Nanang Zulkarnain

111 2015 0113

Supervisor: dr. Muh. Alihasti, SpOT

Advisor: dr. Stefan AGP Kambey
 Name : Mrs. Hj. R
 Sex : Female
 Age : 73 years old
 Religion : Muslim
 Address : Ganggawa st. Sidrap
 Marriage Status : Married
 MR : 13 29 21
 Admission Date : July 20th, 2017
 Main complaint: Pain at left hip region.
Patient come to the emergency room A.
Makkasau with complaints of pain in the left
thigh about ± 20 days ago before admission to
hospital, the patient complained of pain in her left
hip and difficult to move. A history of slippery in
her room was admitted. A history of fainting (-)
headache (-), vomitting (-).
 Past history: allergic history was unknown.
Hypertension and Diabetic was denied.
 Social Economy history: BPJS Insurance.
 Airway and C-Spine Control:
 Patent
 Breathing and Ventilation:
 RR: 88x/i, reguler, spontaneous, thoracoabdominal
type, symmetric.
 Circulation and Haemorraghic Control:
 BP: 130/80 mmHg, HR: 90x/i, reguler, strong pulse,
CRT <2 seconds.
 Disability and Neurologic Evaluation:
 GCS 15 (E4M6V5), pupil isochor, Ø 2.5 mm/2.5 mm,
light reflex +/+
 Exposure and Environment Control:
 Axilla temperature: 36.8oC
Left Hip Joint
 Look:
Deformity (+), swelling (+), Wound (-).
 Feel:
Tenderness (+).
 Move:
Active and passive movement of left hip joint was
limited due to pain.
 NVD:
Sensibility is good, CRT < 2 seconds, pulsation of
posterior tibial artery and dorsalis pedis artery is
palpable.
 Items Result Unit N Value
Hematology:
WBC 7.7 103/ul 4-12
Eosinofil 0,097 % 2-4
Basofil 0,080 % 0-1
Netrofil 9,09 71.5 % 50-70
Limfosit 3,04 23.9 % 25-50
Monosit 5,50 3.16 % 1-6
RBC 4,81 106/ul 3,8-5,2
Hemoglobin 14,1 g/dl 12,8-16,8
Hematokrit 40,80 % 35-47
MCV L 84.9 Fl 80-100
MCH L 29.3 Pg 26-34
MCHC 35,5 g/dl 32-36
PLT 183 103/ul 150-450
Closed Fracture Left Neck Femur
 IVFD RL 20 dpm
 Ketorolac 30 mg / 8hrs / IV
 Ranitidine 50 mg / 12hrs/ IV
 Apply skin traction Load 3kg at Left
Lower Limb
 Referred to Wahidin Sudirohusodo Hospital
 Patient, female, 73 years old, was admitted to
hospital on July 20th 2017 with pain in the pelvis of the
left since 5 days ago. History of slippery in her room
was admitted. Patients being treated in hospitals Andi
Makkasau and planned to referred to Wahidin
Sudirohusodo Hospital.
 In physical examination of left hip joint there are
deformity, Tenderness (+). Range of motion; active and
passive movement of left hip joint was limited due to
pain, Sensibility is good, CRT < 2 seconds, pulsation of
posterior tibial artery and dorsalispedis artery is
palpable.
 Radiologic examination of pelvic APshenton’s line
is disrupted and the joint space is asymmetric.
 Colum fracture femur is a fracture
occurs in volumes the femur. Damage to the
base of the bone continuity that can be
caused by direct trauma, indirect trauma,
muscle fatigue, certain conditions such as
degeneration of the bones / osteoporosis.
 Direct Fracture
 Indirect Fracture
 Patological Fracture
 Increasinglycommon due
to aging population.
 Women > men.
 High energy in young
patients.
 Low energy in older
patients.
 Painin the hip
 Usually a history of fall
 Tenderness and pain when it is moved
 Deformity
 Muscle Spasm
 Othe signs and symptomps:
 Loss of sensory
 Shock Hipovolemic
 Anamnesis

Laboratory Physical
Exmination Examine

Radiology
intervention
 Non-operative:
• Observation
 Operative:
• ORIF
• Cannulated screw fixation
• Prosthetic replacement
• Hemiarthroplasty
• Total Hip Arthroplasty
 Mortality: 25-30% at one year
(higher than vertebral
compression fractures)
 Predictors of mortality:
1. is the most significant
determinant for post-
operative survival.
2. In patients with chronic
renal failure, rates of
mortality at 2 years
postoperatively, are close
to 45%.
1. Osteonecrosis
2. Nonunion
3. Failure rate