IDENTITY
Name
Age
Sex
Admission
Registration
: Ny.H
: 39 years old
: Female
: November 6th, 2014 at 16:47
: 68 80 20
HISTORY TAKING
Chief Complaint: wound at the left leg
History of illness
Suffered since 12 hours before admitted to
Wahidin Sudirohusodo General Hospital. The
patient was riding a motorcycle and got hit by
another motorcycle from opposite direction.
History of unconsciousness (-), Nausea (-),
Vomiting (-).
Prior Treatment at Takalar Hospital
PRIMARY SURVEY
A
B
C
D
E
: Clear
: RR 22 x/min, spontaneous, thoracoabdominal
type
: BP 110/70 mmHg, HR 88x/min strong,
regular
: GCS 15 (E4M6V5), Pupil isochoric, diameter
2.5mm/2.5mm, light reflex +/+
: T: 37oC
SECONDARY SURVEY
Left Leg Region
Look : Stitched wound at anteromedial aspect 1/3 middle size 3 cm,
Deformity (+) at 1/3 middle, Hematoma (+), Swelling (+)
Fell : Tenderness (+)
NVD: Sensibility is good, pulsation of dorsal pedis artery and
tibialis posterior artery are palpable, CRT < 2
Move :Active and passive motion of the knee joint not be evaluated
due to pain
Active and passive motion of the ankle joint not be evaluated
due to pain
Left
ALL
91 cm
90 cm
TLL
84 cm
83 cm
LLD
CLINICAL FINDINGS
CLINICAL FINDINGS
RADIOLOGIC FINDINGS
Cruris AP/Lateral
(November 9th, 2014)
LABORATORY FINDINGS
WBC
14,1
4,00-10,0
CT
700
4-10
RBC
12.5
12,0-16,0
BT
200
1-7
HCT
38.0
37,0-48,0
Na
142
136-145
PLT
230
150-400
4,0
3,5-5,1
GOT
21
< 38
Cl
106
97-111
GPT
16
< 41
HbsAg
Non Reactive
Non Reactive
DIAGNOSIS
Open Fracture 1/3 middle left tibia grade IIIa
Open Fracture 1/3 middle left fibula grade IIIa
RESUME
A 39 years old female was admitted to the
Wahidin Sudirohusodo General Hospital due to
vehicular accident.
In physical exam, there was Stitched
wound at anteromedial aspect 1/3 middle left leg
size 3 cm, deformity, hematome, Swelling and
tenderness, active and passive motion of knee
and ankle joint cannot be evaluated due to pain.
There is no neurovascular compromised.
In radiologic finding, there is an fracture 1/3
middle left tibia-fibula.
MANAGEMENT
Intravenous fluid drips
Antibiotic
Analgetic
Tetanus Toxoid
Debridement
Plan for Open Reduction Internal Fixation
(ORIF)
FRACTURE OF
THE TIBIA
AND FIBULA
INTRODUCTION
Salomon L., Warwick D., Nayagam S. Apleys System of Orthopaedics and Fractures 9 th
ed. UK.2010.23:688
ANATOMY
COMPARTMENT
OF LEG
Anterior
compartment
COMPARTMENT
OF LEG
Lateral
compartment
COMPARTMENT
OF LEG
Superficial
posterior
compartment
COMPARTMENT
OF LEG
Deep posterior
compartment
EPIDEMIOLOGY
Fractures of the tibia and fibula shaft are the most
CLASSIFICATION OF
FRACTURE
Clinical types:
Etiology :
Bone injury
<1cm
Clean
Minimal
II
>1cm
Moderate
Moderate
-moderate comminution
(transverse, short oblique)
III A
>10 cm High
-minimal periosteal
stripping
-soft tissue coverage of bone
is possible
III B
>10 cm Massive
III C
>10cm
Massive
MECHANISME OF INJURY
TREATMENT
DIAGNOSIS
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York :
Arnold. 2010
COMPLICATION
Early
complications
Late complication
Neurovascular injury
Compartment
syndrome
Joint stiffness
infection
Osteoporosis
THANK
YOU