDINGS (20/04/2014)

WBC 9,3x103/mm3

RBC 4.97x106/mm3

HGB 15.7 g/dlHCT 43.4%PLT 245x103/mm3

Ureum 16 mg/dlCreatinin 0,80 mg/dl

SGOT 20 U/LSGPT 14 U/L

HBsAg Non reactiveCT 8’00”BT 3’00”

PELVIC X-RAY (23/09/2014)

Antero posterio/AP lateral view

DIAGNOSISClosed fracture left neck femur

TREATMENT IVFD Analgetik Immobilisasi Operation : Hemiarthoplasty

RESUME A man aged 60 years old came to Wahidin Sudiruhusodo

Hospital with chief complaint of pain at left hip, occurred since 7 weeks before admission. Mechanism of trauma: patient was walking then suddenly fell down at the left side of the hip due to slippery floor at the bathroom. Prior treatment at wahidin Hospital. History bone setter(+)

On physical examination, general status within normal limits. On regional examination of pelvic, there are deformity (+), tenderness (+), NVD within normal limits, CRT < 2”. Passive and active movement of left hip joint are limited due to pain.

On radiological examination, the result is fracture of the left neck femur.

Discussion

FRACTURE NECK FEMUR

MECHANISM OF INJURY Low energy trauma :

Fall by elderly person most common. High-energy trauma :

Motor vehicle accident

GARDEN’S CLASSIFICATIONI: Incomplete fracture; valgus impaction II: Complete Fracture : nondisplaced

III: Complete fracture, partial displacement (varus) IV: Complete fracture, total displacement

PAUWEL’S CLASSIFICATION

This is based on the angle of fracture from the horizontal

Type I : 30 degrees Type II : 50 degrees Type III : 70 degrees

CLINICAL MANIFESTATIONThere is usually a history of a fall,

followed by pain of the hip site.If the fracture is displaced, the

patient lies with the limb in lateral rotation and the leg looks short.

With an impacted fracture the patient may still be able to walk

MANAGEMENTOperative treatmentInternal FixationArthroplasty

By Use ProstheticHalf joint replacement arthroplastyTotal replacement arthroplasty

Internal Fixation Prosthetic replacement

COMPLICATIONSAvascular Necrosis of femoral head General complications : Venosus

Thrombosis, pulmonary emboly, pneumonia, decubitus ulcer.

NonunionOsteoarthritis

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