IDENTITY

Name : Wiranto
Gender : Male

Date of Birth : 5/10/2014

Registration : 116517
ALLOANAMNESIS
Chief complain: Pain on left thigh

 Suffered since 3 weeks before admitted to RS Unhas Policlinic.

 The patient fell from the bed after jumping around the bed.

 There is no history of decreased consciousness.

 There is no history of nausea and vomiting.

 There is history of treatment from bone setter once a week

after the accident.
General Status

Compos Mentis, Well-nourished

HR: 92x/mins
RR: 16x/mins
T: 36.7o C
NRS : 3
Local Status
(Left Thigh Region)

Look : Deformity (shortening, angulation to lateral) (+), hematoma

(-), swelling (-), wound (-)
Feel : Tenderness (+)

Move : Active and passive movement of hip and knee joint can not
be evaluated due to pain
NVD : Sensibility is good. Pulsation of dorsalis pedis and tibialis
posterior artery are palpable. Capillary refill time less than 2
seconds.
CLINICAL FINDINGS
(Leg length discrepancy)

RIGHT LEFT

ALL 71cm 69cm

TLL 55cm 53cm

LLD 2 cm
CLINICAL FINDINGS
CLINICAL FINDINGS
CLINICAL FINDINGS
RADIOLOGY
FINDING
(10/4/2019)
LABORATORY FINDING
WBC 9.2 x 103/mm3

HGB 11,7 g/dL

HCT 42%

PLT 392x103/mm3

HbsAg Non-reactive

SGOT 12 U/L

SGPT 11 U/L

GDS 102 mg/dl

CT/BT 7”/3?

Ur/Cr 12/0.67

Na/K/Cl 140/4.1/99
DIAGNOSIS

• Neglected fracture 1/3 middle left femur

 MANAGEMENT
 Planning:
Open reduction internal fixation
(ORIF) Reconstruction
 Post-operative Management

- Non Weight Bearing with Double Axillary Crutch

- Wound Care
DISCUSSION
EPIDEMIOLOGY
 The most common orthopedic injuries in children and require
hospitalization are femoral fractures.

 Epidemiological research from Indiana in 2006 said that of nearly

10,000 thigh fractures, 1076 (11%) occurred in children less than 2
years, 2119 (21%) in children aged 2 to 5 years, 3237 (33%) in children
aged 6 to 12 years, and 3528 (35%) in adolescents aged 13 to 18 years.
The most (71%) occurred in male patients.

Waters P, Skaggs D, Flynn J. Rockwood and Wilkins' fractures in children. 7th ed. Philadelphia: Wolters Kluwer Health; 2015.
ANATOMY

Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal: 251-7.
ANATOMY

Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010. Hal: 251-7.
ETIOLOGY
Pre-walking age

• Before walking age, up to 80% of femoral fractures

may be caused by abuse

Older children

• High energy trauma

• Unlikely abuse
• Stress fracture: athlete

Loder RT, O'Donnell PW, Feinberg JR. Epidemiology and mechanisms of femur fracture in children. J Pediatr Orthop 2006; 26(5):561-6.
Figure 27-3 The relationship of fracture level and position of the proximal fragment. A: In the resting unfractured state,
the position of the femur is relatively neutral because of balanced muscle pull. B: In proximal shaft fractures the proxim
al fragment assumes a position of flexion (iliopsoas), abduction (abductor muscle group), and lateral rotation (short exter
nal rotators). C: In midshaft fractures the effect is less extreme because there is compensation by the adductors and ext
ensor attachments on the proximal fragment. D: Distal shaft fractures produce little alteration in the proximal fragment
position because most muscles are attached to the same fragment, providing balance. E: Supracondylar fractures often a
ssume a position of hyperextension of the distal fragment because of the pull of the gastrocnemius.
CLASSIFICATION

Egol, K dkk. Femoral Neck Fractures; Handbook of Fractures,5th Ed. Lippincott Williams & Wilkins, 2015. Hal: 319-28.
Waters P, Skaggs D, Flynn J. Rockwood and Wilkins' fractures in children. 7th ed. Philadelphia: Wolters Kluwer Health; 2015.
DIAGNOSIS

Symptoms Physical Examination

• thigh pain • gross deformity

• inability to walk • shortening
• report of deformity or • swelling of the thigh
instability

Egol, K dkk. Femoral Neck Fractures; Handbook of Fractures,5th Ed. Lippincott Williams & Wilkins, 2015. Hal: 319-28.
Waters P, Skaggs D, Flynn J. Rockwood and Wilkins' fractures in children. 7th ed. Philadelphia: Wolters Kluwer Health; 2015.
 DIAGNOSIS

AP and lateral of the complete evaluation of fracture

location, configuration, amount of
femur displacement
Radiographs
Ipsilateral AP and lateral to rule out associated injuries
of knee and hip

Waters P, Skaggs D, Flynn J. Rockwood and Wilkins' fractures in children. 7th ed. Philadelphia: Wolters Kluwer Health; 2015.
Khoriati A, Jones C, Gelfer Y, Trompeter A. The management of paediatric diaphyseal femoral fractures: a modern approach. Strategies in Trauma and Limb Reconstru
ction. 2016;11(2):87-97.
TREATMENT

Waters P, Skaggs D, Flynn J. Rockwood and Wilkins' fractures in children. 7th ed. Philadelphia: Wolters Kluwer Health; 2015.
TREATMENT

Khoriati A, Jones C, Gelfer Y,. The management of paediatric diaphyseal femoral fractures: a modern approach. Strategies in Trauma and Limb Reco. 2016;11(2):87-97.
McKeon K, O’Donnell J, Gordon J. Pediatric femoral shaft fractures: current and future treatment. International Journal of Clinical Rheumatology. 2010;5(6):687-697.
Thank you
RADIOLOGY
FINDING
(19/3/2019)