PRESENTED BY:

Sulpikar Habibie (C111 07 011)

ADVISOR
Dr.Nurjalaluddin Djawie
Dr.Arnold Darmawan


SUPERVISOR
dr. Jainal Arifin, M.Kes, Sp.OT

Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar
2014

CASE REPORT
Mr. AM Name
Male Sex
32 years old Age
673172 Register No.
July 23
rd

2014 Date of admission
PATIENTS IDENTITY
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
HISTORY TAKING
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
Wound at the left leg
Chief
Complain
Suffered Since 4 hours before admitted to Dr
Wahidin Sudirohusodo Hospital due to traffic
accident.
History of
illness
The patient was riding a motorcycle and because
of a hole, he suddenly thrown away and finally
the left leg hit the road.
History of unconscious (-), nausea (-),vomit(-)
Mechanism
of trauma
Primary Survey
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
Patent
A
RR 20x/min regular, spontaneous
thoracoabdominal type, symmetrical
B
BP 120/70 mmHg
HR = 88 x/min regular
C
GCS 15 (E4V5M6),
isochoric pupil, : 2.5 mm, light reflex +/+
D
T = 36,7
0
C (axilla)
E
SECONDARY SURVEY
Left Leg Region
Look Pin point wound at the anterior aspect 1/3 middle, deformity
(+), swelling (+), hematoma (+).
Feel
Move
Tenderness (+)
Active and passive movement of the knee and ankle joints are
limited due to pain.
NVD

Sensibility is good, pulsation of the dorsalis pedis artery is
palpable, CRT <2.
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
LEG LENGTH DISCREPANCY
RIGHT (cm) LEFT (cm)
ALL
94 cm 93 cm
TLL
90 cm 89 cm
LLD
1 cm
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT CLINICAL PHOTO
CASE REPORT
X-RAY PHOTO (AP/LAT)
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
LABORATORY FINDING (23
th
July 2014)

WBC : 12,5x10
3
/uL
RBC : 4,23x10
6
/uL
HGB : 13,1 gr/dl
HCT : 37,7 %
PLT : 232 x 10
3
/lU
BT : 300
CT : 700
HBsAg : Non reactive

DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
RESUME
A 32 years old man came to the hospital with wound at the
left leg suffered since 4 hours ago due to motorcycle
accident. From the physical examination on the left leg : pin
point wound at the anterior aspect, deformity (+),
swelling(+), hematoma (+), tenderness (+). From radiologic
finding, there are fracture 1/3 Middle of the left Tibia and
fracture 1/3 Proximal of the left Fibula.
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
DIAGNOSE
Open fracture 1/3 Middle left Tibia gr I
Closed fracture 1/3 Proximal left Fibula

DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
CASE REPORT
TREATMENT
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
IVFD RL
Analgetic
Anti Tetanus
Antibiotic
Wound Toilet
Immobilization : Apply long leg back slab at left lower limb
Plan for ORIF
DISCUSSION
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL
FACULTY OF HASANUDDIN UNIVERSITY
Introduction
A fracture is a break in the
structural continuity of bone.
If the overlying skin remains intact
it is a closed fracture.
If the skin or one the body cavities is
breached it is an open fracture.
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9
th
Edition. New York : Arnold. 2010
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Fourth Edition. New York: Lippincott Williams &
Wilkins. 20010
Epidemiology
Fractures of the shaft tibia and fibula are the
most common long bone fractures.
Men > women
Average age less than 40 years old
Usually due to traffic accident & sports injury.
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9
th
Edition. New York : Arnold. 2010
Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Fourth Edition. New York: Lippincott Williams &
Wilkins. 2010
ANATOMY
Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
COMPARTMENT
OF LEG



Anterior
Compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
COMPARTMENT
OF LEG
Lateral compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
COMPARTMENT
OF LEG


Superficial Posterior
Compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
COMPARTMENT OF
LEG

Deep Posterior
Compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
Innervation
Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
Vascularitation
Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
CLASSIFICATION OF FRACTURE
Clinical types:
Open fracture / close fracture
Etiology :
Traumatic fracture/ stress fracture/ pathologic fracture
Configuration classification:
Thompson JC. Netters Concise Orthopaedic Anatomy 2
nd
ed. 2010
Gustilo & Anderson classification of open fracture
Grade Wound
size
Contaminat
ion
Soft tissue Bone injury
I <1cm Clean Minimal -Simple (transverse, short
oblique)
-minimal comminution
II >1cm Moderate No extensive soft tissue
injury
-moderate comminution
(transverse, short oblique)
III A >1 cm High -extensive soft tissue
injury
- Adequate soft tissue
coverage
-minimal periosteal stripping
-soft tissue coverage of bone
is possible
III B >10 cm Massive -Extensive soft tissue
injury
- Need soft tissue
reconstruction
-moderate to severe
comminution
-poor bone coverage

III C >10cm Massive -Extensive soft tissue
injury
main vasculer artery
need to repair
-poor bone coverage
-moderate to severe
comminution
Mechanism of Injury
Indirect injury is usually low energy; with a spiral or long oblique fracture
one of the bone fragments may pierce the skin from within.
Direct injury crushes or splits the skin over the fracture; this is usually a
high-energy injury and the most common cause is a motorcycle accident
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics
and Fractures 9
th
Edition. New York: Arnold. 2010. p. 897-904.
CLINICAL FEATURES
Bruising
Swelling
Tenderness at the fracture site.
Deformity
Decreased range of motion at the ankle or knee, depending
on the location of the fracture


Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics
and Fractures 9
th
Edition. New York: Arnold. 2010. p. 897-904.
DIAGNOSIS
4
Laboratory
Examination
3
X-Ray
(rule of
twos)
2
Physical
Examination
1
Anamnesis
1. Look
2. Feel
3. Move
1. Two views
2. Two joints
3. Two limbs
4. Two injuries
5. Two
occasions
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics
and Fractures 9
th
Edition. New York: Arnold. 2010. p. 897-904.
Treatment
1. Conservative (non operative)
Indication :
Have closed fractures with little displacement
Children
Anterior/posterior angulation <10
Varus/valgus <5
Rotation (-)
Contact >50%
Shortening 1 cm
Kenneth J. Koval, Joseph D. Zuckerman Handbook of Fracture 4th edition, 2010
Treatment
2. Operative
The indications for operative :
Definite:
Associated intra-articular and shaft fractures.
Open fractures.
Major bone loss.
Neurovascular injury.
Compartment syndrome.


Kenneth J. Koval, Joseph D. Zuckerman Handbook of Fracture 4th edition, 2010
Complication

Early complications

Late complication
Vascular injury Malunion, delay union,
non- union
Compartment syndrome Joint stiffness
Osteoporosis
Infection
Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics
and Fractures 9
th
Edition. New York: Arnold. 2010. p. 897-904.