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CASE REPORT

“Closed Fracture Os. Radius Distal


Sinistra”
Arraged by
Azizir rohim

Advisor
dr. Wisnu Murti Sp.OT
Intoduction
 A fracture is a break in the structural continuity of bone. The
overlying skin remains intact it is a closed (or simple) fracture; if
the skin or one of the body cavities is breached it is an open
(or compound) fracture, liable to contamination and infection.
 Distal radius fracture (DRF) is a common wrist injury and
the incidence appears to be increasing worldwide. Typically, a
DRF is characterized by a low-energy fracture occurring
approximately 2 cm above the distal articular surface of the
radius at the junction where the cortical bone becomes
thinner and is reinforced by the trabecular bone network
Anatomy of os. Radius
Wrist Regio
Trauma Mechanism
 The usual injury is a fall on the outstretched hand with the
wrist in extension; the distal fragment is forced posteriorly
(this is often called a ‘juvenile Colles’ fracture’). However,
sometimes the wrist is in flexion and the fracture is angulated
anteriorly. Lesser force may do no more than buckle the
metaphyseal cortex (a type of compression fracture, or torus
fracture)
Salter Harris clasification
Management
• Open reduction and
ORIF internal fixation

• Closed reduction
CRIF and Internal fixation
Management
 Absolute Indications for Open Treatment
1.Displacement of condyle into the middle cranial fossa (with
or without fracture)
2.Lateral extracapsular displacement of condyle (with or
without fracture)
3.Impossibility of obtaining proper occlusion by closed
techniques
4.Condylar fractures associated with comminuted fractures at
or above the LF 1 level
 Relative Indications for Open Treatment
I. Loss of Ramus Height
II. Skeletal Maturation of Patient
III. Feasibility of Open Reduction and Internal Fixation
IV. Associated Fractures
V. State of the Dentition.
Closed Reduction and Internal Fixation
 Closed Reduction and Internal Fixation, It is the reduction or
setting of the fracture without surgery. There are no
incisions. Here the surgeon manipulates the fracture into
correct alignment with the use of traction.
 Benefits of a Closed Reduction
1. Help your bone heal quickly and be strong when it heals
2. Decrease pain
3. Improve the chances that your limb will look normal and
you will be able to use it normally when it heals
4. Lower the risk of an infection in the bone
5. Remove tension on the skin and reduce swelling
Complication
 EARLY
Forearm swelling and threatened compartment syndrome This
dire combination can be prevented by avoiding over-forceful
or repeated manipulations, splitting the plaster, elevating the
arm for the first 24–48 hours and encouraging exercises.
 LATE
Malunion This late sequel is uncommon in children
under 10 years of age. Deformity of as much as 30 degrees
will straighten out with further growth and remodelling over
the next 5 years. This should be carefully explained to the
worried parents.
Case Report
Patient status
IDENTITY

 Name : An. A
 Age : 14 years 3 mounth
 Gender : female
 Address : kartikajaya
 Job :-
 Religion : Islam
 At Hospital : May 25th 2019
 Room : Kenanga
 NO. CM : 580703
Patient Status
ANAMNESA Primary Survey
Symptom : Pain in left 1. Airway : Patent, clear
wrist
2. Breathing :Normal,
Patient History :
18x/m
Patient comes to the hospital
post motor cycle traffic 3. Circulation : BP 133/98
acident. Patient didn’t know mmHG, HR 150x/m
position when she falled from
the motor cyle and patient 4. Disability : Compos
didnt remember about the mentis GCS 15
accident et all. Patient felt 5. Exposure : Normal,
pain in regio wrist join, and
difficult to move. nothing lession
Patient Status
 Medical History
History of similary injury : Denied
History allergy drug and food : Denied
History of long cough : Denied
 Family medical history
History of similary symptom : Denied
History of heart disease : Denied
History of diabetics melitus : Denied
 Personal history, sosial, and enveronment
Patient used health insurance BPJS
PHYSICAL EXAMINATION

GCS : E4 M6 V5
 VITAL SIGN
HR : 150x/m
RR : 18x/m
BP : 133/98 mmHG
T : 36,5oC
 Status generalis
Skin : Turgor (N)
Head : Mesocephal
Eyes : Anemis -/-
Ear : Discharge -/-
Nose : Deviation -/-, discharge -/-
Mouth : Bleeding (-)
Neck : Simetris, deviation trachea (-)
Thorax : Normal
Abdomen : Normal
Extremitas
Superior Inferior

Akral -/- -/-


Oedem -/+ -/-
Capilary Refill <2” <2”
Lession -/- -/-
Hematom -/- -/-
Status localis of upper extemitty in
sinistra wrist
Look Feel
 Skin color :  Skin temperature :
Normal Normal
 Edema : (+)  Tenderness : (-)
 Pale and winkled : (-)  Krepitation : (+)
 Vulnus : (-)  Artery pulsation : (+)
 Deformity : (+)  Sensivity : (+)
Movement
 Aktif ( -)
 Pasif (+)
LABORATORY TEST
Pemeriksaan Hasil Normal
HB 12.7 11.5-16.5
Leukosit 14.6 4.00-10.00
Trombosit 294 150-500
Hematokrit 36.6 35.0-45.0
Waktu protrombin Sample 11.3-14.7
APTT sedikit 27.4-39.3
Radiology
Before ORIF After ORIF
DIAGNOSE PLANNING Education PROGNOSIS
• Closed fracture THERAPHY • Describe of the trauma • Quo ad vitam : ad
epifisiolisis distal radius • Ip Terapeutic and the prognosis to the bonam
sinistra • Inf RL 20 tpm family • Quo ad sanam : ad
• Inj ketorolac 30 mg/8 • Explane the possible bonam
jam complication taht can • Quo ad fungsionam : ad
happen to family bonam
• Inj cefazolin
igr/12jam
• Inj ranitidin 5 gr
• Ip operatif
• CRIF
• Ip Monitoring
• General situation, Vital
sign, the result of
supporting
examination
CONCLUSION

Distal radius fracture (DRF) is a common wrist injury and the


incidence appears to be increasing worldwide. The fracture is
reduced by traction, supination and extension of the wrist,
and the forearm is immobilized in a cast. X-rays should be
taken to ensure the fracture has not slipped. Operation
treatment of fracture distal radius depend on result on
radiological. It could be treat by open reduction or close
reduction depend on clinical and radiological indication.

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