CLOSED FRACTURE LEFT NECK FEMUR

Nurul Shafini
C 111 09 869

Mentors
dr. Wendelin Widia
dr. Fahroni Cahyono Winata

Supervisor
dr.Zulfan Oktasatria Siregar, Sp.OT

Orthopaedic and Traumatology Department
Hasanuddin University
2014
PATIENTS IDENTITY
Name : Mr. DH
Age : 60 years old
Sex : Male
RM : 560144
Date of admission : 24/09/2014
HISTORY
Chief complaint: Pain of the left hip
Since 7 weeks before admitted to the
Wahidin Sudirohusodo hospital
Mechanism of trauma: patient was walking
then suddenly fell down at the left side of
the hip due to slippery floor at the bathroom
History of unconsciousness (-), nausea (-),
vomit (-)
Prior treatment at wahidin Hospital
History of bone setter (+)
PRIMARY SURVEY

A : Patent
B : RR 20 x/min, symmetric, spontaneous, abdominal
type
C : BP 120/80 mm/Hg, HR 98/min, regular, strong
D : GCS 15, pupil isochor, pupil diameter
2.5mm/2.5mm, light reflex (+/+)
E : 36.7 C (axillary)
SECONDARY SURVEY

Regio Left Hip Joint
Look : Deformity (+), swelling (-), haematom (-), wound (-)
Feel : Tenderness (+),
Move : Active and passive movement of Hip joint cannot be evaluated
due to pain
NVD : Sensibility is good, pulsation of the dorsalis pedis artery is
palpable.
Capillary refill time <2 second

LEG LENGTH DISCREPANCY
R L
ALL 83 cm 81 cm
TLL 77 cm 75 cm
LLD 2 cm
CLINICAL PICTURE
CLINICAL PICTURE
LABORATORY FINDINGS
(20/04/2014)
WBC 9,3x10
3
/mm
3

RBC 4.97x10
6
/mm
3

HGB 15.7 g/dl
HCT 43.4%
PLT 245x10
3
/mm
3

Ureum 16 mg/dl
Creatinin 0,80 mg/dl
SGOT 20 U/L
SGPT 14 U/L
HBsAg Non reactive
CT 800
BT 300
PELVIC X-RAY (23/09/2014)
Antero posterio/AP lateral view
DIAGNOSIS
Closed fracture left neck
femur
TREATMENT
IVFD
Analgetik
Immobilisasi
Operation : Hemiarthoplasty

RESUME
A man aged 60 years old came to Wahidin Sudiruhusodo
Hospital with chief complaint of pain at left hip, occurred
since 7 weeks before admission. Mechanism of trauma:
patient was walking then suddenly fell down at the left
side of the hip due to slippery floor at the bathroom. Prior
treatment at wahidin Hospital. History bone setter(+)
On physical examination, general status within normal
limits. On regional examination of pelvic, there are
deformity (+), tenderness (+), NVD within normal limits,
CRT < 2. Passive and active movement of left hip joint are
limited due to pain.
On radiological examination, the result is fracture of the
left neck femur.
Discussion

FRACTURE NECK FEMUR

MECHANISM OF INJURY
Low energy trauma :
Fall by elderly person most common.
High-energy trauma :
Motor vehicle accident
GARDENS CLASSIFICATION
I: Incomplete fracture; valgus impaction

II: Complete Fracture : nondisplaced

III: Complete fracture, partial displacement
(varus)

IV: Complete fracture, total displacement
PAUWELS CLASSIFICATION
This is based on the angle of fracture from the
horizontal
Type I : 30 degrees
Type II : 50 degrees
Type III : 70 degrees

CLINICAL MANIFESTATION
There is usually a history of a fall,
followed by pain of the hip site.
If the fracture is displaced, the patient
lies with the limb in lateral rotation and
the leg looks short.
With an impacted fracture the patient
may still be able to walk
MANAGEMENT
Operative treatment
Internal Fixation
Arthroplasty
By Use Prosthetic
Half joint replacement arthroplasty
Total replacement arthroplasty
Internal Fixation
Prosthetic
replacement
COMPLICATIONS
Avascular Necrosis of femoral head
General complications : Venosus
Thrombosis, pulmonary emboly,
pneumonia, decubitus ulcer.
Nonunion
Osteoarthritis


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