Case Report Dintok

Case Report
Open Fracture 1/3 Distal (L) Tibia

Open Fracture Segmental (L) Fibula
Presented by:
A. Dhini Alfiandari (C 111 09 119)
Supervisor :
dr. Henry Yurianto, M.Phil, Ph.D, Sp.OT (K)
Advisor
dr. Rico Alexander
dr. Nia Irayanti
Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar
2014
PATIEN IDENTITY
Name
:I
Age
: 9 years old
Sex
: Male
Date of admittance : 9th February 2014

Medical Record
: 650235
HISTORY TAKING
Chief Complaint: Wound at the left leg
History of illness
Suffered since 6 hours before admitted to
Sudirohusodo hospital due to traffic accident.
the Wahidin
Mechanism of trauma : The patient was walking cross the

street, suddenly patient was hit by motorcycle from the left
and the patient was thrown. History of unconscious (-),
nausea (-), vomiting (-)
PRIMARY SURVEY
A
B
Patent
RR 20x/min regular, spontaneous
thoracoabdominal type, symmetrical
BP 110/80 mmHg
HR = 92 x/min regular, adequate
GCS 15 (E4V5M6),
isochoric pupil, : 2.5 mm, light reflex +/+
T = 36,900 C (axilla)
SECONDARY SURVEY
Localized Status :
Left Cruris region
Inspection
: Lacerated wound size 1x0,5 cm at anteromedial aspect and size
of
1x1 cm in the anteromedial aspect, bone exposed (+),muscle
exposed ( Deformity (+), Hematoma (+), Edema (+)
Palpation
: Tenderness (+)
ROM
pain
: - Active and passive motion of the knee joint are limited due to
- Active and passive motion of the ankle joint are limited due to pain
NVD
t
: Sensibility is good, dorsalis pedis artery is palpable, Capillary refill

ime <2
Right
Left
ALL
69 cm
69 cm
TLL
65 cm
65 cm
LLD
0 cm
CLINICAL PICTURE
LABORATORY FINDINGS
WBC
18,5
4,00-10,0
CT
800
4-10
HGB
11,6
12,0-16,0
BT
300
1-7
HCT
35,0
37,0-48,0
Na
140
136-145
PLT
366
150-400
4,1
3,5-5,1
GOT
38
< 38
Cl
113
97-111
GPT
21
< 41
HbsAg
Non Reactive
Non Reactive
RADIOLOGICAL FINDING
RESUME
An 9 years old boy was admitted to the Wahidin
Sudirohusodo Hospital with wound in the left leg suffered since 6
hours before admitted due to traffic accident.
In physical exam, there was deformity, wound, hematoma,
and edema, tenderness, limited active and passive motion of
knee and ankle joint due to pain. There is no neurovascular
compromised.
In radiologic finding, there is a fracture segmental left fibula
and there is fracture 1/3 distal left tibia
DIAGNOSIS
Open
Fracture 1/3 Distal (L) Tibia
Open
Fracture Segmental (L) Fibula
MANAGEMENT
Plan for Open Reduction Internal Fixation (ORIF)
FRACTURE OF THE TIBIA

AND FIBULA
Introduction
Fracture is break in structural continuity of bone
Open fracture means that skin around the fracture site has been
punctured and exposed to external environment, it increases the
risk for bacterial infection.
Fractures of the tibia and fibula shaft are the most common long
bone fractures.
Men are more commonly affected than women.
Average age < 40 years old
Usually due to traffic accident & sports injury.
Anatomy
MECHANISM OF INJURY
Indirect
Direct
Low energy
Spiral or long oblique
Bone fragment may pierce the skin from
within
High energy
Crushes or splits the skin
Usual open
CLASSIFICATION OF FRACTURE
Clinical types:
open fracture / close fracture
Etiology :
traumatic fracture/ stress fracture/ pathologic fracture
Configuration classification:
Gustilo & Anderson classification of open

fracture
Grade Woun Contamin Soft tissue
Bone injury
d size
ation
<1cm
Clean
Minimal
-Simple (transverse, short

oblique)
-minimal comminution
II
>1cm
Moderate
Moderate
-moderate comminution
(transverse, short oblique)
III A
>10
cm
High
-extensive soft
tissue laceration
- Adequate soft
tissue coverage
-minimal periosteal
stripping
-soft tissue coverage of
bone is possible
III B
>10
cm
Massive
-Extensive soft
tissue injury
- Need soft tissue
reconstruction
-moderate to severe
comminution
-poor bone coverage
III C
>10c
m
Massive
-severe loss of soft

tissue
-need NV
reconstruction
-poor bone coverage

-moderate to severe
comminution
DIAGNOSIS
31
2
4
4
X-Ray
Laboratory
Examination
Anamnesis
Physical
Examination
(rule of twos)
1. Look
2. Feel
3. Move
1. Two views
1. Two views
2. Two joints
2. Two joints
3. Two limbs
3. Two limbs
4. Two injuries
4. Two injuries
5. Two occasions
5. Two occasions
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010
GOALS OF FRACTURE MANAGEMENT

Recognize
Fracture site, types of fracture
Reduction
For adequate apposition and

normal alignment of bone
Retention
Immobilize promote soft

tissue healing
Rehabilitati
on
As early as possible by active

and passive exercise (restore
function)
TREATMENT
Conservative
Operative
Antibiotic
Debridement
Anti tetanus
Using intramedullary
nailing
Using plates and screw
Stabilization with
long leg back slab
COMPLICATIONS
Early complications
Late complication
Vascular injury
Malunion, delay union,

non- union
Compartment syndrome
Joint stiffness
infection
osteoporosis
THANK YOU

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Case Report

Open Fracture 1/3 Distal (L) Tibia

Date of admittance : 9th February 2014

Mechanism of trauma : The patient was walking cross the

: Sensibility is good, dorsalis pedis artery is palpable, Capillary refill

Fracture 1/3 Distal (L) Tibia

Fracture Segmental (L) Fibula

Plan for Open Reduction Internal Fixation (ORIF)

FRACTURE OF THE TIBIA

Fracture is break in structural continuity of bone

Men are more commonly affected than women.

Average age < 40 years old

Usually due to traffic accident & sports injury.

Gustilo & Anderson classification of open

-Simple (transverse, short

-severe loss of soft

-poor bone coverage

GOALS OF FRACTURE MANAGEMENT

Fracture site, types of fracture

For adequate apposition and

Immobilize promote soft

As early as possible by active

Malunion, delay union,

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