Case Report

Closed Fracture 1/3 Media Os

Radius D and Maxillofacial Injury
oleh :
A. Kartini Eka Putri
13 17 777 14 208

Pembimbing :
Dr. dr. Muh. Ardi Munir, Sp.OT, M.Kes, FICS, M.H
 Case Report
Patient Identity

Name : Ms. R

Age : 42 Years

Gender : Women

Profession : Housewife

Address : Pasangkayu
 History

Main complaint Pain in the face and right arm

Guided history The patient is a referral from

Pasangkayu Hospital. Patient was
referred to pain in the right arm
and sores on face and forehead
that were felt about 3 days ago,
after a traffic accident. After the
accident patient was immediately
taken to the Pasangkayu Hospital.
According to the family who
delivered, blood was seen from
patient's nose and mouth. The
patient also had passed out for
about 6 hours. And forget what
happened at the accident.
 The patient is riding a
Mechanism of Injury motorbike using a head
protector at medium speed,
suddenly from behind the car
appears and grabs the
patient. The exact
mechanism of injury is
unknown.
 Primary survey

Airway Clear
Breathing 20 x /minutes
Spontaneous breathing, symmetrical left and right
Circulation TD : 120/80 mmHg
HR : 97 x / minutes Regular
CRT <2 detik

Disability GCS : 15 ( E3 M6 V5 )
Round pupils, Isokor, diameter 2.5 mm / 2.5 mm,
direct / indirect light reflexes + / +
Exposure T : 36,4oc (aksila)
 Lokalist Status
a. Region Facialis b. Antebrachii Region (D)
• Inspection: Teeth and • Inspection: Deformity
Palatum (+) deformity, (+), angulation (+),
Hematoma (+), Swelling hematoma (+), swelling
(+), Wound (-). (+), Wound (-),
• Palpation: Pain relief • Palpation: Pain relief
(+), Crepitation (+) Os. (+), warm palpation (-)
Mandibulla • Move: ROM is limited to
• Move: ROM is limited to the elbow joint and
the temporal wrist joint due to pain
mandibular joint due to • NVD: Pulsation (+) in A.
pain Radial
 Supporting Examination

• Routine Blood
WBC : 25,0 x 103/ul
RBC : 3,69 x 10 6/ul
HGB : 10,0 g/dL
HCT : 31,6 %
PLT : 156 x 103/ul
Radiology  X-Ray of
Antebrachii Dextra AP
 Diagnosis

Closed Fracture 1/3 Media

Os Radius D and
Maxillofacial Injury
 Therapy
a. Non Pharmacological - Oral Surgery and
Anesthesiologist

b. Pharmacological Therapy - IVFD RL 20 tpm Inj.

- Ceftriaxon 1gram / 12
hours / IV Inj.
- Ketorolac 1 ampoule / 8
hours / IV Inj.
- Ranitidine 1 ampoule / 8
hours / IV
c. Operative - ORIF Plan
 Discussion

In this patient a diagnosis of maxillofacial trauma

and closed fracture 1/3 of the os radius dextra
media was based on history, clinical examination
and investigations.
• Radiological examination is performed on
the patient, CT scan on axial and coronal
pieces which is the gold standard in
patients with suspected mandibular
fractures, to obtain fracture patterns,
degrees of displacement and evaluation of
orbital soft tissue.
 Case
In patients also performed X-
ray antebrachii dextra AP
examination and obtained
fractures os radius 1/3
dextra media, the diagnosis
is obtained by combining the
anatomy of location and
morphological characteristics
broken of bones.
References
In the case of closed
fractures, an x-ray is needed
to determine whether there is
an avulsion fracture
associated with the injury, and
to determine whether the
alignment of the joint after the
injury or after dislocation. If
there is an avulsion, it can
change the surgeon's
recommendation for
treatment.
 References
X-RAY
Both bones are broken, either
transversely and at the same level
or obliquely with the radial fracture
usually at a higher level
Classification of fractures

This patient has a

complete closed
fracture, and is
etiologically
included in a
traumatic fracture
 Operative
• Management for maxillofacial trauma in
this patient is repositioning-reduction of
the maxillary mandibular in a fixation
 Case
The treatment of closed
fracture 1/3 of the radius
dextra in this patient has been
planned for an open reduction
internal fixation (ORIF).
References
Recommendations for
operative care rather than
conservative radius fractures
in adult patients ≥ 18 years
produce better results than
conservative care
 Case References
In patients, operative This is because the type of
therapy is recommended fracture is complete, and in
fractures of the radius tends
for repositioning of the to occur rotation so as to
fracture achieve a reduction in position
is by internal fixation using
compression plates and
screws in adults
 Case References
In a patient : According to the theory the
- Fracture is complete, indications for ORIF include
replacing articular fractures
that is, the fracture line with impaction from the joint
crosses or cuts across surface, more than one
the entire bone and broken fragment, fractures
fragments are usually that require proper axial
displaced alignment (for example in an
- Age arm fracture), the patient's
age, and there is a high risk of
damage to neorovascular
structures.
 References
Additional rotation deformity may be produced
by the pull of muscles attached to the radius:
- They are the biceps and supinator muscles
to the upper third, the pronator teres to the
middle third, and the pronator quadratus to the
lower third.
- Bleeding and swelling of the muscle
compartments of the forearm may cause
circulatory impairment.
• The benefits of ORIF include reducing pain and helping
broken arms or legs to heal properly, restore bone to
normal function and prevent further injury.
 Prognosis

References Case
The prognosis of a However, the patient
radius fracture if treated refused to do this operative
action so it is likely to
properly is generally occur several
good. complications
 Complications

Non-union : fracture healing occurs 4 to 6 months after the initial

injury and after spontaneous healing does not seem to occur. Usually
caused by inadequate blood supply and uncontrolled pressure at the
fracture site.

Malunion : is a condition where a broken bone has been connected in

an undue position. Malunion is a bone healing characterized by
increased levels of strength and deformity.

Delayed union : is a healing process that continues to run at a pace

that is slower than normal. Delayed union is a failure of the fracture to
consolidate according to the time it takes for the bone to connect, this
is due to a decrease in blood supply to the bone.
Thank You