Slide Ortho Tibia And Fibula Ppt 3l242t

PATIENT IDENTITY Name :B  Age : 44 years old  Sex : Male  Date of ission :August 23rd, 2015 at 16.30  RM number : 723290 

HISTORY TAKING Chief Complaint: Pain at right leg  Suffered since 22 hours before being itted to Wahidin General Hospital  Patient was riding a motorcycle when he fell down due to loss of balance  Patient’s right leg first came into with the ground.  Vomitting (-) nausea (-)  Prior treatment : Pangkep Hospital

PRIMARY SURVEY Airway : Clear  Breathing: RR = 20x/min, regular, spontaneous, thoracoabdominal type, symmetrical. Circulation: BP = 120/70 mmHg,HR = 80 x/min regular, strong.  Disability : GCS 15 (E4V5M6),isochoric pupil, Ø : 2,5 mm, light reflex +/+  Exposure : T = 36,70 C (axilla) 

SECONDARY SURVEY Localized status : Right Leg region Look:

Deformity (+), swelling (+), hematoma (+), Wound (-) Feel : tenderness (+) Move: Active and ive motions of the knee are limited due to pain Active and ive motions of the ankle are limited due to pain NVD : Good sensibility, dorsalis pedis and tibialis anterior pulses are palpable, CRT <2”,

CLINICAL FINDINGS

LEG LENGTH DISCREPANCY Right

Left

ALL

86

87

TLL

82

83

LLD

1 cm

LABORATORY FINDINGS WBC : 15.400/ ul  RBC : 5.000.000/ ul  HBG : 14.7 g/dl  HCT : 43 %  PLT : 233.000/mm3  CT : 7’30’’  BT : 2’30’’  HBsAg : Non reactive 

X-RAY RIGHT CRURIS

AP View

Lateral View

DIAGNOSIS Closed fracture 1/3 distal right tibia  Closed fracture 1/3 distal right fibula 

MANAGEMENT  IVFD

RL  Analgesic  Report to Orthopaedic senior, advice:  Apply

 Plan

boot slab left lower limb

for ORIF Tibia & Fibula

RESUME • A Boy 44 years old came to the hospital with chief complaint pain at the left leg, suffered since 22 hours before itted to Hospital. • At the anterolateral aspect, there is haematom and edema.The region was tenderness on palpation, with unknown active and ive motion of knee t and ankle t due to pain. Sensibility is good and dorsalis pedis artery is palpable, CRT <2” . • laboratory findings are within normal limit, • From radiology finding (X-Ray cruris dextra AP/Lateral) there is closed fracture 1/3 distal of right tibia and fibula.

Discussion

TIBIA AND FIBULA

Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010.

NETTER’S CONCISE ORTHOPAEDIC ANATOMY, P. 316

NETTER’S CONCISE ORTHOPAEDIC ANATOMY, P. 317

NETTER’S CONCISE ORTHOPAEDIC ANATOMY, P. 318

TYPES OF FRACTURES

Thompson, J. Netter’s Concise Orthopaedic Anatomy, 2nd Ed. Elsevier Saunders, 2010.

Clinical features

Diagnosis

   

Anamnesis



Physical examination



X- ray, with anteriorposterior and lateral view



Laboratory examination





Oedema Hematoma

Tenderness at the fracture site. Decreased range of motion at the ankle or knee, depending on the location of the fracture If fracture is displaced, a deformity may be noted

Appley’s . Sistem Of orthopaedis & fracture,8th edition.

TSCHERNE’S 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

TREATMENT 

Conservative Closed reduction • Apply long leg cast • Functional bracing with Early weight-bearing • Pain medication if needed •

TREATMENT 

Operative

Internal Fixation  External Fixation 

DEFINITIVE TREATMENT Open Reduction Internal Fixation  Indication of ORIF in this patient is :  ORIF Tibia  Acceptable fracture reduction is not indicated anymore in this patient  ORIF Fibula  There’s fracture at 3 cm from syndesmosis at X-Ray findings  Advantage  Adequate reduction  Early movement Disadvantage  Increase risk of infection, skin problem  A high degree of surgical technique and facilities are essential 

COMPLICATIONS Early complications

Late complication

Neurovascular injury

Malunion, delay union, nonunion

Compartment syndrome

t stiffness infection