hasnah ortho
TRANSCRIPT
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PRESENTED BY:
JOEL GUNTER SINURAT, MD
ADVISORDR.FELIX BATUNADR.ARIEF FAISAL
SUPERVISORdr. Henry Yurianto, M.Phil, Ph.D, Sp.OT (K)
Orthopaedic and Traumatology DepartmentMedical Faculty of Hasanuddin University
Makassar
201
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IDENTITY
!ame " !y#H
$ge " %& years old
'e( " Female
$dmission " !ovem)er *th+ 201 at 1*",
-egistration " *. .0 20
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HISTORY TAKING
Chief Complaint: wound at the left leg
Hitory of illne
Suffered since 12 hours before admitted to
Wahidin Sudirohusodo General Hospital. Thepatient was riding a motorcycle and got hit by
another motorcycle from opposite direction.
History of unconsciousness (-! "ausea (-!
#omiting (-.$rior Treatment at Ta%alar Hospital
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PRIMARY SURVEY
$ " /lear
" -- 22 (min+ spontaneous+ thoracoa)dominaltype
/ " 110,0 mmHg+ H- ..(min strong+regular
D " 3/' 14 56M*748+ upil isochoric+ diameter2#4mm2#4mm+ light refle( 99
6 " T" %,o/
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SECONDARY SURVEY
:eft :eg -egion
:ook " 'titched ;ound at anteromedial aspect 1% middle si
Move "$ctive and passive motion of the knee ?oint not )e evaluateddue to pain
$ctive and passive motion of the ankle ?oint not )e evaluateddue to pain
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LEG LENGTH DISCREPANCY
Right L!t
ALL "# $% "& $%
TLL '( $% ') $%
LLD #
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CLINICAL FINDINGS
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CLINICAL FINDINGS
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RADIOLOGIC FINDINGS
/ruris $:ateral5!ovem)er &th+ 2018
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LABORATORY FINDINGS
*BC 1+1 +00@10+0
RBC 12#4 12+0@1*+0
HCT %.#0 %,+0@.+0
PLT 2%0 140@00
GOT 21 = %.
GPT 1* = 1
CT ,A00 @10
BT 2A00 1@,
N+ 12 1%*@14
K +0 %+4@4+1
C 10* &,@111
H-Ag !on -eactive !on -eactive
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DIAGNOSIS
Open !ra"ture #$% middle left ti&ia 'rade a
Open !ra"ture #$% middle left fi&ula 'rade a
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RESUME
& ' years old female was admitted to theWahidin Sudirohusodo General Hospital due to
)ehicular accident.
*n physical e+am! there was Stitchedwound at anteromedial aspect 1,' middle left leg
sie ' cm! deformity! hematome! Swelling and
tenderness! acti)e and passi)e motion of %nee
and an%le oint cannot be e)aluated due to pain.
There is no neuro)ascular compromised.
*n radiologic finding! there is an fracture 1,'
middle left tibia-fibula.
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MANAGEMENT
I/t0+1/23 !3i4 40i5
A/ti-i2ti$
A/+gti$
Tt+/3 T262i4
D-0i4%/t
P+/ !20 O5/ R43$ti2/ I/t0/+ Fi6+ti2/
7ORIF8
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FRACTURE OFFRACTURE OF
THE TIBIATHE TIBIA
AND FIBULAAND FIBULA
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INTRODUCTION
$ fracture is a )reak in thestructural continuity of )one#
/lassification of fractures"
1# open vs close
2# /omplete B transverse+o)liCue+ spiral+ comminuted
ncomplete B greenstick+)uckle or torus
Salomon L., Warwick D., Nayagam S. Apleys System of Orthopaedics and Fractres !thed. "#.$%&%.$'()**
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ANATOMY
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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COMPARTMENT
OF LEG
$nteriorcompartment
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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COMPARTMENT
OF LEG
:ateralcompartment
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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COMPARTMENT
OF LEG
'uperficialposterior
compartment
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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COMPARTMENT
OF LEG
Deep posterior
compartment
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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EPIDEMIOLOGY
Fractures of the ti)ia and fi)ula shaft are the mostcommon long )one fractures#
n an average population+ there are a)out 2* ti)ialdiaphyseal fractures per 100+000 population per year#
Men are more commonly affected than ;omen+ ;ith themale incidence )eing a)out 1 per 100+000 per year andthe female incidence a)out 12 per 100+000 per year#
The average age of a patient sustaining a ti)ia shaftfracture is %, years+ ;ith men having an average age of %1years and ;omen 4 years#
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CLASSIFICATION OFFRACTURE
Clinical types:open fracture / close fractureEtiology :
traumatic fracture/ stress fracture/pathologic fractureConfguration classifcation:
+hompson -. Netters -oncise Orthopaedic Anatomy $nded. $%&%
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G3ti2 9 A/402/ C+i!i$+ti2/ 2! O5/F0+$t30
G0+4 *23/
4 i
C2/t+%i/
+ti2/
S2!t ti3 B2/ i/;30<
=1cm /lean Minimal @'imple 5transverse+ shorto)liCue8@minimal comminution
E1cm Moderate Moderate @moderate comminution5transverse+ short o)liCue8
$ E10 cm High @e(tensive soft tissuelaceration@ $deCuate softtissue coverage
@minimal periostealstripping@soft tissue coverage of )oneis possi)le
E10 cm Massive @6(tensive soft tissuein?ury@ !eed soft tissuereconstruction
@moderate to severecomminution@poor )one coverage
/ E10cm Massive @severe loss of softtissue@need !7reconstruction
@poor )one coverage@moderate to severecomminution
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MECHANISME OF INJURY
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TREATMENT
#enneth . #oal, oseph D. /ckerman 0 1and2ook of Fractre 'rd edition,
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D$3!O''
Solomon. L. et al. Apleys System of Orthopedics and Fractures 9thEdition. New York
Arnold. !"#"
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COMPLICATION
E+0