Presented By:

Fajrin Dwi Syaputra

C111 09 804

Advisors:
dr. Hendra Hermanto
dr. Herbert Yurianto

Supervisor :
dr. Muh.Petrus Johan, Sp.OT

ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY
HASANUDDIN UNIVERSITY
2014
 NAME : A.R
AGE : 7 years old / Boy
MR : 691034
ADMISSION : October 29th, 2014 at
19.54
 CHIEF COMPLAINT: Decrease of
consciousness
Suffered since 8 hours before admitted to Wahidin General
Hospital.
Patient was crossing the road and got hit by a motor cycle
from his left side.
History of loss of conciousness (+), vomiting (-).
History of treated at Pinrang Hospital then he was refered
to Wahidin Sudirohusodo Hospital.
 A : Clear
B : RR 24x/min (spontaneous, regular,
symmetrical, thoraco abdominal type)
C :Blood pressure 100/60mm, HR 100x/min,
strong, regular
D : GCS 12 (E3M5V4), pupil isochoric,
diameter 2 mm/2mm, light reflex +/+
E : Temperature 36,7C
Left Leg Region
I : Lacerated Wound at medial aspect of 1/3 middle
cruris, sized 0,5 x 0,5 cm, subcutis exposed (+),
Deformity (+), Hematome (+), Swelling (+).

P : Tenderness (+).

ROM : Active and passive motions of knee and ankle joint

are not evaluated.

NVD : Sensibility is good, pulsation of dorsal pedis artery

and tibial posterior artery are palpable, CRT < 2.
 R L
ALL 68 cm 67 cm
TLL 62 cm 61 cm
LLD 1 cm
 29/11/2014

WBC 14.600/ ul PLT 335.000/ ul

RBC 3.860.000/ ul CT 700

HB 10,4 g/dl BT 300

HCT 30 % HBsAg Non-Reactive

 Boy, 7 year old came to the hospital with Decrease of
consciousness and wound at the left cruris since 8 hours
before admitted that caused by traffic accident. The patient
already had got prior treatment at Pinrang Hospital. From
physical examination of the left cruris, Lacerated Wound at
medial aspect of 1/3 middle cruris, sized 0,5 x 0,5 cm,
subcutis exposed, Deformity, Hematome, and Swelling.
ROM Active and passive motions of knee joint and ankle
joint are not evaluated due to pain. Dorsalis pedis artery and
tibialis posterior artery are palpable and CRT is < 2 seconds.
NVD Sensibility is good, pulsation of dorsal pedis artery
and tibial posterior artery are palpable, CRT < 2.
Radiological findings shows features of fracture
comminutif of 1/3 medial of tibia et fibula sinistra and Cranial Ct
Scan : EDH + Edema Cerebri.
 Moderate Head Injury GCS 12 due to EDH
+ Edema Cerebri
Open fracture 1/3 middle left tibia grade I
Open fracture 1/3 middle left fibula grade
I
 IVFD RL
Antibiotic
Analgesic
Tetanus Prophylaxis
Wound Toilet
Apply Long Leg Back Slab at left lower extremity
Plan for ORIF elective
Report to Neurosurgeon Conservative
 Fracture is a break in structural continuity of bone

Open fracture means that skin around the fracture

site has been punctured and exposed to external
environment

Fractures of the tibia and fibula shaft are the most

common long bone fractures.

Men > women.

Average age < 37 years old

Usually due to ok
Handbook traffic
Fracture,accident & sports
Chapter 37: Lower Extremityinjury
Fracture and Dislocations
Anterior tibialis
muscle

Extensor digitorum Extensor hallucis

longus muscle longus muscle

Thompson,JD. Netter's concise atlas of

 Fibularis (peroneus)
longus muscle and tendon

Fibularis (peroneus) brevis

muscle and tendon

Thompson,JD. Netter's concise atlas of

 Plantaris muscle

Gastrocnemius
muscle

Soleus muscle

Thompson,JD. Netter's concise atlas of

 Polpiteal muscle

Flexor digitorum longus

muscle

Tibialis posterior Flexor hallucis longus muscle

muscle

Thompson,JD. Netter's concise atlas of

Thompson,JD. Netter's concise atlas
Thompson,JD. Netter's concise atlas
of orthopedic anatomy. 2004.
 Clinical types:
Open fracture / close fracture
Etiology :
Traumatic fracture / Stress fracture / Pathologic
fracture
Configuration classification:

Short oblique Triangular butterfly Tranverse pattern

Spiral attern
pattern fragment (bending) (tension)
(twispting)
(compression)

Apleys System of Orthopaedics and fracture, Chapter 23: Principle of fracture

 Mechanism of injury

Handbook ok Fracture, Chapter 37: Lower Extremity Fracture and Dislocations

Handbook of fracture, Chapter 1: Open Fracture
 Clinical
Diagnosis Features

Anamnesis Oedema
Physical examination Hematoma
X- ray, with AP and Tenderness at the
lateral view fracture site.
Laboratory Decreased range of
examination motion at the ankle
or knee.
Check neurovascular
distal

Appleys Sistem of Orthopaedis and fracture

 Conservative Operative

Antibiotic Debridement

Anti tetanus External fixation

Stabilization with Intramedullary nailing

long leg back slab
Plate and screw
Early complications Late complication

Compartment syndrome Malunion, delay union,

non- union

Infection Joint stiffness

Apleys System of Orthopaedics and fracture, Chapter 30: Injury of the knee and leg