CHAPTER IV

DISCUSSION

Anamnesis

The patient couldnt move her arm due to stiffness. This problem felt by
patient was about 2 months ago. This was started when the patient had an injury
from motorcycle accident. The initial complain was edema on her left arm. Then
she looked after the massage therapist to resolve her problem. Day by day, the
edema was come back and patient felt pain and became difficult to move her left
arm due to stiffness. Then the patient went to hospital to do a radiology study and
consult her condition. The problem was felt all day long and didnt resolve by
rest.

Physical Examination

Look:
- Skin colour : normal
- Edema : (+) at left upper arm and forearm
- Pale and wrinkled : (-)
- Wound : (-)
- Deformity : (-)
Feel:
- Skin temperature : normal
- Tenderness : (-)
- Crepitation : (-)
- Artery pulsation : (+)
Movement:
Active (-)
Passive (+)

Definitive diagnosis of fracture on the region of the left upper arm

established based on the result of the x-ray region of the left AP and lateral
humeri indicating complete closed fracture of midshaft humerus sinistra.
Laboratory test HB, leukocyte, trombocyte, HT, PT, APTT, intended as
preparation if conducted operative intervention in these patients.

Medical management of the case are : Inj cefazoline 2x1g, Inj ranitidine
3x50mg, Inj dexketoprofen 2x50mg, Per-Oral Levofloxacin 1x500 mg,
Dexketoprofen 2x25mg, Kalk. Dexketoprofen is used to relieve painful problems
of the muscles and bones and other pain of mild to moderate intensity. Cefazolin
is an antibiotic used to treat a wide variety of bacterial infections to help prevent
infection and ranitidine protect the gaster. Calcium lactate is used to prevent and
to treat calcium deficiencies, especially for bone formation and maintenance.

To treat this kind of fracture in adults are optimally treated with open
anatomic reduction and stable fixation to allow for early anatomic restoration and
upper extremity ROM with screw and plate insertion (ORIF). There must be
adequate soft tissue exposure sufficient to provide an area for the plate. The plate
should be centered over the fracture, and long enough to allow neuroplate six
holes in each of the proximal and distal fragment.