Old fracture femur sinistra

mid shaft
malunion

OLEH:
dr. Nidhia Badjak
PEMBIMBING :
dr. Bartholomeus Tana, Sp. B

Identitas Pasien

Nama
: Tn M I
Umur
: 16 Tahun
Jenis Kelamin
: Laki-laki
Tanggal MRS
: 11 Agustus 2015
No. RM
: 16 58 35

Anamnesis
Keluhan Utama:
Berjalan pincang

Anamnesis Tambahan:

Dialami sejak 2 bulan sebelum masuk

RS akibat kecelakaan lalu lintas.
Riwayat berobat ke dukun (+)

Mekanisme Trauma:

Pasien sedang mengendarai sepeda

motor dan bertabrakan dengan sepeda
motor lainnya dari arah berlawanan.
Pasien lalu terjatuh dan motor
membentur paha kirinya
Riwayat pingsan (-), mual (-), muntah (-)

Secondary Survey
Status Lokalis
Regio Femur sinistra
Inspeksi
: Deformitas (+), eksorotasi,
shortening
Palpasi : Nyeri tekan (-)
ROM
: Gerakan aktif dan pasif pada hip joint
dan knee joint terbatas karena nyeri
NVD
: Sensibilitas baik, a. dorsalis pedis teraba,
CRT < 2,
ekstensi ibu jari kaki (+)

LLD (Leg Length

Discrepancy)
L

ALL

86 cm

91 cm

TLL

81 cm

86 cm

LLD

5 cm

X-Ray Radiologi Femur (S) AP

Laboratorium
11 Agustus 2015
LAB

Hasil

Unit

Hemoglobin

13,2

gr%

Hematokrit

40,7

Vol%

Leukosit

6.300

Per-mm3

Trombosit

346

Per-mm3

GDS

80

mg/dl

HbsAg

negatif

CT

Menit

BT

menit

Resume
Seorang laki-laki, 16 tahun, masuk RS
dengan keluhan utama nyeri pada
paha kiri yang dialami sejak 2
bulan SMRS akibat KLL.
Dari pemeriksaan fisis ditemukan
deformitas, eksorotasi, dan
pemendekan tungkai kiri sebanyak 5
cm. Pergerakan aktif dan pasif hip
joint dan knee joint terbatas karena
nyeri, NVD dalam batas normal.
Pada gambar radiologi ditemukan
fraktur pada 1/3 tengah femur
sinistra.

Diagnosis
Old fracture left femur mid shaft

Penanganan
IVFD
Analgetik
Antibiotik
ORIF

FRAKTUR SHAFT FEMUR

DISKUSI

Anatomy of Femur

Thompson, Jon C. Netters Concise Orthopaedics Anatomy 2nd Edition

Introduction
A fracture is a break in the structural
continuity of bone
A femoral shaft fracture is a fracture of
the femoral diaphysis occurring
between 5 cm distal to the lesser
trochanter and 5 cm proximal to the
adductor tubercle.
Fracture patterns are clues to the type
of
force that produced the break.

1. Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition
2. Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd edition.

Principles of Fracture
Classification of Fracture

Open versus closed

Level of fracture : proximal, middle, distal third
Fracture pattern : transverse, spiral, or oblique
Comminuted, segmental, or butterfly fragment
Shortening, angulation or rotation deformity

Fractures result from

Injury
Repetitive stress
Pathological fracture
Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

TREATMENT
Nonoperative
Skin Traction
Skeletal traction
Casting
Splint

Operative
Intramedullary Nailing
External Fixation
Plate and Screw Fixation
Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition

COMPLICATION
Early

Shock
Vascular injury
Nerve Injury
Compartement
syndrome
Infection

Late

Non union or
delayed union
Malunion
Joint stiffness
Refracture and
implant failure

Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010

Malunion Fracture

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010

Clinical Features of Malunion

Fracture
Deformity is usually obvious, but
sometimes the true extent of malunion
is apparent only on x-ray.
X-rays are essential to check the
position of the fracture while it is
uniting (3 weeks), when the situation
may change without warning.

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9 th Edition. New York : Arnold. 2010

foto kontrol 13 agustus 2015

01/18/16

Thank You