Case Presentation

February

2015

CLOSE FRACTURE NECK FEMUR

PRESENTED BY:
Fadilah Rezki Said
C 111 09 280
ADVISORS:
dr. Alfa Januar
dr. Fahroni
SUPERVISOR:
dr. Notinas Horas, M.Kes, Sp.OT

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY
HASANUDDIN UNIVERSITY
2015

IDENTITY
Name

: Mrs. M

Age

: 54 years old / Female

Admission : February 3rd, 2015 at 22:00

Registratio : 69 97 84
n
Status

: BPJS

AUTOANAMNESIS

Chief Complain : Pain at right thigh

Since 2 days ago before admitted to

Wahidin General Hospital due to traffic
accident. After that, patient cant walk.
Mechanism of trauma : Patient was being a
passenger and suddenly the motorcycle
stopped and the patient fell to the right
side with her right hip landed first.
History of loss of consciousness (-), vomit
(-).

GENERAL STATUS
SG: Composmentis / Well Nouris
BP

:120/80 mmHg

HR

: 82 x/min strong, regular

RR : 20 x/min, symetric,
thoracoabdominal type
T : 36,9 oC
NRS : 2

LOCALIS STATUS
Region Right Lower Extremity
Look : Deformity (+), swelling
(+),
hematome (+) and wound
(-).
Feel
: Tenderness (+)
Move :
Active
and
passive
movement of
hip joint and knee
joint are not
evaluated due to
pain
NVD: Sensibility is good , Capillary
Refill
Time < 2, pulsation of
dorsalis
pedis
artery
is
palpable.

LEG LENGTH DISCREPANCY

R

ALL

83 cm

85 cm

TLL

77 cm

79 cm

LLD

2 cm

CLINICAL
FINDINGS

CLINICAL FINDINGS

SUPPORTING
MODALITIES
LABORATORIUM
:
Pemeriksaan

Hasil

WBC

11.3 x 103

RBC

3.25 x 106

HB

11

HCT

33

PLT

316.000

GDS

110

Ureum

23

Kreatinin

GOT

23

GPT

11

Albumin

3.6

Na/K/Cl

138/3.4/101

CT/BT

800/300

HBsAg

Non reactive

RADIOLOGY
FINDINGS

X-RAY FINDING

AP PEVIC
Fracture
Neck
Femur
Dextra

 Right Femur
AP / Lateral
Fracture
Neck Femur
Dextra

MANAGEMENT
Intra Venous Fluid Drips Ringer
Lactat
Analgesic
Pre-operatif traction: Apply Skin
Traction right lower limb load 3
kg
Plan : Hemiarthoplasty

DIAGNOSIS

Closed Fracture Right Neck

Femur Garden Type III

DISCUSSION

INTRODUCTION

A fracture is a loss of
contuinuity of bone, joint
cartilage, epiphyseal
cartilage is both total or
parsial
Close fracture means the
fracture that does not
penetrate the skin

ANATOMY OF FEMUR

Thompson, Jon C. Netters Concise Orthopaedics Anatomy 2nd Edition

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

MECHANISM OF INJURY

Low-energy
trauma

Direct : Fall into Greater Trochanter (valgus

impaction)
Indirect : Muscle forces overwhelm the strength of
the femoral neck

High-energy
trauma

Younger and older, such a motor vehicle accident or

fall from a significant height

Cyclical
loading- stress
fractures

Athletes, military recruits, ballet dancers;

Patient with osteoporosis and osteopenia
particulary risk

Handbook of Fracture 3rd Edition.

are

CLINICAL FEATURES
Usually, there is
history of
trauma (a fall,
motorcycle
accident).
Pain in the hip,
worsened with
attempted ROM.
In displaced
fracture, patient
lies with the
injured limb in
Thompson,JD.
Netter's concise atlas
of orthopedic anatomy.2004.
shortened
and

CLASSIFICATION OF NECK FEMUR

FRACTURE
GARDEN
Type l

: Incomplete/valgus impacted

Type ll : Complete and nondisplaced on AP and lateral views

Type lll : Complete with partial displacement
Type IV : Completel fracture with total displaced

Handbook of Fracture 3rd Edition.

CLINICAL EVALUATION

Subtle findings:
anterior capsular tenderness
pain with axial compression
lack of deformity
maybe able to bear weight.

Pain is evident on attempted range of hip motion,

with pain on axial compression and tenderness to
palpation of the groin.

Obtaining a history of:

loss of consciousness
prior syncopal episodes
medical history, prior hip pain (pathologic fracture)
preinjury ambulatory status

Handbook of Fracture 3rd Edition.

EVIDENCE LEADING TO DIAGNOSIS

HISTORY TAKING
PHYSICAL EXAMINATION
ADDITIONAL EXAMINATION

TREATMENT
1. Internal fixation :
. Multiple screw fixation
. Three parallel screws
2. Prosthetic replacement
. Unipolar hemiarthroplasty
. bipolar hemiarthroplasty
. total hip replacement

COMPLICATION

General : vein thrombosis, pulmonari

embolism, pneumonia, decubitus

Avascular Necrosis of Head Femur

Non union

Ostheoartritis

Shortening of the extremity

Mal unioin

Mal rotation

THANK YOU