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CASE REPORT

Closed Fractured 1/3 Proximal of the Left Femur

PATIENT IDENTITY

Name : An. F

Age : 10 years old

Work : Student

Address : Gowa

Day admitted : 21 June 2011

Medical Record : 444139

HISTORY TAKING

Chief complaint: Pain at the left thigh.

History Taking:

Suffered since four hours before admitted to the hospital due to the traffic accident.

Mechanism of trauma :

Patient was crossing a street and suddenly he got hit by a motorcycle from his left side .

History of unconsciousness (-), nausea and vomiting (-).

History of prior treatment at Gowa General Hospital

PRIMARY SURVEY

A : Patent

B : symmetry left = right , Thoracoabdominal type, RR 20 x/minutes, bronchovesicular

C : BP: 110/60 mmHg, HR:88 x/minutes

D : GCS15(E4V5M6), pupil isokor 2,5 mm/2,5mm, light reflex +/+

E : Temperature 36,70 C (axillar)

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SECONDARY SURVEY

LOCAL STATUS

Left Thigh Region

I : Deformity (+), swelling (+),haematoma (+), wound (-).

P : Tenderness (+)

ROM : Active and passive motion at hip and knee joints are limited due

to pain.

NVD :Sensibility is good, pulse of dorsalis pedis and tibialis posterior

arteries are palpable, capillary refill time < 2.

CLINICAL FINDING

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LEG LENGTH DISCREPANCY

Right Leg Left Leg

Apparent Leg Length 72 cm 70 cm

True Leg Length 68 cm 66 cm

Leg Length Discrepancy 2 cm

Laboratorium Findings

WBC 16,25 x 103 /uL

RBC 4,39 x 106 /uL

HGB 11,2 g/dL

HCT 33,8 %

PLT 281 x 103 /uL

CT 8 30 mnt

BT 2 30 mnt

GDS 146 mg/dl

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Ureum 22 mg/dl

Creatinin 0,8 mg/dl

SGOT 47 U/I

SGPT 14 U/I

PELVIC AP VIEW

LEFT FEMUR AP/LATERAL VIEW

RESUME

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A boy, 10 years old, was admitted to hospital with chief complaint pain at the left thigh due to

traffic accident. History of prior treatment at Gowa General Hospital.

Physical examination finding ,at the left thigh seen deformity (+), swelling (+), haematoma (+)

wound(-) . Tenderness on palpation. Leg length discrepancy is 2 cm, and the NVD within normal

limit

From pelvis X-Ray and Left Femur X-ray finding, there is transverse fracture 1/3 proximal of

the left femur.

DIAGNOSIS

Closed Fracture 1/3 proximal of the left femur

TREATMENT

Analgetic

Skin Traction

Plan for Open Reduction Internal Fixation (ORIF)

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DISCUSSION

Anatomy of Femur

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Anterior compartment

Medial compartment

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Posterior compartment

MECHANISM OF INJURY

Direct trauma : Motor vehicle accident, pedestrian injury, fall, and child abuse.

Indirect trauma : Rotational injury.

Pathologic fractures

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CLASSIFICATION OF FRACTURE

Stable

I : Minimal comminution

II : Comminuted > 50% of cortices

intact

Unstable

III : Comminuted < 50% of cortices intact

IV : Complete comminution, no intact cortex

TREATMENT

Conservative

Indication :

1)Length

2) Angulation

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3)Rotation

Operative

Indication :

Multiple trauma, including head trauma

Open fracture

Vascular injury

Pathologic fracture

Uncooperative patient

COMPLICATION

EARLY LATE

Compartment Syndrome Shortening

Fat embolism and ARDS Malunion/ non-union

Thromboembolism Fracture disease

SLIDE

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