Case Presentation of Outpatient

Orthopaedic Surgery Department

Group 2 International 2012
Rochmanita
Yonanda
Hifdza 15320
Meydita 14880
Danica 14863
Timotius 15317
Rut 15334
Agra 15338
Jindan 15344
Jia Ing 15368
Divya 15369
Lydia 15379
 Case
• A man, age 27, a bird seller, came to
Orthopaedic policlinic for follow up. 6 months
ago, he had an accident and tibial and fibula
fracture. He had his surgical repair in Bantul.
However, there was an imperfect fixation and
the plate is broken. Thus, the healing lead to
improper alignment of the bones. He was
referred to Sardjito 3 days ago.
 Tibial and Fibular Fracture
• Lower leg fractures include fractures of the
tibia and fibula.
• Of these two bones, the tibia is the only
weight-bearing bone. Fractures of the tibia
generally are associated with fibula fracture,
because the force is transmitted along the
interosseous membrane to the fibula.
 Etiology
• Direct trauma
– Motor vehicle crash

• Indirect trauma
– Twisting
 Mechanism of Injury
• Low energy
– Ground levels falls and athlete injuries

• High energy
– motor vehicle injuries, pedestrians struck by
motor vehicles, and gunshot wounds
 Signs and Symptoms
• Pain
• Swelling
• Redness
• Unable to walk without crutches
 Physical Examination
• Look
– Swelling, redness, discolouration, bleeding, gross
deformity, type of fracture, debridement
• Feel
– Pain, Tenderness, numbness, temperature, capillary
refill time, pulse, neurovascular assessment
• Move
– Range of movement of the injured joint compared to
the normal
 Supporting Examination
• Radiography (Gold standard)

Post 2nd surgery:

Art. Genu normal
Post 2nd surgery:
• Fibula  conventional method
• Tibia  fixated with “Plates & Screws”
 Prehospital Care
• Address airway, breathing, and circulation.
• Check and document neurovascular status.
• Apply sterile dressing to open wounds.
• Apply gentle traction to reduce gross
deformities; splint the extremity.
• Administer parenteral analgesics for an
isolated extremity injury in a
hemodynamically stable patient.
 Emergency Care
• Parenteral analgesic
• Debridement and wound
care
• Open fracture  tetanus
vaccination and appropriate
antibiotic within 3 hours
• Immobilization
• Refer to orthopaedic
department
 Pharmacological Management
• Analgesic (eg: Piroxicam)
• Non-Steroidal Anti-Inflammatory Drugs (eg:
Ibuprofen)
Non-Pharmacological Management
• Keep dry
• Rest and less straining of the legs
• Attend follow up weekly
• Immediately visit doctor if there is
complication (worsen pain, bleeding,
infection)
Thank You!