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Case Report :

FRACTURE OF
LEFT FEMORAL NECK
Presented by :
SITI AISHAH BT KHAIRUDIN
C111 11 849
Advisors :
dr. HERBERT
dr. QARIAH M.
Supervisor :
dr. Henry , Yurianto, M.Phil , PhD, Sp.OT
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PATIENT IDENTITY
Name
: Mr. MF
Age
: 16 years old
Sex
: Male
Address
: Jl. Kumala
Occupation
: Student
Regist Number: 778129
Date of admission : November, 5th
2016

HISTORY TAKING
Chief Complain
: Pain at the left groin
Suffered since 1 month before admitted to Wahidin Hospital due to
falling down while painting wall. After falling down, the patient used
traditional therapy as alternative treatment for two weeks. After there
is no improvement and consistently feel the pain, patient went to
Labuang Baji Hospital and had treated with skin traction, operative
therapy and recommended to do joint replacement. There was no
history of loss of consciousness. There was no prior history of
diabetes or hypertension
Mechanism of trauma: Patient felt down from 3 meter high and fell
over his left side of the body

GENERAL STATUS
Well nourish/ Mild illness/ Compos Mentis
Blood pressure : 110/70 mmHg
Heart rate
: 88 bpm
Respiratory rate : 20 rpm
Temperature: 36,8 0 C (Axilla)
NRS score : 2/10

LOCALIZED STATUS
REGIO FEMORALIS SINISTRA

Deformity (+), swelling (-), hematom (-), stitched


wound 20 cm long at lateral proximal aspect
o Feel
: Tenderness (+)
Left Femur Region
Active and passive motion of hip joint cannot be
o Move
:
evaluated due to pain.
Sensibility is good
Pulsation of dorsalis pedis artery and tibialis
o NVD
:
posterior artery are palpable
CRT < 2
o Look

PHYSICAL EXAMINATION
Leg Length Discrepancy (LLD)
Right

Left

ALL

97 cm

95 cm

TLL

83 cm

81 cm

LLD

2 cm

CLINICAL FINDINGS

RADIOLOGIC FINDINGS
Pelvis AP (05/11/2016)

RADIOLOGIC FINDINGS
Left Femur AP/Lat (05/11/2016)

LABORATORY FINDINGS
JENIS
PEMERIKSAAN

HASIL

NILAI RUJUKAN

WBC

6.3 x 103

4 - 10 x 103/uL

HGB

11.1

12 - 16 g/dL

PLT

259x103

150 - 400 x 103/uL

CT

7.00

4 10 mnt

BT

3.00

1 7 mnt

Na/K/Cl

144/4.7/ 102

Mmol/L

SGOT

23

<35 U/L

SGPT

26

<45 U/L

GDS

92

80-180 mg/dl

HBsAg

Non Reactive

Non Reactive

RESUME
A male, 16 years-old was admitted to the hospital because of
pain in the left groin, suffered since 1 month before admission,
due to fall.
Based on physical examination, wound incision present at
anterolateral left thight region, deformity and tenderness were
present. Active and passive motions of the hip joint cannot be
evaluated due to pain.
Laboratory findings showing anemia.
X-Ray of pelvis and left femur showed Fracture Left Basic Neck
of Femur.

DIAGNOSIS

Closed Fracture of Left Neck of


Femur

MANAGEMENT

INITIAL
IVFD
Analgesic
Skin traction with load 3kg

DEFINITIVE
ORIF
Cannulated Screw Fixation

Discussion:

FEMORAL NECK
FRACTURE
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DEFINITION
o
o
o

A break in the structural continuity of bone


If overlying skin is intact : Closed fracture
If skin is not intact: Open fracture

Fracture of proksimal femur,


intracapsular fracture
Direct

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

OVERVIEW
>250,000 hip
fractures occur in the
US each year (50%
involve the femoral
neck)

80% occur in ,
Incidence; younger
doubles every 5 to 6
patients low; older
years in age >30
patient high
years.

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

FEMUR BONE

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

BLOOD SUPPLY

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

MECHANISM OF INJURY
Direct

Breaks at the
point of impact

Indirect

Bone breaks at a
distance where the
force is applied

Repetitive stress

Normal bone,
repeated heavy
loading.

Typically in
athletes, dancers
or military.

Pathological
fracture

Bone weakened
by a change in its
structure

Osteoporosis,
tumor, congenital
anomalies

Injury/ Trauma

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

DIAGNOSIS

Pain on left groin


Simple, highenergy trauma
history of fall on
left region position

HISTORY
TAKING

PHYSICAL
EXAMINATION
Tenderness at left
groin
Pain on
movement

Campbell Operative Orthopedics 12th Edition.


Rockwood and Green's Fractures in Adults (7Ed. 2010)

Xray shows
fracture left neck
of femur

IMAGING

CLASSIFICATION
Classification by
Anatomic Location
Subcapital
Transcervical
Basicervical

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


Campbell Operative Orthopedics 12th Edition.

Pauwels classification

anatomical
classification

garden
classification

TREATMENT GOALS
Restore hip
function
Minimize
patient
discomfort

Rapid
mobilization

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

MANAGEMENT
Non Operative
External Reduction
Gradual mobilization
Operative preferred

Cannulated screw fixation


Sliding hip screw
Hemiarthroplasty
Total Hip Arthroplasty

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

MANAGEMENT
Cannulated Screw Fixation
Garden I & II fracture in the elderly
Displaced transcervical fracture in young patient

Sliding Hip Screw

Basicervical fracture
Vertical fracture pattern in a young patient

MANAGEMENT
Hemiarthroplasty
Elderly with poor bone quality

Total Hip Arthroplasty


Eldery with high functional demands and good bone
density
Garden III & IV fracture in patient > 85 years

COMPLICATIONS
Early Complication :
DVT
PE
Ulcus decubitus
Late Complication :
Osteonecrosis Avascular Necrosis of femoral head
Non union
Secondary Osteoarthritis

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 4th Edition

Thank You