Fraktur Humerus Sepertiga Distal

8/11/2019 Fraktur Humerus Sepertiga Distal

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Arsyi Adliah Anwar

C11109266

Advisor :

dr. Helmiyadi Kuswardhana

dr. Wendelin

Supervisor :

dr. M. Ruksal Saleh, Ph.D, Sp.OT (K)

Closed Fracture One third Distal

of The Left Humerus

CASE REPORT

Department of Orthopaedic and Traumatology

Faculty of Medicine Hasanuddin University 2013


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Patient Identity

Name : G

Gender : Boy

Date of birth : June 11th2011

Medical Record : 635528

Date of admission : November 4th2013


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History Taking

Chief Complaint: Pain at left arm

suffered since 10 hours before admission to the hospital

after got a traffic accident.

Mechanism of trauma :

The patient was walking at roadside when suddenly got

hit by a car from the back and the patient fell on the

asphalt with the left side of the body.

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

Prior treatment in Hospital of Barru.


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Primary Survey

Airway

Patent, clear

Breathing

Spontaneous, symmetric, thoracoabdominal type

RR : 22x/minute

Circulation

BP : 90/60 mmHg

HR : 88x/minute, regular, adequate

Disability

GCS 15 (E4M6V5), pupils isochoric 2,5mm /2,5 mm, LR +/+

Environment

Temperature 36,8o

C

Physical

Examination


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Head and neck region : No abnormality was found

Thoracal region : No abnormality was found

Abdominal Region : No abnormality was found

Back Region : No abnormality was found

Urogenitalia region : No abnormality was found

Upper extremity Region

Lower Extremity Region : No abnormality was found

Physical Examination

Secondary Survey


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Upper Extremity

Left arm region

Inspection : multiple excoriation wounds on posterolateral of

hand, deformity (+), Swelling (+), hematoma (+)

Palpation : Tenderness (+)ROM : active and passive motion of shoulder joints could not be

examined due to pain. Active and passive motion of elbow

joints could not be examined due to pain..

NVD :sensibility is difficult to be identified, radial artery is

palpable, Capillary Refill Time


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Additional Examination


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TEST RESULT

WBC 18,69 x 103/uL

RBC 3,26 x 106 /uL

HGB 9,6 mg/dL

HCT 26,5 %

PLT 169 x 103/Ul

GDS 92

GOT 54 U/LGPT 20 U/L

Ureum 26 mg/dL

Creatinine 0,4 %

HbsAg Negative

Additional Examination


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A 2 years old boy admitted with pain at the left arm suffered

since 10 hours ago due to traffic accident. The patient was

walking at roadside and got hit by a car from the back and the

patient fell to the left side.

On physical examination of the left arm region was found

ultiple excoriation wounds, deformity, swelling and hematoma,

with tenderness. Active and passive motion of shoulder and elbow

joints couldntbe examined due to uncooperative patient.

On radiological imaging there was a closed fracture at the

one-third distal of the left humerus.

Resume


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CLOSED FRACTURE ONE

-THIRD

DISTAL OF THE LEFT HUMERUS

Diagnosis


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Analgesic

Apply slab

Plan for ORIF

Treatment


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Discussion


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Fracture is a break in the

structural continuity of

bone

Fracture of the humeral

shaft is 10% of all

humeral fractures in

children and 2-5.4% of all

childrensfracture

shaft

Proximal

Distal


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Direct

Direct blow to the arm

Transverse/comminuted

fracture

Indirect

A fall on an outstrechedarm

Spiral/oblique fracture


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HistoryTaking

PhysicalExamination

X-rayImaging


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ANAMNESIS

Chief complaint

Mechanism of injury

Prior Treatment

IMAGING

X-ray examination

PHYSICAL EXAMINATION

Inspection

Palpation

Range of motion

Neurovascular Distal


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Non Operative

Cast immobilization

Sling immobilization

Coaptation splint

Shoulder spica cast

Functional bracing


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INDICATION FOR SURGERY

Multiple fracture

Inadequate closed reduction

Open fracture

Segmental fracture

Bilateral humeral fracture

Displaced intra-articular

extension of the fracture

Neurovascular compromise

Unstable fracture fragment


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SURGICAL TECHNIQUES

Open Reduction and Plate Fixation

Percutaneous Pinning

External Fixation


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Thank You

Documents

Fraktur Humerus Sepertiga Distal