ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY HASANUDDIN UNIVERSITY

2015

Case Presentation

November 2015

PRESENTED BY:

A.Adhiyatma A.

C 111 07 009

ADVISORS:

dr. Nur Rahmansyah

dr. Nurjalaluddin Djawie

SUPERVISOR:

dr. Andry Usman, Sp.OT

Name : Miss. A

Age : 27 years old /

Female

Admission : October 26th, 2015

Registrati

on

: 730711

Status : Single

Chief Complaint : pain at the right kneeSuffered since 4 hours ago before admitted due to motorcycle accident.Mechanism of injury: the patient was riding a motorcycle and from opposite motorcycle was appear at the right side. She suddenly thrown up, her right knee hit the road first.No history of unconsciousness, no history of vomiting.

PRIMARY SURVEYAirway : ClearBreathing : RR 18x/min regular, spontaneous

thoracoabdominal type, symmetricalCirculation : BP 110/70 mmHg HR = 86 x/min

regular, strongDisability : GCS 15 (E4V5M6), pupil isochors,

Ø : 2.5 mm/2.5 mm, light reflex +/+Environment : T = 36,70 C (axillary) VAS : 5

SECONDARY SURVEYRight Knee RegionLook : There is deformity, there is swelling, there is hematome.Feel : There is Tenderness, Ballotement (+)Move : Active and passive movement of knee joint and can’t be evaluated due to pain.NVD : Sensibility is good ,Capillary Refill Time < 2”, pulsation of dorsalis pedis artery and tibialis posterior artery is palpable.

Right Leg RegionLook : There is deformity, there is swelling, there is hematome.Feel : There is Tenderness. Move : Active and passive movement of knee joint and can’t be evaluated due to pain. Active and passive movement of the ankle joint is good.NVD : Sensibility is good ,Capillary Refill Time < 2”, pulsation of dorsalis pedis artery and tibialis posterior artery is palpable.

  TLL ALL

Right 90 80

Left 90 80

LLD 0 cm

Anterior View

Medial View

Lateral view

Laboratorium (26/10/2015) WBC : 20080/mm3 RBC : 3,95 x 106 /mm3 HGB : 12,1 g/dL HCT : 46,0 % PLT : 460 x 103 /mm3 HbsAg Non Reactive BT 3’ CT 9’

A 27 years woman came to the hospital with

pain at right knee suffered since 4 hours ago

due to motorcycle accident. From the physical

examination on the right knee : deformity (+),

swelling (+), hematoma (+), tenderness (+).

On the right leg : deformity (+), swelling (+),

hematoma (+), tenderness (+). From radiologic

finding, there are fracture tibial plateau of the

right.

Closed fracture right tibial plateau Schatzker I

o IV fluid dripso Analgesico Apply long leg back slab at right lower

extremityo Elevation right lower extremityo Plan for ORIF

Koval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4th edition

Fracture can caused by trauma, stress fracture, and pathological fractures

Mechanism of injury

Miniscus tear

Ligament injury

Popliteal neurovascular

injury

Soft tissue injury

Peroneal nerve injury

Right Knee Region

Look : There is deformity, swelling, and hematome at right knee

Feel : There is Tenderness, ballotement (+)

Physical Examination

Compartement SyndromeLigament InjuryLacerated Artery PoplitealRupture Nerve PeronealInfection

Mal Union Non union Osteoarthritis Joint Stiffnes Avascular necrosis

Koval, Kenneth j.; Zuckerman, joseph d. handbook of fractures, 4th edition