Orthopaedic and Traumatology Department

Medical Faculty of Hasanuddin University

Makassar

CASE REPORT
MARCH 2016

CLOSED FRACTURE RIGHT NECK FEMUR

G. P. Januar R. A. Tehupeiory
Advisor :
dr. Andhika
dr. Putra
Supervisor :
dr. Supriadi, Sp. OT

PATIENT IDENTITY
Name : Mr. N
Number Register : 747786
Sex : Man
Age : 76 years old
Date of Admission

: March 21st, 2016

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

Suffered since 16 days before admitted to

Wahidin sudirohusodo hospital
Mechanism of Trauma : this occurs in the
time when patient was go to bank and
suddenly slipped, patient hit the ground
with sit position.
The patient felt pain at the area of the hip
and spread at the back and groin.
History of nausea and vomiting worsen
especially increase of back pain
After falling, patient cannot stand by his
feets anymore and patient taken to his
house. He didnt take any medication in 16
days

Before fall patient still can walk by himself

History of Ca. Prostate
operation 5 years ago.

and

hernia

History of numbness, cramps, and limb

weakness
No history of chronic headache
No history of HHD and DM
Prior treatment : UNHAS hospital (1 days)

GENERAL STATUS
General condition: well-nourished, compos mentis (GCS 15)
Vital signs

:BP = 150/90 mmHg;

HR = 80x/minutes, reguler, palpable
RR = 20x/minute
T =37,1

LOCAL REGION
Right Thigh Region
Look

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

(-), wound (-), shortening and external
rotation
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
86 cm
75 cm

L
88 cm
77 cm
2 cm

CLINICAL FINDINGS

LATERAL

MEDIAL

LABORATORY FINDINGS
Result

Normal Level

WBC

8,1

4,00-10,0

RBC

1,99

4,50-6,50

HGB

6,1

14,0-18,0

HCT

18,5%

40,0-54,0

PLT

453

150-400

CT

7,30

4-10

BT

3,00

1-7

HBsAg

Non Reactive

Non Reactive

FRACTU
RE

RADIOLOGICAL IMAGING
Pelvis AP (12/03/2016)

RADIOLOGICAL IMAGING
Right Femur AP/Lat (12/03/2016)

FRACTURE

RESUME
Man, 76 years old, was admitted to Hospital because of pain

in the right groin, suffered since 16 days before admission,

the patient was slipped and hit the ground with sit position.
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..

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
hypotension

disease,

4. Diabetes
5. CNS disorder, syncope, epilepsy

EXTRINSIC ENVIROMENTAL
HAZARDS

postural 1. poor lighting

2. unsafe stairways
3. irregular floor/ road surface

6. Certain drugs (sedatives, hypoglycemic 4. Slippery floor/ road surface

drugs, etc)
5. slippery shoes/ slipper

Psychological problems
1. Suicidal tendency
2. Senile dementia

Classification by
Anatomic Location

Subcapital
Transcervical
Basicervical

Pauwels
Classification

Garden Classification

Ganti gambar ->

garden
classification

anatomical
classification

pauwels
classification

EVIDENCES LEADING TO
DIAGNOSIS
PATIENT EVALUATION
HISTORY

-Pain on left groin

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

PHYSICAL EXAMINATION

- 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 GOALS
Goals
Minimize
patient
discomfort

Restore hip
function

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition

Rapid
mobilization

Treatment

Initial treatment

Surgery

Skin traction

Hemiarthroplasty

Pain alleviation
To minimize soft tissue
injury
To hold fracture alignment

Elderly patient with displaced

fracture

Apley s System of Orthopaedics and Fractures 9th Edition. UK: Arnold. 2010.

MANAGEMENT

Cannulated Screw Fixation

Hemiarthroplasty

MANAGEMENT

Total Hip Arthroplasty

FUNDAMENTALS OF MUSCULOSKELETAL F. A. DAVIS COMPANY Philadelphia IMAGING

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