CASE REPORT

MARCH 2016

Orthopaedic and Traumatology

Department
Medical Faculty of Hasanuddin
University
Makassar

DISLOCATION OF SHOULDER
AZRIN
Advisor :
dr. Ahmad Rizan
dr. Andiks
Supervisor :
dr. Supriadi Sp.OT

PATIENT IDENTITY
Name : Mr. Y
Number Register : 748823
Sex : Male
Age : 74 years old
Date of Admission

: March 9th , 2016

HISTORY TAKING
(HETEROANAMNESIS)

Chief Complain : Dyspneu and pain on

the right shoulder

Suffered since 12 hour before admitted to

Wahidin Hospital
Mechanism of Trauma : The patient was
slipped and fell down from 5 metres tree in
pronate position (with right side come first
to the ground) and hit the stone on right
chest.
No history of headache, nausea, vomiting
and unconsciousness prior to fall
After falling, patient is taken to the
Janeponto Hospital and patient was consult
to
Wahidin
hospital
for
further
intervention.

No history of shortness of breath

No history of long cough
No history of respiratory infection
No history of tuberculosis drug taken
No history of HHD and DM
No history of numbness, cramps, and limb weakness
No history of backpain

Prior treatment : Janeponto Hospital for 4 hours

GENERAL STATUS
General condition: wellnourished, compos mentis
(GCS 15)
Vital signs

:BP = 130/80 mmHg;

HR = 90x/minutes, reguler, palpable

RR = 28x/minute
T
NRS

=36,5
:8/10

LOCAL REGION
Right Shoulder region
Look

: Deformity (+), swelling (+), hematoma

(-), wound (-)
Feel : Tenderness (+)
Move : Active and pasive motion of shoulder
cannot be evaluated due to pain
NVD : Sensibility is good, pulsation of radial
artery is palpable, capillary refill time
< 2

Thorax region
Look : asymetrical right and left chest
Feel : vocal fremitus on the right chest reduce,
Tenderness (+) on the CV Th. III,IV, V,VI
Percussion : hypersonor on the right lung
Auscultation :vesicular on the right lung

RIGHT UPPER LIMB LENGTH

DISCREPANCY

ALL
TLL
LLD

R
55 cm
50 cm

L
56 cm
51 cm
1 cm

CLINICAL FINDINGS

ANTERIOR

CLINICAL FINDINGS

LATERAL

MEDIAL

LABORATORY FINDINGS
Result

Normal Level

WBC

17,26

4,00-10,0

RBC

4,31

4,50-6,50

HGB

12,1

14,0-18,0

HCT

35.2%

40,0-54,0

PLT

288

150-400

PT

10.0

10-14

APTT

27.2

22.0-30.0

HBsAg

Non Reactive

Non Reactive

FRACTUR
E

RADIOLOGICAL
IMAGING
Pelvis AP (19/02/2016)

FRACTUR
E

RADIOLOGICAL
IMAGING
Right Femur AP/Lat (19/02/2016)

RADIOLOGICAL
IMAGING
Chest x ray (19/02/2016)

NO COIN
LESION

RESUME
Male, 74 years old, was admitted to Hospital because of shortness of breath and pain on the right
shoulder , suffered since 12 hours before admission, the patient was slipped and fell down from 5 metres
tree in pronate position (with right side come first to the ground) and the right chest hit the stone first.
Based on physical examination, deformity, swelling & tenderness is present in the right shoulder. Active
and passive motions of the shoulder cannot be evaluated due to pain.
X- ray of shoulder joint showed
-not in alignment
-dislocation of the head of humerus to the anterior,
-good bone density
- swelling of the soft tissue
X-ray of thorax (AP views) showed
- chest tube in right hemithorax at CV Th V
-right pneumothorax
- right lateral fracture of costal III,IV,V, VII

DIAGNOSIS
- RIGHT SHOULDER DISLOCATION
Secondary Diagnosis
- Pneumothorax dextra
- Frakture costal III, IV ,V,VI

MANAGEMENT
IVFD RL
Oxygen 3 L /menit
Ketorolac 30mg/8 hours/iv
Metamizole 19mg/8hours/iv
Ranitidin 50mg/8hours/iv
Ceftazidin 1gr/12jam/iv
Apply arm sling on the right shoulder
Planning :Closed Reduction of Right Shoulder

Discussion

FEMORAL NECK
FRACTURE

NECK FEMUR
FRACTURE

Fracture of proksimal
femur, intracapsular
fracture

ARTERIES
Netter Concise Orthopedic, 2nd edition, 2002

GERIATRIC PEOPLE PROBLEMS which increases risk of

falls
HEALTH PROBLEMS
1. Muskuloskeletal problems
(osteoporosis, muscle weakness)
2. Impairment of special senses (Visual
and auditory impairment)
3. Cardio vascular disease, postural
hypotension
4. Diabetes
5. CNS disorder, syncope, epilepsy
6. Certain drugs (sedatives,
hypoglycemic drugs, etc)

Psychological problems
1. Suicidal tendency
2. Senile dementia

EXTRINSIC ENVIROMENTAL
HAZARDS
1.
2.
3.
4.
5.

poor lighting
unsafe stairways
irregular floor/ road surface
Slippery floor/ road surface
slippery shoes/ slipper

CLINICAL MANIFESTATION
pain in
motion
shortening of
extremity
deformity of
rotation in
resting
position
angulation

NRS : 4/10
right leg shortened
LLD = 1 cm
external rotation
varus

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

Orthopaedics and Fractures 9th Edition.
Robert et al. Rockwood and Green.Fractures in Adult. 7th edition

Classification by
Anatomic Location

Subcapital
Transcervica
l
Basicervical

Pauwels
Classificatio
n

Garden Classification

pauwels
classification

anatomical
classification

garden
classification

EVIDENCES LEADING TO
DIAGNOSIS
PATIENT
EVALUATION
PHYSICAL EXAMINATION
HISTOR
Y

-Pain on left groin

-history of fall on
sitting position
-Risk of fall (+)

- Hip Deformity &

Tenderness at right
groin
- Pain on movement

Fracture of Right Neck Femur

RADIOLOGICAL
EXAMINATIONS

X- Ray shows
fracture right neck
of femur

Skin traction

Hemiarthroplasty

Pain alleviation
Elderly patient with displaced
To minimize soft tissue
fracture
injury
To hold fracture
alignment
Apley s System of Orthopaedics and Fractures 9th Edition. UK:

COMPLICATIONS
Early Complication :
- DVT
- PE
- Ulcus decubitus
- Orthosatic pneumonia
Late Complication :
- Osteonecrosis Avascular Necrosis of femoral head
- Non union
- Secondary Osteoarthritis
Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition