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7/25/2019 Slide Ortho Tibia and Fibula PPT
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PATIENT IDENTITY
Name : B
Age : 44 years old
Sex : Male
Date of Admission:August 23rd, 2015 at16.30
RM number : 723290
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HISTORY TAKING
Chief Complaint:Pain at right leg
Suffered since 22 hours before being admitted toWahidin General Hospital
Patient was riding a motorcycle when he fell down
due to loss of balancePatients right leg first came into contact with theground.
Vomitting (-) nausea (-)Prior treatment : Pangkep Hospital
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PRIMARY SURVEY
Airway :Clear
Breathing:RR = 20x/min, regular, spontaneous,
thoracoabdominal type, symmetrical.
Circulation:BP = 120/70 mmHg,HR = 80 x/min regular,strong.
Disability :GCS 15 (E4V5M6),isochoric pupil, : 2,5 mm,light reflex +/+
Exposure :T = 36,70C (axilla)
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SECONDARY SURVEY
Localized status :
Right Leg region
Look:Deformity (+), swelling (+), hematoma (+),Wound (-)
Feel :tenderness (+)
Move:Active and passive motions of the knee arelimited due to pain
Active and passive motions of the ankle arelimited due to pain
NVD :Good sensibility, dorsalis pedis and tibialisanterior pulses are palpable, CRT
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CLINICAL FINDINGS
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LEG LENGTH DISCREPANCY
Right Left
ALL 86 87
TLL 82 83
LLD 1 cm
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LABORATORY FINDINGS
WBC : 15.400/ ulRBC : 5.000.000/ ul
HBG : 14.7 g/dl
HCT : 43 %
PLT : 233.000/mm3
CT : 730
BT : 230
HBsAg : Non reactive
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X-RAY RIGHT CRURIS
AP View Lateral View
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DIAGNOSIS
Closed fracture 1/3 distal right tibia
Closed fracture 1/3 distal right fibula
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MANAGEMENT
IVFD RL
Analgesic
Report to Orthopaedic senior, advice:Apply boot slab left lower limb
Plan for ORIF Tibia & Fibula
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RESUME
A Boy 44 years old came to the hospital with chiefcomplaint pain at the left leg,sufered since 22 hoursbeore admitted to Hospital.
At the anterolateral aspect, there is haematom and edema.The
region was tenderness on palpation, with unknown active and
passive motion of knee joint and ankle joint due to pain.
Sensibility is good and dorsalispedis artery is palpable, !T "#$ .
laboratory findings are within normal limit, From radiology finding (X-Ray cruris dextra AP/Lateral)
there is closed fracture 1/3 distal of right tibia and fibula.
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Discussion
7/25/2019 Slide Ortho Tibia and Fibula PPT
13/25Thompson, J.Netters Concise Orthopaedic Anatomy, 2ndEd. Elsevier Saunders, 2010.
TIBIA AND
FIBULA
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14/25NETTERS CONCISE ORTHOPAEDIC ANATOMY, P. 316
7/25/2019 Slide Ortho Tibia and Fibula PPT
15/25NETTERS CONCISE ORTHOPAEDIC ANATOMY, P. 317
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NETTERS CONCISE ORTHOPAEDIC ANATOMY, P.318
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TYPES OF FRACTURES
Thompson, J.Netters Concise Orthopaedic Anatomy, 2ndEd. Elsevier Saunders, 2010.
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Diagnosis Clinical features
Anamnesis Physical examination
X- ray, with anteriorposterior and lateral view
Laboratory examination
Oedema
Hematoma
Tenderness at the fracture
site. Decreased range of motion
at the ankle or knee,
depending on the location
of the fracture
If fracture is displaced, adeformity may be noted
Appleys . Sistem Of orthopaedis & fracture,8thedition.
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TSCHERNES CLASSIFICATION OF SKIN
LESION IN CLOSED FRACTURES
Grade 0 Injury from indirect forces with negligible soft tissue
damage
Grade I Closed fracture caused by low-moderate energy
mechanisms, with superficial abrasions or contusions ofsoft tissues overlying the fracture
Grade II Closed fracture with significant muscle contusion, with
possible deep, contaminated skin abrasions associated with
moderate to severe energy mechanisms and skeletal injury;
high risk for compartment syndrome
Grade III Extensive crushing of soft tissues, with subcutaneous
degloving or avulsion, with arterial disruption or
established compartment syndrome
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TREATMENT
Conservative
Closed reduction
Apply long leg cast
Functional bracing with Early weight-bearing
Pain medication if needed
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TREATMENT
Operative Internal Fixation
External Fixation
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DEFINITIVE TREATMENT
Open Reduction Internal FixationIndication of ORIF in this patient is :
ORIF Tibia
Acceptable fracture reduction is not indicated anymore inthis patient
ORIF FibulaTheres fracture at 3 cm from syndesmosis at X-Rayfindings
AdvantageAdequate reduction
Early movementDisadvantage
Increase risk of infection, skin problemA high degree of surgical technique and facilities areessential
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COMPLICATIONS
Early complications Late complication
Neurovascular injury Malunion, delay union, non-
union
Compartment syndrome Joint stiffness
infection
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