April 2016

Case Report

Closed
Segmental Fracture Left Tibia
Closed Fracture 1/3 Middle Left Fibula
IRMA RUSNU
C111 11 283
ADVISOR:
dr.Shandy
dr. Jansen
SUPERVISOR:
Dr.dr Muh Sakti Sp.OT(K)

Orthopaedic and Traumatology Department

Medical Faculty of Hasanuddin University
Makassar
2016

PATIENTS IDENTITY

Name
Age
Gender
RM
Admitted date

: Mr. O
: 33 years old
: Male
: 74 85 86
: 7 March 2016

HISTORY TAKING
Chief complain

: Pain at the left leg

Anamnesis

:Suffered since 2 hours before

admitted to the hospital due to
accident during working. History
of loss consciousness vomiting
(-)

Mechanism of trauma : The Patient was managing and

counting asbestos at his shop
And suddenly they dropped on
left leg.

PRIMARY SURVEY

SECONDARY SURVEY
Cruris Region sinistra

LEG LENGTH DISCREPANCY

DEXTRA

SINISTRA

ALL

93 cm

92 cm

TLL

84 cm

83 cm

LLD

1 cm

CLINICAL FINDINGS

Anterior

CLINICAL FINDINGS

Medial

CLINICAL FINDINGS

lateral

LABORATORY FINDINGS

WBC
RBC
HGB
HCT
PLT
BT
HBsAg

:8,4 x 103 /uL

:4,19 x 106 /uL
:13,2 g/dL
:34,3 %
:189 x 103 /uL
:114
: Non Reactive

RADIOLOGY FINDINGS

RESUME
Male, 33 years old admitted to the hospital with pain
at the left leg, suffered since 2 hours before admitted
to Wahidin General Hospital.

From the physical examination there is deformity

(+), swelling (+), tenderness (+), and hematoma (+)

From the radiology finding, there are, Closed

Segmental Fracture Left Tibia And Closed Fracture
1/3 Middle Left Fibula

DIAGNOSIS
Closed Segmental Fracture Left Tibia
Closed Fracture 1/3 Middle Left Fibula

MANAGEMENT
IVFD
Analgesic
Long Leg Back Slab on left lower
leg and elevation
Plan for Open Reduction Internal
Fixation

DISCUSSION

DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

INTRODUCTION
Fracture a break in the structural continuity of
bone,growth plate,joint,and cartilage
If overlying skin remains intact
If skin not intact

: Closed fractured
: Open fractured

Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York:
Lippincott Williams & Wilkins. 2006.

EPIDEMIOLOGY
Fractures of the tibia and fibula shaft are the
most common long bone fractures.
Usually due to traffic accident & sports
injury.
Male 3 times > Female
Diaphyseal tibia fractures highest rate of
nonunion for all long bones

Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York: Lippincott
Williams & Wilkins. 2006.

Fibula and Tibia Bone

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2004

How a Fracture Happen

Mullers Classification

AO Mueller. AO Principle of Fracture Management. 2000.

Tschernes Classification of skin

lesion in closed fractures
Grade 0

Injury from indirect forces with negligible soft tissue

damage

Grade I

Closed fracture caused by low-moderate energy mechanisms,

with superficial abrasions or contusions of soft tissues
overlying the fracture

Grade II

Closed fracture with significant muscle contusion, with

possible deep, contaminated skin abrasions associated with
moderate to severe energy mechanisms and skeletal injury;
high risk for compartment syndrome

Grade III

Extensive crushing of soft tissues, with subcutaneous

degloving or avulsion, with arterial disruption or established
compartment syndrome

Anterior tibialis muscle

Extensor digitorum longus muscle

Extensor hallucis longus

muscle

Fibularis (peroneus) longus

muscle and tendon
Fibularis (peroneus) brevis muscle
and tendon

Gastrocnemius muscle

Soleus muscle

Plantaris muscle

Polpiteal muscle

Flexor digitorum longus muscle

Tibialis posterior muscle

Flexor hallucis longus muscle

Innervation

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

VASCULARIZATION

Netters concise orthopaedic anatomy ,p. 320

Evidence Leading to Diagnosis

ClosedSegmental
Fracture Left Tibia
Closed Fracture 1/3
Middle Left Fibula

Clinical Features of Tibia and Fibula Fracture

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York : Arnold. 2010

Goals Of Fracture Management

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

Treatment
CONSERVATIVE
Indication :
- Closed fracture
- Minimal Displaced

OPERATIVE
Indication :
- Fail Conservative
- Open fracture
- Fracture associated with compartement
syndrome
-For traction (avulsion) fractures
in which fragment are held apart

Circular Casting
Internal Fixation
External Fixation
Nalyagam S. Principles of Fractures. In: Solomon L. Apleys System of Orthopaedics and
Fractures Ninth edition. 2010

ACCEPTABLE MINIMAL DISPLACEMENT

Koval, Kenneth J.; Zuckerman, Joseph D. Handbook of Fractures, 4th Edition.

Initial Treatment

Apply long leg back slabonly for temporary

stabilization
To minimize pain
To limit soft-tissue damage
To obtain and hold fracture alignment
To prevent or at least observation a compartment
syndrome

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

Operative
The indications for operative :
Open fractures.
Multiple fracture
Neurovascular compromize.
Unstable fracture

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

DEFINITIVE
ORIF
Plate And Screws
this form of fixation is
useful
for
treating
metaphyseal fractures
of long bones.

DEFINITIVE
ORIF
Intramedullary Nailing

This is the method of

choice for internal fixation,
closed intramedullary nailing
preferred
treatment
for
unstable
tibia
fractures.
Active
movements
and
partial weight beraing were
started soon after operation

COMPLICATION
EARLY COMPLICATION

LATE COMPLICATION

Neurovascular injury

Delayed Union

Compartment Syndrom

Non Union
Malunion
Infection
Joint Stifness

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New
York : Arnold. 2010

THANK YOU
DEPARTEMENT OF
ORTHOPAEDIC AND
TRAUMATIC MEDICAL FACULTY
OF HASANUDDIN UNIVERSITY