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Case Presentation

CLOSED FRACTURE
INTERTROCHANTER RIGHT FEMUR

Moch. Imam Nur Fadly


111 2015 0147

SUPERVISOR:
dr. Muh.Alihasti, Sp.OT,

ADVISOR: dr. Randy


Patients Identity

Name : An. A
Age : 15 years old
Sex : Male
Religion : Moslem
Address : sidrap
Date of admission : sept 30th 2017
Medical Record number : 13.71.11
History Taking
Chief Complain : Pain at the right thigh.
Anamnesis : Suffered since 3 hours before admitted
to Andi Makkasau Hospital due to traffic accident.
Mechanism of Trauma : Patient was riding
motorcycle, suddenly he hitted by a car from the
opposite direction.
History of loss of consciousness (-), history of nausea
and vomiting (-), history of headache (-).
Primary Survey

Airway and C-spine Airway : Patent, clear


control C-spine control : -

22x/min, thoracoabdominal, spontaneous


Breathing breathe, symmetric chest movement

BP 100/70 mmHg, HR 80x/min, regular,


Circulation strong on palpation

GCS 15(E4M6V5), light reflex +/+ ,


Disability pupil isochors, : 2.5mm/2.5mm,

Exposure Temp 36.9C (axilla)


Secondary Survey

Left Thigh Region


Look Deformity (+), swelling (+), hematoma (+), wound (+)

Feel Tenderness (+)

Move Active and passive movement of hip and knee joint can not be
evaluated due to pain

NVD Good sensibility, pulsation dorsalis pedis artery and posterior


tibial artery are palpable, CRT <2 seconds
CLINICAL FINDING
Radiologi Finding
Laboratorium

Pemeriksaan Hasil Nilai normal


HGB 9,1 g/dl 11,5 17,0 g/dl
RBC 3,18 x 106/mm3 3,8 6,5 x 106/mm3
WBC 9,3 x 106/mm3 4,0 10 x 106/mm3
HCT 28,7 % 37 54 x 106/mm3
Resume
A 15 years male admitted to Andi Makkasau Hospital with chief complain pain
at the right thigh, suffered since 3 hours before admitted to the hospital due to
traffic accident. Patient were riding motorcycle, suddenly he hitted by a car from
the opposite direction.

General status clear.

Localized status: right thigh regio

Look : deformity (+), swelling (+), hematom (+) wound (+)

Feel : tenderness (+).

Move : can not be evaluated due to pain.


NVD : normal.

X-ray examination is fracture 1/3 proximal intertrochanter right femur


Diagnosis
Initial Management
1. Immobilisation: splinting
2. Elevation of right leg
3. IVFD
4. Analgesic
5. Plan for ORIF
Intertrochanter
Fracture
Anatomy of
Femur
Anatomy of Femur
Introduction
Fracture a break in the structural continuity of bone, cartilage, joint and
growth plate
If overlying skin remains intact : closed fracture
If skin not intact : open fracture
CLASSIFICATION

http://emedicine.medscape.com/article/1247210-overview#a04
Mechanism of Injury

Direct trauma High-energy Motor vehicle


injuries accident

Indirect trauma Low energy Torsional


injuries (Fall and
twisting)
PHYSICAL EXAM

LOOK FEEL MOVE


Deformity Tenderness Decreasing
of ROM

Angulation Crepitation

Rotation Pulsation

Shortening

Oedema
Diagnose

History and Mechanism of Trauma

Physical Examination

X-ray with Anteroposterior/ lateral


view
Treatment

CONSERVATIVE

Traction

OPERATIVE

Internal Fixation
External Fixation
Complication

EARLY COMPLICATION LATE COMPLICATION

Nerve injury
Vascular injury Malunion
Compartment syndrome Delayed union
Infection Non union
DEPARTEMENT OF ORTHOPAEDIC
AND TRAUMATIC MEDICAL FACULTY
OF HASANUDDIN UNIVERSITY