CASE REPORT

FEBRUARY 2016

Orthopaedic and Traumatology

Department
Medical Faculty of Hasanuddin
University
Makassar

FRACTURE NECK OF FEMUR

FAUZIAH
Advisor :
dr. Ahmad Rizan
dr. Yohanes toban
Supervisor :
dr. M. Ruksal Saleh , Ph.D, Sp.OT(K)

PATIENT IDENTITY
Name : Mr. MN
Number Register : 051766
Sex : Male
Age : 76 years old
Date of Admission

: February 19th , 2016

HISTORY TAKING
(HETEROANAMNESIS)
Chief Complain : Pain on the right groin

Suffered since 7 days before admitted to

UH hospital
Mechanism of Trauma : The patient was
slipped and fell down in sitting position
(with right side come first to the ground)
while he was walking on street
No history of headache, nausea, vomiting
and unconsciousness prior to fall
After falling, patient only lying on the bed
at home and didnt seek medical treatment
for 2 days
Before fall patient still can walk by himself

Family said the patient seems to drag his foot

when he was walking
History of Visual impairment (Refractive error,
Cataracts)
History of Dementia (forgetfulness)
No history of numbness, cramps, and limb
weakness
No history of backpain
No history of chronic headache
No history of HHD and DM
History of carcinoma of prostate
History of prostate operation 3 years ago
Prior treatment : Salewangan hospital (5 days)

GENERAL STATUS
General condition: wellnourished, compos mentis
(GCS 15)
Vital signs

:BP = 130/80 mmHg;

HR = 86x/minutes, reguler, palpable

RR = 16x/minute
T
NRS

=36,5
:4/10

LOCAL REGION
Right Thigh Region
Look

: Deformity (+), swelling (+), hematoma

(-), wound (-)
Feel : Tenderness (+)
Move : Active and pasive motion of hip joint
cannot be evaluated due to pain
NVD : Sensibility is good, dorsalis pedis
artery is palpable, capillary refill time
< 2

LEG LENGTH DISCREPANCY

ALL
TLL
LLD

R
85 cm
80 cm

L
86 cm
81 cm
1 cm

CLINICAL FINDINGS

ANTERIOR

CLINICAL FINDINGS

LATERAL

MEDIAL

LABORATORY FINDINGS
Result

Normal Level

WBC

7,170

4,00-10,0

RBC

3,45

4,50-6,50

HGB

10,3

14,0-18,0

HCT

31,9%

40,0-54,0

PLT

322

150-400

CT

7,30

4-10

BT

3,00

1-7

HBsAg

Non Reactive

Non Reactive

FRACTUR
E

RADIOLOGICAL
IMAGING
Pelvis AP (19/02/2016)

FRACTUR
E

RADIOLOGICAL
IMAGING
Right Femur AP/Lat (19/02/2016)

RADIOLOGICAL
IMAGING
Chest x ray (19/02/2016)

NO COIN
LESION

RESUME
Male, 76 years old, was admitted to Hospital because of pain in
the right groin, suffered since 7 days before admission, the
patient was slipped and fell down in sitting position (with right
side come first to the ground) while he was walking
Based on physical examination, deformity, swelling &
tenderness is present in the right hip region. Active and passive
motions of the hip joint cannot be evaluated due to pain
X- ray of pelvic and right femur (ap and lateral views) showed a
fracture in the right femoral neck

DIAGNOSIS
Closed fracture right neck of femur

MANAGEMENT
IVFD RL
Analgesic
Apply skin traction load 3 kg
Plan for right hemiarthroplasty

Discussion

FEMORAL NECK
FRACTURE

NECK FEMUR
FRACTURE

Fracture of proksimal
femur, intracapsular
fracture

ARTERIES
Netter Concise Orthopedic, 2nd edition, 2002

GERIATRIC PEOPLE PROBLEMS which increases risk of

falls
HEALTH PROBLEMS
1. Muskuloskeletal problems
(osteoporosis, muscle weakness)
2. Impairment of special senses (Visual
and auditory impairment)
3. Cardio vascular disease, postural
hypotension
4. Diabetes
5. CNS disorder, syncope, epilepsy
6. Certain drugs (sedatives,
hypoglycemic drugs, etc)

Psychological problems
1. Suicidal tendency
2. Senile dementia

EXTRINSIC ENVIROMENTAL
HAZARDS
1.
2.
3.
4.
5.

poor lighting
unsafe stairways
irregular floor/ road surface
Slippery floor/ road surface
slippery shoes/ slipper

CLINICAL MANIFESTATION
pain in
motion
shortening of
extremity
deformity of
rotation in
resting
position
angulation

NRS : 4/10
right leg shortened
LLD = 1 cm
external rotation
varus

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of

Orthopaedics and Fractures 9th Edition.
Robert et al. Rockwood and Green.Fractures in Adult. 7th edition

Classification by
Anatomic Location

Subcapital
Transcervica
l
Basicervical

Pauwels
Classificatio
n

Garden Classification

pauwels
classification

anatomical
classification

garden
classification

EVIDENCES LEADING TO
DIAGNOSIS
PATIENT
EVALUATION
PHYSICAL EXAMINATION
HISTOR
Y

-Pain on left groin

-history of fall on
sitting position
-Risk of fall (+)

- Hip Deformity &

Tenderness at right
groin
- Pain on movement

Fracture of Right Neck Femur

RADIOLOGICAL
EXAMINATIONS

X- Ray shows
fracture right neck
of femur

Treatment

Initial treatment

Surgery

Skin traction

Hemiarthroplasty

Pain alleviation
Elderly patient with displaced
To minimize soft tissue
fracture
injury
To hold fracture
alignment
Apley s System of Orthopaedics and Fractures 9th Edition. UK:

COMPLICATIONS
Early Complication :
- DVT
- PE
- Ulcus decubitus
- Orthosatic pneumonia
Late Complication :
- Osteonecrosis Avascular Necrosis of femoral head
- Non union
- Secondary Osteoarthritis
Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition