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FEMUR FRACTURE and

DISLOCATION HIP JOINT

Presciptor : Dr.dr. Erwien Isparnadi Sp.OT

BY :
NASRUL ANNAFIQ
GALIH MEGA PUTRA
RORO FEBRIANA RATNA W

Preface
Lower Extremity Movement
Femur fracture caput, collum, corpus
and femur distal
Elderly collum femur patologis
fracture
Youth corpus traffic accident

Anatomy

Epiphysis

Diaphysis

Epiphysis Distalis

Caput femoris

Corpus femoris

Condylus medial

Collum femoris

Linea Aspera

Condylus lateral

Trochanter major

Tuberositas Gluteal

Fossa intercondyloid

Proximalis

Trochanter minor
Sulcus
intertrochanteric

Classification
Traumatic fracture
Direct
Indirect

Patologic

Caput femuris

Clinical appearence

Treatment

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Complication

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Trochanteric fracture
Beetwen major and minor trocanter
Ekstra-articular

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type

1 no displacement
2 minor trocanter displacement
3 communitif
4 with spiral femur fracture

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therapy
Conservative if without displacement
Hemispica cast

Mostly operative
Strong fixation
Early mobilitation

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Subtrocanter fracture(fielding)

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Clinical appearence
External rotation, shortening, soft tissue
swelling (femur proximal)

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therapy
Mostly, operative
Nail or plate and screw

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Diaphisis femur fracture


> traffic injury
Massive bleeding

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Corpus femuris

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Clinical apperance
Soft tissue swelling
Deformity external rotation, shortening
shock

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therapy
Concervative
Skin traction temporary, non definitif
muscle spasm
Skeletal traction pearson area (knee joint)
communitive and segmental
Cast hip spica (clinical union)

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Complication
Early

Shock
Vascular trauma
Tromboemboli
Infection

Late
Delayed union ( normal 4 month)
Malunion
Contracture
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Supracondilar fracture

Trauma history
Swelling
Deformity supracondilar area
krepitation

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therapy
Concervative
Traction thomas and pearson
Hip spica

Operative
Openfracture
Displacement unreduction with
concervative therapy

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Condylus femur fracture

A non displacement
B displacement
C dual condilus fracture
D coronal fracture

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Clinical apperance

Pain
Swelling
Krepitation
Hemartrosis knee joint

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therapy
Concervative
Non-displacement
Circular gips above knee

Operative

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Hip dislocation
Dislokasi posterior
Dislokasi anterior
Dislokasi sentral

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Classification
Posterior dislocation
No fracture
Single posterior fracture
Acetabulum communitive fracture
Base acetabulum fracture
Fracture caput femur

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Posterior dislocation
Trauma caput femur posterior of
acetabulum, mostly with flexion of hip joint
Traffic injury

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Clinical appearance

Pain
Deformity of hip joint posterior
Adduction, flexy, internal rotasi
shotening

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therapy
Emergency
Direct reposition
Type 2 fracture fracment screw
Type 3-5 operative
Skin traction 4-6 weeks, non weight
bearing 3 months
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Allis & bigelow manuver

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Steamson gravity

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Anterior dislocation
Rare
Flexy obturator
Extention pubic and illiaca

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Clinical appearance

External rotation, abduction, flexy


No shortening
Inguinal mass caput femoris
ROM

X-ray AP-Lat

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therapy
Emergency
Direct reposition
Flexy 90 and pull the tight vertically +
adduction

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Allis manuver

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Central dislocation

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Clinical appearance

Swelling, bleeding
Pain in trocanter area
ROM
Shortening

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therapy
If without protrusion of the femural neck to
the pelvis cavity
Concervative skeletal traction 4-6 weeks

With protution
2 traction component lateral and distal 6
weeks
Weight bearing 8 weeks
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