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