Patient’s Identity

• Name : Miss. YK
• Age : 18 years old
• Sex : Female
• Address : Pare-pare
• Work : Student
• Date of admission : April 8 , 2018
• Medical record : 133104
 HISTORY TAKING
• Main Complain : Pain at left thigh
• Anamnesis : Patient come to the emergency room A. Makkasau with complaints
of pain in the left thigh about 30 minutes ago before admission to hospital post
traffic accident (crashing into a car in front of her), the patient complained that her
left thigh difficult to move. Patient go to medicaster first, before come to hospital.
• Mechanism of Trauma : the patient is uncooperative and nobody
can give any information about the mechanism
• History of loss of consciousness (-), history of nausea and vomiting
(-), history of headache (-).
 GENERALIST STATUS
• Moderate ill/Adequat Nutrition/Compos Mentis, GCS 15
• Blood Pressure : 130/80 mmHg
• Heart Rate : 88x/i
• Respiratory Rate : 20x/i
• Temperature : 36,0oC
 LOCALIZED STATUS
Left femur Region
Look Deformity (+), swelling (+), hematoma (-),
wound (-), Shortening (+).
Feel Tenderness (+), Crepitations (+)
Move Active and passive movement of knee and hip
joint limitted due to pain
NVD Good sensibility, pulsation poplitea artery and
dorsalis pedis artery are palpable, CRT <2
seconds
 Left Cruris Region
Look Deformity (-), swelling (-), hematoma (-), wound
(+) laceration with size 4x2 cm.
Feel Tenderness (-), Crepitations (-)
Move Active and passive movement of knee and hip
joint limitted due to pain
NVD Good sensibility, pulsation poplitea artery and
dorsalis pedis artery are palpable, CRT <2
seconds
CLINICAL FINDING
RADIOLOGICAL FINDING
LABORATORY FINDING
Pemeriksaan Hasil Nilai normal

WBC 16,4 4.00-10.0

RBC 4,39 3.80-6.50

HGB 12,9 11.5-17.0

HCT 46,4 37.0-54.0

PLT 214 150-500

CT 9’00” <15’00’’

BT 1’00” 1’00”-3’00”

GDS 122 <140

HBsAg nonreaktif
 RESUME
A woman 18 years old, admitted to Andi Makkasau Hospital with main complaints of pain in the left thigh
about 30 minutes ago before admission to hospital after crashed a car, the patient also complained the
her thigh difficult to move. History of loss of consciousness (-), history of nausea and vomiting (-), history
of headache (-).

Generalist status : normal

Localized status: left femur

Look :Deformity (+), swelling (+), hematoma (-), shortening (+), wound (-)
Feel : Tenderness (+), Crepitations (+)
Move : limitted due to pain.

NVD : Good sensibility, pulsation brachialis artery and radialis artery are palpable, CRT <2 seconds

Localized status: left cruris

Look :Deformity (-), swelling (-), hematoma (-), wound (+) laceration with size 5x3 cm.
 DIAGNOSIS

CLOSED FRACTURE 1/3 MEDIAL

OF FEMUR
• Non operatif
1. Non medikamentosa
• Education
2. Medikamentosa :
• IVFD RL 20 tpm
• Ceftriaxone inj. 1gr/12h/iv
• Ketorolac inj. 30mg/8h/iv
• Ranitidine inj. 50mg/12h/iv

• Operatif : Open Reduction Internal Fixation

ANATOMY OF THIGH
FRACTURE FEMUR
 DEFINITION
• Fracture of the femur is the discontinuation or loss of
the continuity of the femoral stem which can occur as a
result of direct or indirect trauma (traffic accidents,
falling from a height). Clinical fracture conditions of the
femur can be an open femoral fracture accompanied by
soft tissue damage (muscle, skin, nerve and vascular
tissue) and a closed femur fracture that can caused by
direct trauma to the thigh.
 Etiology

• Traumatic Injury
• Pathologic Fracture
• Spontaneously
 CLASSIFICATION
• Femoral Head Fractures
• Femoral Neck Fractures
• Intertrochanteric fractures
• Subtrochanteric fractures
• Femoral shaft fractures
• Distal femur fractures
Winquist Hansen Classification
 Winquist and Hansen Classification
Type 0 • No comminution

Type I • Insignificant amount of comminution

Type II • Greater than 50% cortical contact

Type III • Less than 50% cortical contact

Type IV • Segmental fracture with no contact

between proximal and distal fragment
 CLINICAL MANIFESTATION
• Deformity
• Swollen
• Echimosis from Subculaneous hemorrhage.
• Spasms of muscle spasms involunters near the fracture.
• Tenderness
• Pain
• Loss of sensation
• Abnormal movement.
• Krepitasi
 DIAGNOSIS
(CLINICAL FEATURE)
• The diagnosis of femoral shaft fracture is usually obvious,
with the patient present with pain, deformity, swelling,
and shortening of the affected extremity
• The effect of blood loss and other injuries, some of which
can be life-threatening, may dominate the clinical picture.
 TREATMENT
• Non Operative : skeletal
traction and skin traction,
branching

• Operatif :
• External fixation
• Plate fixation
• Intramedulary nailing
 COMPLICATION
• Early
• Shock
• Fat embolisme
• Compartement syndrome

• Late
THANK YOU