Case Presentation

November

2015

CLOSED FRACTURE 1/3 MIDDLE LEFT TIBIA

PRESENTED BY:
Muthmainnah
C 111 10 259
ADVISORS:
dr. Wira Sundoko
dr. Nur Rahmansyah
SUPERVISOR:
dr. M. Ruksal Saleh, Ph.D, Sp.OT (K)

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY
HASANUDDIN UNIVERSITY
2015

PATIENTS IDENTITY

Name

: Mrs. Y

Age

: 33 years old / female

Admission : November 13, 2015

Registratio : 686608
n

AUTOANAMNESIS

Chief Complain :

Pain at left leg

Suffered since 6 hours before admitted to the
Wahidin Sudirohusodo General Hospital due to
traffic accident.

Mechanism of injury : The patient was walking

across the street when suddenly got hit by a car
from the left side. After the accident patient
couldnt stand due to pain at his left leg.

History of unconciousness (-), vomiting (-)

PHYSICAL EXAMINATION

PRIMARY SURVEY
Airway : Clear
Breathing : RR 18x/min regular
Circulation : BP 120/80 mmHg HR = 88 x/min
regular
Disability : GCS 15 (E4V5M6), Pupil isokor 2,5
mm /
2,5 mm, LR +/+
Exposure : T = 36,70 C (axillary)

PHYSICAL EXAMINATION

SECONDARY SURVEY
Left Leg Region
Look
: Deformity (+), swelling (+), hematome (+),
and wound (-)
Feel
: Tenderness (+)
Move
: Active and passive movement of the knee
joint and ankle joint cannot be evaluated due to
pain.
NVD
: Sensibility is good , pulsation of dorsalis
pedis artery and tibialis posterior artery is
palpable, Capillary Refill Time < 2.

LEG LENGTH DISCREPANCY

ALL
TLL
LLD

R
85 cm
80 cm

L
85 cm
80 cm
0 cm

CLINICAL FINDINGS

Anterior
view

Lateral view

Medial view

SUPPORTING
MODALITIES
Parameter

Value

Normal

WBC

12,13

4,00-10,0

RBC

4,23

4,00-6,00

HGB

12,8

12,0-16,0

HCT

37,1

37,0-48,0

PLT

352

150-400

CT

800

4-10

BT

300

1-7

HBsAg

Non
Reactive

Non
Reactive

RADIOLOGY
EXAMINATION

Fracture 1/3
Middle Left
Tibia

RESUME
Female, 33 years old, was admitted to the hospital
with the chief complaint pain at left leg, since 6
hours.
The mechanism of trauma : the patient was
crossing then suddenly hit by car from the left.
Primary survey : normal limit. Secondary survey :
at the left leg
from the look : there were
deformity, swelling and hematoma, feel there is
tenderness. move difficult to evaluate due to pain,
NVD in normal limit, LLD = 0 cm.
From laboratory finding, there is slightly increase
of WBC.
From radiologic finding, there is fracture 1/3 middle

DIAGNOSIS

Closed Fracture 1/3 Middle of the Left Tibia

MANAGEMENT

IVFD RL 20 drips per minute

Analgetik
Apply long leg back slab left lower limb
Elevation of left lower limb
Plan for circular cast

DISCUSSION

PATIENT EVALUATION

HISTORY TAKING

Suspect
fracture of
Tibia + no
neurovascul
ar
complicatio
n + no
tendency to
compartme
nt
syndrome

EVIDENCE LEADING TO
DIAGNOSIS
(SUPPORTING MODALITIES)

Fracture 1/3
middle left tibia

EVIDENCE LEADING TO
DIAGNOSIS

History Taking
Physical
Additional
Examination
Examination

Close Fracture 1/3 Middle Left Tibia

MECHANISM OF INJURY

Koval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4 th edition

INITIAL TREATMENT

Apply long leg back slab

Pain alleviation
To minimize soft-tissue injury
To hold fracture alignment
Sean E. Nork. Femoral Shaft Fracture in Rockwood And Greens Fracture in Adult, 7 th Edition

TREATMENT

Koval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4 th edition

TREATMENT
Conservative (Non- Operative) :
Indication:
Acceptable Fracture
< 5o of varus/valgus 2o of
varus
< 10o of anterior/posterior
angulation 5o
0o of rotational deformity
0o
< 1cm of shortening 0 cm
> 50% cortical contact

Koval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4 th edition

DEFINITIVE
TREATMENT

Circular Cast
Advantages:
Non invasive
Low risk of infection
Disadvantages:
Risk of skin problem
Risk for compartment syndrome

Sean E. Nork. Femoral Shaft Fracture in Rockwood And Greens Fracture in Adult, 7 th Edition

COMPLICATION

Delayed union
Non-union
Malunion
Infection
Joint stiffness

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9 th Edition. New York : Arnold. 2010

THANK YOU