CASE REPORT : FEMORAL

CLOSED FRACTURE

Supervisor :
Presented by: dr. Arianto Arief, M. Kes, Sp.OT
Irvan Rinaldi Advisor :
111 2016 1005 dr.
 Patient’s Identity
• Name : Mrs. RW
• Age : 16 years old
• Sex : Male
• Address : Pare-pare
• Work : Student
• Date of admission : May 10 , 2018
• Medical record : 149253
 HISTORY TAKING
• Main Complain : Pain at right thigh
• Anamnesis : Patient come to the emergency room A. Makkasau with complaints
of pain in the right thigh about 20 minutes ago before admission to hospital post
traffic accident. The patient complained that his right thigh difficult to move.
• Mechanism of Trauma : Patient was driving motorcycle, suddenly
his hit by a car from the oppocite direction.
• History of loss of consciousness (-), history of nausea and vomiting
(-), history of headache (-).
 GENERALIST STATUS
• Moderate ill/Adequat Nutrition/Compos Mentis, GCS 15
• Blood Pressure : 110/70 mmHg
• Heart Rate : 84x/i
• Respiratory Rate : 22x/i
• Temperature : 37,0oC
 LOCALIZED STATUS
Right femur Region
Look Deformity (+), swelling (+), hematoma (+),
wound (+), Shortening (+).
Feel Tenderness (+), Crepitations (+)
Move Active and passive movement of knee and hip
joint limitted due to pain
NVD Good sensibility, pulsation poplitea artery and
dorsalis pedis artery are palpable, CRT <2
seconds
 Right Cruris Region
Look Deformity (-), swelling (-), hematoma (-), wound
(-)
Feel Tenderness (-), Crepitations (-)
Move Active and passive movement of knee and hip
joint limitted due to pain
NVD Good sensibility, pulsation poplitea artery and
dorsalis pedis artery are palpable, CRT <2
seconds
CLINICAL FINDING
RADIOLOGICAL FINDING
LABORATORY FINDING
Pemeriksaan Hasil Nilai normal

WBC 9,06 4.00-10.0

RBC 3,49 3.80-6.50

HGB 9,77 11.5-17.0

HCT 27,0 37.0-54.0

PLT 239 150-500

CT 10’00” <15’00’’

BT 2’15” 1’00”-3’00”

GDS 103 <140

HBsAg nonreaktif
 RESUME
A man 16 years old, admitted to Andi Makkasau Hospital with main complaints of pain in the right thigh
about 20 minutes ago before admission to hospital after crashed a car, the patient also complained the his
thigh difficult to move. History of loss of consciousness (), history of nausea and vomiting (-), history of
headache (-).

Generalist status : normal

Localized status: right femur

Look :Deformity (+), swelling (+), hematoma (+), shortening (+), wound (+)
Feel : Tenderness (+), Crepitations (+)
Move : limitted due to pain.

NVD : Good sensibility, pulsation brachialis artery and radialis artery are palpable, CRT <2 seconds

Localized status: right cruris

Look :Deformity (-), swelling (-), hematoma (-), wound (-)
 DIAGNOSIS

CLOSED FRACTURE 1/3 MEDIAL

OF FEMUR
• Non operatif
1. Non medikamentosa
• Education
2. Medikamentosa :
• IVFD RL 20 tpm
• Ceftriaxone inj. 1gr/12h/iv
• Ketorolac inj. 30mg/8h/iv
• Ranitidine inj. 50mg/12h/iv

• Operatif : Open Reduction Internal Fixation

ANATOMY OF THIGH
FRACTURE FEMUR
 DEFINITION
• Fracture of the femur is the discontinuation or loss of
the continuity of the femoral stem which can occur as a
result of direct or indirect trauma (traffic accidents,
falling from a height). Clinical fracture conditions of the
femur can be an open femoral fracture accompanied by
soft tissue damage (muscle, skin, nerve and vascular
tissue) and a closed femur fracture that can caused by
direct trauma to the thigh.
 Etiology

• Traumatic Injury
• Pathologic Fracture
• Spontaneously
 CLASSIFICATION
• Femoral Head Fractures
• Femoral Neck Fractures
• Intertrochanteric fractures
• Subtrochanteric fractures
• Femoral shaft fractures
• Distal femur fractures
Winquist Hansen Classification
 Winquist and Hansen Classification
Type 0 • No comminution

Type I • Insignificant amount of comminution

Type II • Greater than 50% cortical contact

Type III • Less than 50% cortical contact

Type IV • Segmental fracture with no contact

between proximal and distal fragment
 CLINICAL MANIFESTATION
• Deformity
• Swollen
• Echimosis from Subculaneous hemorrhage.
• Spasms of muscle spasms involunters near the fracture.
• Tenderness
• Pain
• Loss of sensation
• Abnormal movement.
• Crepitation
 DIAGNOSIS
(CLINICAL FEATURE)
• The diagnosis of femoral shaft fracture is usually obvious,
with the patient present with pain, deformity, swelling,
and shortening of the affected extremity
• The effect of blood loss and other injuries, some of which
can be life-threatening, may dominate the clinical picture.
 TREATMENT
• Non Operative : skeletal
traction and skin traction,
branching

• Operatif :
• External fixation
• Plate fixation
• Intramedulary nailing
 COMPLICATION
• Early
• Shock
• Fat embolisme
• Compartement syndrome

• Late
THANK YOU