CASE REPORT

OPEN FRACTURE 1/3 MIDDLE RIGHT TIBIA AND

OPEN SEGMENTAL FRACTURE RIGHT FIBULA

C111 12 022 Andi Muh. Octavian Pratama

C111 12 060 St. Maryam A.
C111 12 137 Ade Rifka Junita
C111 12 322 Rizal Ichwansyah
C111 12 915 Ishak Fanshury Iskandar
ADVISOR :
dr. Handoko dr. Loli Anton

SUPERVISOR :
dr. Zulfan Oktosatria Siregar, Sp.OT

ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT HASANUDDIN UNIVERSITY 2017

 EXIT IDENTITY HISTORY TAKING OBJECTIVE DIAGNOSE
PRESENTATION

CASE REPORT

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 EXIT
PRESENTATION
IDENTITY HISTORY TAKING OBJECTIVE DIAGNOSE

Patients Identity

Name : Mrs. D
Age : 64 yo
Reg. Number : 799436
Sex : Female
Date of Admission : 30th April 2017
 EXIT HISTORY
IDENTITY OBJECTIVE DIAGNOSE
PRESENTATION TAKING
Chief Complaint

History Taking

Pain at right Leg

 EXIT HISTORY
IDENTITY OBJECTIVE DIAGNOSE
PRESENTATION TAKING
Chief Complaint

History Taking Suferred since 6 hours before admittance at

Wahidin General Hospital.
Patient was crossing the street and the same
time there was motorcycle from other side and
hit the patient.
There is no History of vomit
There was no history of unconcious
Prior treatment from RSUD H. A. Sulthan
Dg Radja Bulukumba
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

Patent, clear
AIRWAY
18x/min, thoracoabdominal, spontaneous,
BREATHING symmetric

BP 110/70mmHg, HR 80x/min, regular, strong

CIRCULATION on palpation

GCS 15(E4M6V5), light reflex +/+ , pupil

DISABILITY isochors, : 2,5mm/2,5mm,

Temp 36.8C (axilla)

EXPOSURE
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

SECONDARY SURVEY
(Right Leg Region)

LOOK Deformity with 2 stitched wounds at middle medial

aspect size 3 cm each.

FEEL Tenderness (+) at middle aspect

Active and passive movement on the knee joint can not be

MOVE evaluated due to pain

Active and passive movement on the ankle joint can not be
evaluated due to pain
Sensibility are good,

NVD Pulsation dorsalis pedis and tibialis posterior artery are palpable
adequate
CRT <2 second
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

SECONDARY SURVEY
(Right Leg Region)

LOOK Deformity with 2 stitched wounds at middle medial

aspect size 3 cm each.

FEEL Tenderness (+) at middle aspect

Active and passive movement on the knee joint can not be

MOVE evaluated due to pain

Active and passive movement on the ankle joint can not be
evaluated due to pain
Sensibility are good,

NVD Pulsation dorsalis pedis and tibialis posterior artery are palpable
adequate
CRT <2 second
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

SECONDARY SURVEY
(Right Leg Region)

LOOK Deformity with 2 stitched wounds anterior and lateral at

middle cruris size 3 cm and 2,5 cm..

FEEL Tenderness (+) at middle aspect

Active and passive movement on the knee joint can not be

MOVE evaluated due to pain

Active and passive movement on the ankle joint can not be
evaluated due to pain
Sensibility are good,

NVD Pulsation dorsalis pedis and tibialis posterior artery are palpable
adequate
CRT <2 second
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

SECONDARY SURVEY
(Left Ankle Region)

LOOK Deformity +, Swelling +, hematoma +, Wound -

FEEL Tenderness (+)

MOVE Active and passive movement on the ankle joint can

not be evaluated due to pain
Sensibility are good,

NVD Pulsation dorsalis pedis and tibialis posterior artery are

palpable adequate
CRT <2 second
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION
RADIOLOGY FINDING
RADIOLOGY FINDING
RADIOLOGY FINDING
 EXIT IDENTITY HISTORY TAKING DIAGNOSE
PRESENTATION

LABORATORY FINDING
WBC : 12.200/ul
HGB : 8 g/dL
HCT : 25.2 %
PLT : 204.000 /ul
HbsAg : Non- Reactive
CT : 800
BT : 300
RBS : 156 mg/dl
SGOT : 75 U/L
SGPT : 50 U/L
 EXIT IDENTITY HISTORY TAKING OBJECTIVE DIAGNOSE
PRESENTATION

Resume
No Problem s Identification Management
1. 1. Open Fracture 1/3 middle 1. IVFD
right tibia grade IIIA 2. Analgesic
2. Open Segmental Fracture 3. Antibiotic
right Fibula grade IIIA 4. Tetanus Prophylaxis
5. Plan : Consult Orthopedic
Open Reduction Internal
Fixation
DISCUSSION
Orthopedic and Traumatology Department
Medical Faculty Hasanuddin University, Makassar
 a break in the structural continuity of bone
It may be no more than a crack, a crumpling or a splintering of the cortex
more often the break is complete and the bone fragment are displaced

1. Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi,cetakan ke-V. Jakarta: Yarsif Watampone, 332-
334.
2. Sjamsuhidajat R, Jong W. Buku Ajar Ilmu Bedah, Edisi 2. Jakarta: EGC, p. 840-841.
 EPIDEMIOLOGY
In an average population, there are about 26
tibial diaphyseal fractures per 100,000
population per year.

Diaphyseal tibia fracture high highest rate of

nonunion for all long bones

Price, Sylvia Anderson (1995). Phatophysiology: Clinical Concept of Disease Process.Alih bahasa: Peter Anugerah, Patofisiologi: Konsep Klinis Proses-proses Penyakit. Edisi 4 vol. 2. Jakarta :EGC.
Brinker. Review Of Orthopaedic Trauma, Pennsylvania: Saunders Company, 127-135.
 ANATOMY OF CRURIS

ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
 CLASSIFICATION
CLASSIFICATION

OPEN FRACTURE CLOSED FRACTURE

1. Takata, S. & Yasui, N. 2007. The Effect of Bedrest on Various Parameters of Physiological Function. The journal of medical investigation, Department of Orthopedic Surgery, The University of
Tokushima School of Medicine, Tokushima, Japan.
2. Cuccurullo, Sara . Physical Medicine and Rehabilitation Board Review. Department of Physical Medicine and Rehabilitation University of Medicine and Dentistry of New Jersey Robert Wood
Johnson Medical School. Demos Medical Publishing, 386 Park Avenue South, New York, New York. 2006. p.47-76
 TRAUMA

REPETITIVE STRESS

PATHOLOGYCAL

Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi,cetakan ke-V. Jakarta: Yarsif Watampone, 332-334.
Price, Sylvia Anderson (1995). Phatophysiology: Clinical Concept of Disease Process.Alih bahasa: Peter Anugerah, Patofisiologi: Konsep Klinis Proses-proses Penyakit. Edisi 4 vol. 2. Jakarta :EGC.
Brinker. Review Of Orthopaedic Trauma, Pennsylvania: Saunders Company, 2001. 127-135.
 Pathophysiology of Fracture
Trauma Direct

Indirect

Twisting Injury
Long Bending and Compression Injury
Bone Combination twisting, bending, and compression injury
Pull of tendon or ligament
ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
 CLINICAL MANIVESTATION

Severe pain at the site of the fracture

Unable to move the lower extremities

Followed by general signs of fracture such as

:altered function, swelling, cryptitation, sepsis
in open fractures, deformity

The outer rotation of the leg is shorter

1. Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi,cetakan ke-V. Jakarta:

PHYSICAL MEDICINE & REHABILITATION DEPARTMENT Yarsif Watampone, 332-334.
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY 2. Price, Sylvia Anderson . Phatophysiology: Clinical Concept of Disease
 HOW TO DIAGNOSE

History Taking

Physical Examination

Radiology Test

Followed by general signs of fracture such as

:altered function,swelling,cryptitation,sepsis
in open fractures,deformity

PHYSICAL MEDICINE & REHABILITATION DEPARTMENT

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
 MANAGEMENT
MANAGEMENT

NON OPERATIVE CLOSED FRACTURE

- Immobilisasi - Intramedullary nailing

Fracture reduction followed by -External Fixation
application of long leg cast -Internal Fixation

1. Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi,cetakan ke-V. Jakarta: Yarsif Watampone, 332-334.
2. Sjamsuhidajat R, Jong W. Buku Ajar Ilmu Bedah, Edisi 2. Jakarta: EGC, p. 840-841.
 COMPLICATION

Nonunion
Malunion

Infection

Compartment Syndrome
Post Traumatic Arthritis

1. Rasjad, Chairuddin. Pengantar Ilmu Bedah Ortopedi,cetakan ke-V. Jakarta: Yarsif Watampone, 332-
334.
2. Sjamsuhidajat R, Jong W. Buku Ajar Ilmu Bedah, Edisi 2. Jakarta: EGC, p. 840-841.

PHYSICAL MEDICINE & REHABILITATION DEPARTMENT

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY