Date post: | 02-Jun-2018 |
Category: |
Documents |
Upload: | nurul-rezki-fitriani-azis |
View: | 254 times |
Download: | 0 times |
of 26
8/11/2019 Fraktur Humerus Sepertiga Distal
1/26
Arsyi Adliah Anwar
C11109266
Advisor :
dr. Helmiyadi Kuswardhana
dr. Wendelin
Supervisor :
dr. M. Ruksal Saleh, Ph.D, Sp.OT (K)
Closed Fracture One third Distal
of The Left Humerus
CASE REPORT
Department of Orthopaedic and Traumatology
Faculty of Medicine Hasanuddin University 2013
8/11/2019 Fraktur Humerus Sepertiga Distal
2/26
Patient Identity
Name : G
Gender : Boy
Date of birth : June 11th2011
Medical Record : 635528
Date of admission : November 4th2013
8/11/2019 Fraktur Humerus Sepertiga Distal
3/26
History Taking
Chief Complaint: Pain at left arm
suffered since 10 hours before admission to the hospital
after got a traffic accident.
Mechanism of trauma :
The patient was walking at roadside when suddenly got
hit by a car from the back and the patient fell on the
asphalt with the left side of the body.
History of unconscious (-), nausea (-), vomit (-)
Prior treatment in Hospital of Barru.
8/11/2019 Fraktur Humerus Sepertiga Distal
4/26
Primary Survey
Airway
Patent, clear
Breathing
Spontaneous, symmetric, thoracoabdominal type
RR : 22x/minute
Circulation
BP : 90/60 mmHg
HR : 88x/minute, regular, adequate
Disability
GCS 15 (E4M6V5), pupils isochoric 2,5mm /2,5 mm, LR +/+
Environment
Temperature 36,8o
C
Physical
Examination
8/11/2019 Fraktur Humerus Sepertiga Distal
5/26
Head and neck region : No abnormality was found
Thoracal region : No abnormality was found
Abdominal Region : No abnormality was found
Back Region : No abnormality was found
Urogenitalia region : No abnormality was found
Upper extremity Region
Lower Extremity Region : No abnormality was found
Physical Examination
Secondary Survey
8/11/2019 Fraktur Humerus Sepertiga Distal
6/26
Upper Extremity
Left arm region
Inspection : multiple excoriation wounds on posterolateral of
hand, deformity (+), Swelling (+), hematoma (+)
Palpation : Tenderness (+)ROM : active and passive motion of shoulder joints could not be
examined due to pain. Active and passive motion of elbow
joints could not be examined due to pain..
NVD :sensibility is difficult to be identified, radial artery is
palpable, Capillary Refill Time
8/11/2019 Fraktur Humerus Sepertiga Distal
7/26
8/11/2019 Fraktur Humerus Sepertiga Distal
8/26
Additional Examination
8/11/2019 Fraktur Humerus Sepertiga Distal
9/26
TEST RESULT
WBC 18,69 x 103/uL
RBC 3,26 x 106 /uL
HGB 9,6 mg/dL
HCT 26,5 %
PLT 169 x 103/Ul
GDS 92
GOT 54 U/LGPT 20 U/L
Ureum 26 mg/dL
Creatinine 0,4 %
HbsAg Negative
Additional Examination
8/11/2019 Fraktur Humerus Sepertiga Distal
10/26
A 2 years old boy admitted with pain at the left arm suffered
since 10 hours ago due to traffic accident. The patient was
walking at roadside and got hit by a car from the back and the
patient fell to the left side.
On physical examination of the left arm region was found
ultiple excoriation wounds, deformity, swelling and hematoma,
with tenderness. Active and passive motion of shoulder and elbow
joints couldntbe examined due to uncooperative patient.
On radiological imaging there was a closed fracture at the
one-third distal of the left humerus.
Resume
8/11/2019 Fraktur Humerus Sepertiga Distal
11/26
CLOSED FRACTURE ONE
-THIRD
DISTAL OF THE LEFT HUMERUS
Diagnosis
8/11/2019 Fraktur Humerus Sepertiga Distal
12/26
Analgesic
Apply slab
Plan for ORIF
Treatment
8/11/2019 Fraktur Humerus Sepertiga Distal
13/26
Discussion
8/11/2019 Fraktur Humerus Sepertiga Distal
14/26
Fracture is a break in the
structural continuity of
bone
Fracture of the humeral
shaft is 10% of all
humeral fractures in
children and 2-5.4% of all
childrensfracture
shaft
Proximal
Distal
8/11/2019 Fraktur Humerus Sepertiga Distal
15/26
8/11/2019 Fraktur Humerus Sepertiga Distal
16/26
8/11/2019 Fraktur Humerus Sepertiga Distal
17/26
8/11/2019 Fraktur Humerus Sepertiga Distal
18/26
8/11/2019 Fraktur Humerus Sepertiga Distal
19/26
Direct
Direct blow to the arm
Transverse/comminuted
fracture
Indirect
A fall on an outstrechedarm
Spiral/oblique fracture
8/11/2019 Fraktur Humerus Sepertiga Distal
20/26
HistoryTaking
PhysicalExamination
X-rayImaging
8/11/2019 Fraktur Humerus Sepertiga Distal
21/26
ANAMNESIS
Chief complaint
Mechanism of injury
Prior Treatment
IMAGING
X-ray examination
PHYSICAL EXAMINATION
Inspection
Palpation
Range of motion
Neurovascular Distal
8/11/2019 Fraktur Humerus Sepertiga Distal
22/26
Non Operative
Cast immobilization
Sling immobilization
Coaptation splint
Shoulder spica cast
Functional bracing
8/11/2019 Fraktur Humerus Sepertiga Distal
23/26
INDICATION FOR SURGERY
Multiple fracture
Inadequate closed reduction
Open fracture
Segmental fracture
Bilateral humeral fracture
Displaced intra-articular
extension of the fracture
Neurovascular compromise
Unstable fracture fragment
8/11/2019 Fraktur Humerus Sepertiga Distal
24/26
SURGICAL TECHNIQUES
Open Reduction and Plate Fixation
Percutaneous Pinning
External Fixation
8/11/2019 Fraktur Humerus Sepertiga Distal
25/26
8/11/2019 Fraktur Humerus Sepertiga Distal
26/26
Thank You