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Presented by:

Zulkarnain Hasyim
Advisor :
dr. Arnold Darmawan
dr. Muhammad Arief Faisal
Supervisor:
dr. Petrus Johan, M.Kes,Sp OT
Orthopaedic and Traumatology Dept
Medical Faculty of Hasanuddin University
Makassar, 2014

PATIENT IDENTITY

Name
Age
Sex
Date of admittance
MR

:D
:19 years old
: Female
: September 18th, 2014
: 681070

HISTORY TAKING
Chief Complaint: Pain at the right thigh
History of illness
Suffered since 3o minutes before admitted to
hospital due to traffic accident.

the

Mechanism of trauma:
Patient was ride a motorcycle and hit by another
motor on the right side of the right thigh of the
patient
History of unconsciousness (-), nausea (-) vomiting (-)

PRIMARY SURVEY

SECONDARY SURVEY
LOCALIZED STATUS :
Right femur region
Inspection: deformity (+), swelling (+) , haematoma (+), shortened
right lower limb compared to opposite, , wound (-)
Palpation: Tenderness (+)
ROM: Active and passive motion of hip and knee joints are not
evaluated due to pain.
NVD: Sensibility is good, dorsalis pedis artery palpable and Capillary
refill time <2
Right

Left

ALL

80

82

TLL

72

74

LLD

2 cm

CLINICAL PICTURE (September 18TH,


2014)

CLINICAL PICTURE (September 18TH,


2014)

CLINICAL PICTURE (September 18TH,


2014)

LABORATORY FINDING
WBC
HGB
RBC
PLT

: 14.600/mm3
: 12,0 mg/dl
: 3.890.000/mm3
: 341.000/mm3

CT
: 700
BT
: 300
HbsAg : non reactive

X-RAY September 18TH, 2014

RESUME
A female 19 years Suffered since 3o minutes before
admitted to the hospital due to traffic accident.
From the physical examination vital sign is normal and at
the right femur
Inspection: deformity (+), swelling (+) , haematoma (+), shortened right lower
limb compared to opposite, swelling (+), haematoma (+), wound (-)
Palpation: Tenderness (+)
ROM: Active and passive motion of hip and knee joints are can not be evaluated
due to pain.
NVD: Sensibility is good, dorsalis pedis artery palpable and Capillary refill time
<2

X-Ray examination is fracture 1/3 middle (R) femur

DIAGNOSIS
Closed fracture 1/3 middle of the right femur

MANAGEMENT

IVFD RL
Analgesic
Apply skin traction 3 kg
Plan for ORIF

Femur Shaft Fracture

Introduction
The femoral shaft is circumferentially
padded with large muscles.
A femoral shaft fracture is a fracture of
the femoral diaphysis occurring between 5 cm
distal to the lesser trochanter and
5 cm proximal to the adductor tubercle.
Fracture patterns are clues to the type of
force that produced the break.
1. Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition
2. Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd edition.

Anatomy of Femur

Thompson, jon C. Basic Science. In Netters Concise Atlas of Orthopedics Anatomy, 1st edition.

Thompson, jon C. Basic Science. In Netters Concise Atlas of Orthopedics Anatomy, 1st edition.

Thompson, jon C. Basic Science. In Netters Concise Atlas of Orthopedics Anatomy, 1st
edition.

Deforming muscle forces on


the femur

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition

Thompson, jon C. Basic Science. In Netters Concise Atlas of Orthopedics Anatomy, 1st
edition.

Mechanism of Injury

PHYSICAL EXAMINATION
Inspection: deformity, swelling, hematoma.
Present with tenderness
Decreased range of motion at the hip or knee,
depending on the location of the fracture
Hip

Knee

Flexion

0-120

Extend

20-30

Flexion 125 - 135

Abduct

40-50

Extend

Adduct

20-30

Internal
rotate

30

5 - 15

NVD
evaluation
External
50
rotate
Solomon Louis, Warwick David, Nayagam Selvadurai : Apleys System of Orthopaedics and Fractures 9th Edition

Thompson, Jon C. Netters Concise Orthopaedics Anatomy 2nd Edition

TREATMENT
Nonoperative
Skin Traction
Skeletal traction
Casting
Operative
Intramedullary Nailing
External Fixation
Plate and Screw Fixation

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 3rd Edition

COMPLICATION

Malunion
Nonunion
Muscle weakness
LLD
Overgrowth
Shortening

Kenneth Koval, et al. Handbook of fractures third edition. 2006. Lippincott Williams and wilkins. USA

THANK YOU