140612_case Report Orto_tibial Shaft Fracture...Ppt

8/10/2019 140612_case Report Orto_tibial Shaft Fracture...Ppt..

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CLOSED FRACTURE 1/3 DISTAL LEFT TIBIACLOSED FRACTURE 1/3 DISTAL LEFT FIBULA

Presented By:HELDA

c1110727

Advisors:

Dr. Hendra HermantoDr. Aries Freddy Hutabarat

Supervisor:Dr. M. Ruksal Saleh, PhD, SpOT(K)

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENTMEDICAL FACULTY

HASANUDDIN UNIVERSITY2014


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PATIENT IDENTITY

Name : Mr.B

Age : 23 years old / Male

Admission : June 1 st, 2014 at 10.00

Registration : 665944


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AUTOANAMNESIS

Suffered since 2 weeks before admitted to Wahidin

General Hospital due to traffic accident.Patient was crossing, the street and suddenly get hit by a high-velocity motorcycle.History of unconscious (+), vomit (-), nausea (-)

History of prior treatment at Kaimana Hospital, westPapua.

No histrory of going to bonesetter (-)

Chief Complain : pain at the left leg


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GENERAL STATE

General Appearance :Conscious/ Well NourishedVital sign VAS : 2/10 Blood pressure : 120/80 mmHg Heart rate : 80x/min regular, strong

Respiratory rate : 18x/min, spontaneous,thoracoabdominal Temperature : 36 o C (axilla)


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LOCAL STATELeft Leg Region

I : Excoriated wound at lateral left distal aspectsize 2x1cm. Deformity (+), minimal swelling

(+), hematoma (+)P : Tenderness (+)RoM : Active and passive motion on knee and ankle joints

cannot be evaluated due to painNVD : Sensibility is good, pulsation ofdorsalis pedis artery was palpable, CRT < 2


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Leg Length Discrepencies

Right Left

ALL 97 cm 96 cm

TLL 88 cm 87 cm

LLD 1 cm


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CLINICAL FINDING


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LABORATORY FINDINGWBC 10.9 10 3/mm 3 RBC 6.27 10 6/mm 3 HGB 13.9 g/dLHCT 42.7 %PLT 253 10 3/mm 3 HbsAg ReactiveBT 3 CT 8


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RADIOLOGY FINDING


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RESUMEMale, 23 years old came to Wahidin Hospital with

pain on the left leg suffered 2 weeks before admitteddue to traffic accident.

There is deformity (+) on the left leg withexcoriated wound at lateral distal aspect. Tenderness(+). NVD is good. ROM cant be evaluated. TheLLD shows 1 cm.

Radiologic shows comminuted fracture 1/3 distalof the left tibia and fibula.


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DIAGNOSIS

Closed fracture 1/3 distal left tibia

Closed fracture 1/3 distal left fibula


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MANAGEMENT

IVFDAnalgesic

Apply long leg back slab of the left lower limbPlan for Operative treatment (Open reductioninternal fixation)


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DISCUSSION


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Anamnesis

Hit by a high-velocity motorcycle highenergy trauma

2 weeks already Soft callus formation Compartment syndrome risk

No history of bone setter treatment moresoft tissue damage


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Physical Examination

Excoriated wound mild soft tissue injury(Tscherne grade I)

Deformity Anterior angulation Shortening (LLD=1cm)


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Grade 0 Injury from indirect forces with negligible soft tissue damage

Grade I Closed fracture caused by low-moderate energy mechanisms, withsuperficial abrasions or contusions of soft tissues overlying thefracture

Grade II Closed fracture with significant muscle contusion, with possibledeep, contaminated skin abrasions associated with moderate tosevere energy mechanisms and skeletal injury; high risk forcompartment syndrome

Grade III Extensive crushing of soft tissues, with subcutaneous degloving oravulsion, with arterial disruption or established compartmentsyndrome

Koval, Kenneth J, Zuckerman, Joseph D. Tibia fibula shaft. In: Handbook of fractures. 3rd Edition. USA:Lippincott Williams & Wilkins; 2006. p.470

Tschernes Classification of skin

lesion in closed fractures


17/23

Radiologic finding

Fracture pattern Comminuted type unstable Fibular fracture as level as tibial fracture high-energy trauma associated injury?

Lateral view : Anterior angulation = 5 AP view : Lateral/valgus angulation = 3

Cortical contact : 0-25%


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Management

NonoperativeAcceptable Fracture Reduction

5varus/valgus angulation

10 anterior/posterior angulation10 degrees of rotational deformityMore than 50% cortical contact

Koval, Kenneth J, Zuckerman, Joseph D. Tibia fibula shaft. In: Handbook of fractures. 3rd Edition. USA:Lippincott Williams & Wilkins; 2006.p.471


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Management

Operative Unstable fracture

Associated intra-articular and shaft fractures Open fractures Major bone loss Neurovascular injury Compartment syndrome


20/23

Management

Conservative Operative

Active pts

Unstablefracture

5 angulationdeformity

1cm LLD


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Management

Conservative

Immobilization( full-length cast)

Operative

ORIF( Plate and screw,

Intramedullarynailling)


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Complications

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and Fractures

9th Edition. UK: Arnold. 2010.

Early complications Late complication

Neurovascular injury Malunion, delayedunion, non- union

Compartmentsyndrome

Joint stiffness

Infection


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140612_case Report Orto_tibial Shaft Fracture...Ppt