Jorgi neforinaldy M

112015082

 IDENTITY OF PATIENTS
Full Name: Mr. A
Age: 61 years
Marital status: Married
Occupation: Labour
School
Address: Warakas

Gender: Male
Ethnic : Java
Religion: Islam
Education: High

 History
Taken from: Autoanamnesa, date: February 2, 2016, Time: 07:30 pm
Main complaints: Os felt pain in his left knee since 2 days SMRs
Disease History Now:
2 Days SMRs patient claimed fall in the bathroom with a footstool position left knee
when he fell. patient fell due to feel the outlook is dark and the head feels dizzy. After
the fall, patient felt his left leg pain and difficult to move.patient felt her legs were
swollen and the skin becomes reddish color. patient difficult to move his legs because
of very painful. patient said he did not do anything except take medication medicine
paracetamol. patient deny massaging his leg after a fall. Nausea and vomiting denied
by the patient. Complaints of fever also denied. Karna had two days taking
medication was no improvement on his left knee, patient and then go to the
emergency room and then decided Koja Hospital to be treated for a broken suspicion
on his kneecaps.

 Past medical history

OS claimed to have hypertension since 10 years ago
and take medication regularly, but lately rarely take
medication because the drug out and the OS family that
had no escort.

 STATUS generalist
General appearance: looks ill being
Awareness: compos mentis
Vital signs: BP: 170/90 N: 78x / mnt RR: 18x / mnt T:
36,5oC

 Head: Normocephali, black hair, uneven distribution

Eyes: The conjunctiva pallor - / -, sclera jaundice - / -,
Ears: Normotia, secretions - / -, abscesses - / Nose: septum deviation (-), Normosepta, secretions (-),
hemorrhage (-)
Throat: hyperemia (-), Tonsil T1-T1
Neck and neck lymph nodes are not palpable enlarged
thyroid gland, trachea in the middle

Lungs:
Inspection: Both hemithorax symmetrical in a state of static and dynamic,
wound (-), bump (-), hematoma (-), retractions intercostal space (-)
Palpation: There is no tenderness,fremitus vocal symmetrical right and left
lung, lump (-)
Percussion: Sonor
Auscultation: vesicular breath sounds, ronkhi - / -, wheezing - / heart:
Inspection: Iktus cordis is not visible
Palpation: Ictus cordis palpable at the left midclavicular intercostal 4 linea,
Percussion: Sound dim
Auscultation: heart sound I and II regular, murmur (-), gallops (-)

 abdomen:
Inspection: brown skin color, lesion (-), bump (-), symmetrical
Palpation: tenderness (-), bump (-).
Percussion: timpani sound around the abdomen
Auscultation: bowel sounds (+), Normoperistaltik
Liver: no enlargement of the liver
Spleen: no enlargement of the spleen
Kidney: Pain word-CVA - / -, Balotement - / -, bimanual - / urogenital
Region Supra symphisis: Tenderness (-)
Genital Regio: Not installed DC

 Upper Ekstremitas :

Right

Tonus :
normal

Massa :
No

Sendi :
normal

Move :
normal

Power :

Edema :

Left
normal
No
normal
normal
normal
No

normal
No

 Ekstremitas bawah:

Kanan
Kiri

Tonus :
normal
normal

Massa :
No

Sendi :
normal
no exam

Gerakan :
normal
Limit

Kekuatan :
normal
Less

Edema :
tidak ada
yes

No

Refleks

Kanan

Reflekstendon

Kiri

Bisep

Baik

Baik

Trisep

Baik

Baik

Patella

Baik

Archiles

Baik

Kremaster
Reflekspatologis

Tidakdilakukan
Baik
-

 I. STATUS localist Regio Genu sinistra

Look: Looks bandages (+) Visible edema.
Feel: Tender (+) CRT <2 seconds
Move: ROM is limited because of pain

Hemoglobin

13,2 g/dL

12.5 16.0 g/dL

Leukosit

7600/uL

4.00010.500/uL

Hematokrit

38.8%

37.047.0%

Trombosit

185.000/uL

182.000269.000/uL

Ureum

33.7 g/dL

16.6 48.5

Kreatinin

0.78g/dL

0.510.95

Natrium

144mEq/L

Kalium

2.99mEq/L

Klorida

101mEq/L

 RESUME
Anamnesis:
On January 30, 2016, IOS Koja Hospital came to the emergency room
complaining of pain in the left knee. 2 Days SMRs Os claimed fall in the
bathroom with a footstool position left knee when he fell. Os fell due to feel
the outlook is dark and the head feels dizzy. After the fall, Os felt his left
leg pain and difficult to move. Os felt her legs were swollen and the skin
becomes reddish color. Os difficult to move his legs because of very
painful. Os said he did not do anything except take medication medicine
paracetamol. Os deny massaging his leg after a fall. Nausea and vomiting
denied by the patient. Complaints of fever also denied. Because it has
been two days taking medication was no improvement on his left knee, Os
and then go to the emergency room and then decided Koja Hospital to be
treated for a broken suspicion on his kneecaps.

 Physical examination :
Regio Genu sinistra
Look: Looks bandages (+) Visible edema, Seemingly no
shortening or deformity
Feel: Tender (+) CRT <2 seconds
Move: ROM is limited because of pain
II. DIAGNOSIS OF WORK
Closed fracture of the left patella os
Hypertension grade 2

Fraktur
fracture is a break in the continuity of the bone structure. If
the overlying skin is intact, the condition is called a closed
fracture (or simple), whereas if the shell or one of the body
cavity is broken, the condition is called an open fracture (or
compound), which tend to experience contamination and
infection.
patella fracture a bone integrity disorder characterized by
damage to or breaking the continuity of bone tissue due to
excessive pressure that occurs in the kneecap.

ANATOMI
Patella is a sesamoidea os, the size of approximately 5 cm,
triangular in shape, is in the tendon (the tendon grows in)
m.quadriceps femoris.

ETIOLOGY
Most fractures are the result of injury, such as car
accidents, sports or from falls. Fractures occur if the
power is greater than the bone against bone strength. The
type and severity of fractures is influenced by:
- Directions, speed and strength of the force against the
bone.
- Age of patients.
- Flexibility of the spine.
- Bone type.

 Classification of fractures (fractures) in general is:

a. Based on the relationship with the outside world
1. Closed fracture (closed)
If there is no connection between the bone fragments with
the outside world, also known as a clean fracture (because
the skin is intact) without complications
2. Open fracture (open / compound)
When there is a relationship between the bone fragments
with the outside world for their skin injury. This type of
fracture is divided into:
a) Grade 1: tear the skin with skin damage muscle
b) Grade 2: as grade 1, with bruising of the skin and muscle
c) Grade 3: wound by 6-8 cm by damage to blood vessels
and nerves muscles and skin

 Based on extensive and lines

1. Complete Fractures
If the broken line to cross from one side to the other and
the whole cortex
2. Fracture Incomplete
If the broken line not to cross so that they cortex intact

 Based on the shape of broken lines and their relationship to the

mechanism of trauma
1. Fractures spiral
Fractures that direction spiral fracture line caused trauma rotation
2. Transverse fracture
Fractures in the bones and the transverse direction is the result of
direct trauma or angulation
3. Compression Fractures
Fractures that occur because of trauma axial spine flexion pushed
towards the surface of another
4. Fracture oblique
Fractures that direction fracture lines form an angle to the axis of
the bone and is the result of trauma angulation
5. avulsion fractures
Fractures due to trauma or traction pull of muscle on the bone
insertion

 Based shifting bone fragments

1. undisplaced fractures (not shifting)
Full broken lines but the second fragment is not shifted
and the periosteum is intact
2. Fractures displaced (shifted)
A shift in bone fragments also called dislocation

 Symptoms and Signs

1. History of trauma directly or indirectly
2. Tenderness or pain when actuated
3. Oedema
4. On patella fracture with displaced found a gap in the
patella and patellar fragment and extends to the
weakness in the leg against gravity
5. In the non DISPLACED fracture found no abnormality
on palpation

 diagnosis fractures
1. History.
If there is no history of trauma, meaning a pathological
fracture. Trauma should be itemized when it happened,
where it happened, kind, heavy-mild trauma, trauma
direction, and the position of the patient or limb in
question (the mechanism of trauma). Do not forget to
re-examine trauma elsewhere systematically in the
head, face, neck, chest, and abdomen.

 general inspection
Wanted possible common complications such as shock
in multiple fractures, pelvic fractures, open fractures;
signs of sepsis in open fractures that were infected.

 Checking the status of localist

The clinical signs in long bone fractures:
a. Look, find whether there:
deformity, consisting of a protrusion abnomal (for example on the lateral
condyle fracture of the humerus), angulation, rotation, and shortening
functio laesa (loss of function), for example in a fracture crus can not run.
See also the length of the bone, compare left and right, for example in the
lower limbs include an apparent length (distance between the umbilicus to
the medial malleolus), and the true length (distance between the medial
malleolus SIAS).
b. Feel, whether there is tenderness. Examination axis pain is not
do again because it will add to the trauma.
c. Move, to look for:
Krepitasi, felt when the fracture is moved. But at the spongy bone or
cartilage epiphyseal not feel crackles. This examination should not be done
because it adds to the trauma.
Pain when you move, both in active and passive movements.
How far disturbances function, the movements can not afford

 Supporting investigation
ca. radiologically
Performed on the area suspected fractures, must follow
the role of two consisting of:
Includes two images are anteroposterior and lateral
Load two joints between the fracture, which is part of
the proximal and distal
Load two extremities (especially in children) either
injured or not (to compare with normal)
Do 2 times, before and after the action

 Laboratory examination
hemoglobin and hematocrit may be low due to bleeding
LED increases when very extensive soft tissue damage
Ca and P in blood increases during the healing
c. examination of arteriography
Done if the vascular damage is suspected to have
occurred as a result of fracture
d. X-rays
To find out the location of the fracture and the fracture
line directly knows the place and type of fracture. Usually
taken before and after surgery and during the healing
process periodically

MANAGEMENT
Reduction and traction
retention
Rehabilitation

BONE HEALING PROCESS

inflammatory phase
proliferative phase
Phase formation of callus
Consolidation phase
remodeling phase

complication
Complications In Old Timea.
a. Delayed Union
Delayed Union a failure to consolidate fracture in accordance with the time
needed to connect the bone. This is due to a decrease in blood supai to the
bone.
b. Nonunion
Nonunion a failure to consolidate fractures and producing connections are
complete, robust, and stable after 6-9 months. Nonunion characterized by
excessive movement on the side of the fracture which forms a false joint or
pseudoarthrosis. It is also caused because of poor blood flow.
c. Malunion
Malunion the bone healing is characterized by increasing levels of strength and
deformation (deformity). Malunion done with surgery and reimobilisasi good.