Case Report

August 2017

Closed Fracture 1/3 Distal

Left Tibia Et Fibula
BY
Musyarrafah Sukman 111 211 0071

SUPERVISOR:
dr. MUH. ALI HASTI SP.OT

P R E S E N T I N G A S A TA S K O N C L E R K S H I P
D E PA R T M E N T O F O R T H O P E D I A N D T R A U M AT O L O G Y
M E D I C A L FA C U LT Y
MUSLIM UNIVERSITY OF INDONESIA
MAKASSAR
2017
 Patient Identity

Name : NI
Age : 55 years old
Gender : Female
Admission : August 4th 2017
Registration : 133751
 HISTORY TAKING

Chief Complain : Pain at the left Leg

Suffered since 5 days before admitted to Andi Makassau

Hospital due to the flagpole. She fell to the ground and than it
rolls to her legs. Prior treatment at Enrekang Hospital History
of unconciousness (-), history of vomit (-)
 Physical Examination

General Status
General condition : Conscious, well nourished
GCS : 15 (E4M6V5)
Blood pressure : 130/80 mmHg
Pulse rate : 90 times / minute
Respiratory rate : 18 times / minute
Temperature : 36,8oC
 Localized Status
Left Leg Region
Inspection : deformity (+), hematom (+), swelling (+) wound (-)

Palpation : Tenderness (+)

NVD : Sensibility is good, posterior tibialis artery is palpable, dorsalis

pedis artery is palpable, CRT <2

Move : Active and passive motions of ankle joint is difficult to evaluated

due to pain
Clinical Pictures
Clinical Pictures
Clinical Pictures
 Laboratory

WBC 9500/ul
RBC 3.790.000uL
HBG 10.9 gr/dl
HCT 34.1%
PLT 205.000 ul
CT 1000
BT 300
HBsAG Non-Reactive
 Radiology Findings

X-Ray Cruris AP LATERAL

 RESUME
Woman 55 years old came to emergency unit with
chief complain pain at the left leg suffered since 5
days ago due to the flagpole. She fell to the ground
and than it rolls to her legs. At left leg region, there
are deformity (+) hematom (+), swelling (+)
tenderness (+), NVD within normal limits, ROM of
ankle and knee joint difficult to evaluated due to
pain. Left femur AP/Lat X-Ray show fracture at 1/3
distal left femur.
Assesment

Closed Fracture 1/3 Distal Left Tibia Et

Fibula

Planning

IVFD
Antibiotic
Analgesic
Plan for ORIF
Discussion
ANATOMY
ANATOMY
 Tscherne Classification

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;

Grade III Extensive crushing of soft tissues, with subcutaneous

degloving or avulsion, with arterial disruption or established
compartment syndrome, high risk of compartemen syndrom.
 MECHANISM OF INJURY

Direct

High energy Bending

Penetrating
Low energy Bending

Indirect

Stress Fracture
 TREATMENT

Non Operative

Operative
 Fracture Complications

Immediate Early Late

Haemorrhage Compartment Mal-union

(Shock)
syndrome
Infection Delayed and non-
Vascular injury union
Avascular necrosis
Neurological injury
Visceral injury Joint stiffness
 THANK YOU

Wassalamu Alaikum
Warahmatullah Warabakatuh