CASE REPORT Closed Fractured 1/3 Proximal of the Left Femur

PATIENT IDENTITY

Name Age Work Address Day admitted Medical Record

: An. F : 10 years old : Student : Gowa : 21 June 2011 : 444139

HISTORY TAKING
Chief complaint: Pain at the left thigh. History Taking:

Suffered since four hours before admitted to the hospital due to the traffic accident. Mechanism of trauma : Patient was crossing a street and suddenly he got hit by a motorcycle from his left side . History of unconsciousness (-), nausea and vomiting (-). History of prior treatment at Gowa General Hospital PRIMARY SURVEY A : Patent B : symmetry left = right , Thoracoabdominal type, RR 20 x/minutes, bronchovesicular C : BP: 110/60 mmHg, HR:88 x/minutes D : GCS15(E4V5M6), pupil isokor 2,5 mm/2,5mm, light reflex +/+ E : Temperature 36,70 C (axillar)

SECONDARY SURVEY LOCAL STATUS Left Thigh Region

I P ROM

: :

Deformity (+), swelling (+),haematoma (+), wound (-). Tenderness (+) : Active and passive motion at hip and knee joints are limited due to pain.

NVD

:Sensibility is good, pulse of dorsalis pedis and tibialis posterior arteries are palpable, capillary refill time < 2.

CLINICAL FINDING

LEG LENGTH DISCREPANCY Right Leg Apparent Leg Length True Leg Length 72 cm 68 cm Left Leg 70 cm 66 cm

Leg Length Discrepancy 2 cm

Laboratorium Findings WBC RBC HGB HCT PLT CT BT GDS 16,25 x 103 /uL 4,39 x 106 /uL 11,2 g/dL 33,8 % 281 x 103 /uL 8 30 mnt 2 30 mnt 146 mg/dl

Ureum

22 mg/dl

Creatinin 0,8 mg/dl SGOT SGPT 47 U/I 14 U/I

PELVIC AP VIEW

LEFT FEMUR AP/LATERAL VIEW

RESUME

A boy, 10 years old, was admitted to hospital with chief complaint pain at the left thigh due to traffic accident. History of prior treatment at Gowa General Hospital. Physical examination finding ,at the left thigh seen deformity (+), swelling (+), haematoma (+) wound(-) . Tenderness on palpation. Leg length discrepancy is 2 cm, and the NVD within normal limit From pelvis X-Ray and Left Femur X-ray finding, there is transverse fracture 1/3 proximal of the left femur.

DIAGNOSIS Closed Fracture 1/3 proximal of the left femur

TREATMENT Analgetic Skin Traction Plan for Open Reduction Internal Fixation (ORIF)

DISCUSSION Anatomy of Femur

 Anterior compartment

Medial compartment

 Posterior compartment

MECHANISM OF INJURY Direct trauma : Motor vehicle accident, pedestrian injury, fall, and child abuse. Indirect trauma : Rotational injury. Pathologic fractures

CLASSIFICATION OF FRACTURE

Stable I II intact Unstable III IV : Comminuted < 50% of cortices intact : Complete comminution, no intact cortex : Minimal comminution : Comminuted > 50% of cortices

TREATMENT Conservative Indication : 1)Length 2) Angulation

3)Rotation

Operative Indication : Multiple trauma, including head trauma Open fracture Vascular injury Pathologic fracture Uncooperative patient

COMPLICATION EARLY Compartment Syndrome Fat embolism and ARDS Thromboembolism LATE Shortening Malunion/ non-union Fracture disease

SLIDE