Case Presentation

CLOSED FRACTURE 1/3 MIDDLE OF RADIUS ULNA

RIFKA NOVRIANTY
111 2015 2167

SUPERVISOR:
dr. Ariyanto Arief, Sp.OT,M.kes
ADVISOR: dr. Stefan
 PATIENT’S IDENTITY

Name : An. R
Age : 17 years old
Sex : Boy
Address : Pare-pare
Work : Student
Date of admission : January 22, 2018
Medical record : 142949
 HISTORY TAKING

•Chief Complain : Pain at right arm

• Anamnesis : Suffered since 3 days before admitted to
Andi Makkasau Hospital due to falling when playing
socccer
•Mechanism of Trauma : patient was fall with
outstretched hand
•History of loss of concisiousness (-), history of vomiting
(-)
 General Status
Compos mentis, well nourished
BP: 100/70 mmHg
HR: 88 x/min
RR: 20 x/min
Temp: 36.8
NRS : 4
 Local Status

Right Forearm Region

Look Deformitas (+), udem (+), hematoma (+), wound (-)
Feel Tenderness (+)
Move Active and passive movement of motion elbow joints can not
be evaluated due to pain
Active and passive movement of wrist joint can not be
evaluated due to pain
NVD Good sensibility, pulsation A. radialis and A ulnaris, CRT <2
seconds
Clinical Photo
RADIOLOGY FINDING

Photo antebrachii PA/Lateral

 LABORATORY FINDING
Items Result Unit N Value
Hematology:
WBC 8,62 103/ul 4-12
Eosinofil 2,83 % 2-4
Basofil 1,5 % 0-1
Netrofil 51,5 % 50-70
Limfosit 32,8 23.9 % 25-50
Monosit 4,8 3.16 % 1-6
RBC 5,34 106/ul 3,8-5,2
Hemoglobin 15,0 g/dl 12,8-16,8
Hematokrit 41,3 % 35-47
MCV 77,2 Fl 80-100
MCH 28,0 Pg 26-34
MCHC 36,3 g/dl 32-36
PLT 108 103/ul 150-450
Items Result Unit N Value

Imuno-Serologi:
Negative
HBsAg (Kualitatif)
Negatif
Hemostasis:
CT
BT 7’00’’
< 15’00”
1’35’’
Minutes 1’00” – 3’00”
minutes
 RESUME
17-years-old boy arived to Andi Makkasau Hospital with pain in his
right arm since about 3 days before. The boy was felt when playing a
football.

Primary survey clear.

Secondary survey:

Right arm : deformity (+) Swelling (+) Wound sized 7x7cm

bone based at anterior aspect as level distal right arm.

Neurovascular distal within normal limit

Investigations of humerus AP/Lateral and antebrachii PA/Lateral

photos: fracture 1/3 middle of radius ulna
POST OPERATIVE
 DIAGNOSIS

OPEN FRACTURE 1/3 MIDDLE RIGHT

RADIUS ULNA
 PLANNING OF DIAGNOSIS
Non Operatif Non • Education for the patient about
Medikamentosa his condition
• Stabilize the arm to prevent
Medikamentosa neurovascular injury.

• Intravenous Fluid Drips

• Intravenous Antibiotic
• Analgetik

Operatif Open Reducation Internal Fixation (ORIF)

ANATOMI
 FRACTURE
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
EPIDEMIOLOGY
ETIOLOGY

NON TRAUMA
TRAUMA
CLASSIFICATION OF SALTER AND HARRIS
PATHOPHYSIOLOGY

Humerus fractures are caused by direct trauma to arm or

shoulder or by axial loading transmitted through the
elbow.

Fractures of both the radius and ulna together are usually

the result of a fall onto an outstretched hand (FOOSH)
injury . Injury can also occur as the the result of a direct
blow.
 Diagnose
History and Mechanism of Trauma

Physical Examination

X-ray Humerus AP Lateral dextra and

antebrachii dextra lateral
ANAMNESIS
History of trauma
- Trauma can occur due to a traffic accident, fall (e.g., football,hockey)
Pain
swelling
Impaired limb function or motion abnormality
Deformity
PHYSICAL EXAMINATION
• Inspection: deformity, swelling, hematoma.

• Present with tenderness, crepitus

• Decreased range of motion at the arm,

depending on the location of the fracture

• NVD evaluation
TREATMENT
OPERATIVE

open reduction with internal

fixation (ORIF).
 COMPLICATION

EARLY COMPLICATION LATE COMPLICATION

- Compartement syndrome
- Neurovaskular injury -Mal union
- Severe displacement - Non union