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    23 Juli 2011, Ny M, Closed Multiple Fracture Distal Os Fibula Dextra + Closed Fr. Distal Os Tibia Dextra + VL, DR Iwan SPB, DR Budi

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    Steffi Natadidjaja
    ER physician : Budi, MD Supervisor : Iwan, MD, Surgeon IDENTITY Name Age : 23 years old : Saturday, July 23rd 2011, 18.00 Time of the event. Chief complaint : o pain at right leg Additional complaint o open wound on right leg universal precautions : latex gloves PRIMARY SURVEY Airway with cervical control a. B. Airway Asses Suction Guedel Endotrakeal :::Patient can talk clear and

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    23 Juli 2011, Ny M, Closed Multiple Fracture Distal Os Fibula Dextra + Closed Fr. Distal Os Tibia Dextra + VL, DR Iwan SPB, DR Budi

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    Steffi Natadidjaja
    46 views35 pages
    ER physician : Budi, MD Supervisor : Iwan, MD, Surgeon IDENTITY Name Age : 23 years old : Saturday, July 23rd 2011, 18.00 Time of the event. Chief complaint : o pain at right leg Additional complaint o open wound on right leg universal precautions : latex gloves PRIMARY SURVEY Airway with cervical control a. B. Airway Asses Suction Guedel Endotrakeal :::Patient can talk clear and

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    23 Juli 2011, Ny M, Closed Multiple Fracture Distal Os Fibula Dextra + Closed Fr. Distal Os Tibia Dextra + VL, Dr Iwan SpB, Dr Budi,

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    ER physician : Budi, MD Supervisor : Iwan, MD, Surgeon IDENTITY Name Age : 23 years old : Saturday, July 23rd 2011, 18.00 Time of the event. Chief complaint : o pain at right leg Additional complaint o open wound on right leg universal precautions : latex gloves PRIMARY SURVEY Airway with cervical control a. B. Airway Asses Suction Guedel Endotrakeal :::Patient can talk clear and

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    46 views35 pages

    23 Juli 2011, Ny M, Closed Multiple Fracture Distal Os Fibula Dextra + Closed Fr. Distal Os Tibia Dextra + VL, DR Iwan SPB, DR Budi

    Uploaded by

    Steffi Natadidjaja
    ER physician : Budi, MD Supervisor : Iwan, MD, Surgeon IDENTITY Name Age : 23 years old : Saturday, July 23rd 2011, 18.00 Time of the event. Chief complaint : o pain at right leg Additional complaint o open wound on right leg universal precautions : latex gloves PRIMARY SURVEY Airway with cervical control a. B. Airway Asses Suction Guedel Endotrakeal :::Patient can talk clear and

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    of 35

    EMERGENCY CASE REPORT

    July 26th 2011


    ER physician : Budi, MD Supervisor : Iwan, MD, Surgeon

    S te ffi 2 0 0 9 .0 6 1 .1 8 5

    IDENTITY
    Name Age : Mrs. M : 23 years old : Saturday, July 23th 2011, 18.00 Time of the event Sent by : taxi

    Time of admission : Saturday, July 23th 2011, 18.15 Prehospital treatment : - Chief complaint : o Pain at right leg Additional complaint
    o Open wound on right leg

    o
    o

    universal precautions : latex gloves

    PRIMARY SURVEY

    Airway with cervical control


    A. B.

    Cervical Immobilization:
    1. Collar :2. LSB :-

    Airway Asses
    Suction Guedel Endotrakeal :::-

    Patient can talk clear and spontaneously Airway Clear 18.16

    Breathing and Ventilation


    Look Spontaneus breathing deformity , retraction , symmetrical hemithorax movement Cyanosis -, difficulty in breathing Feel Air blown from nose Listen Vesiculair, rhonci -/-, wheezing -/ RR= 24x/min Breathing clear : 18.17

    Circulation
    ASSES : Pulse : 84 X / mnt Blood Pressure : 110/70 mmHg Signs of shock : (-)

    Circulation clear : 18.20

    Disability
    GCS :E4M6V5 = 15 since arrival Pupil :Symmetric, round, 3mm/3mm, Light Reflex +/+ Motoric : 5555 5555 ???5 5555

    Exposure
    Axilar temperature : 36,9 C

    SECONDARY SURVEY

    History of present illness


    20 minutes before the admission patient has an accident when she was walking across the street, a motorcycle bumped her and she fell at her left side limb hiting the asphalt first The motorcycle scratched her right leg so theres an open wound on her right leg After the event she complained the pain on right leg and it got worse when it being moved

    History Taking
    Alergic : denied Medication : denied Past illness : denied Last meal : 2 hrs before admission Event : accident

    Physical Examination
    General condition : in pain. Consciousness : GCS 15, E4M6V5 BP : 110/70 mmHg Pulse : 84 bpm RR : 24 x/m Temperature : 36.9 C

    Physical Examination (2)

    HEAD
    Eyes : conjunctiva not anemic, sclera not icteric, isocor , round, 3 / 3 mm , light reflex + /+ Nose, mouth, ears within normal limit Neck : trachea in the middle, no lymph node palpable

    Physical Examination (3)

    Thorax

    Pulmo

    Cor

    : symmetric in static and dynamic, Inspection swelling(-), hematome(-), open wound(-) : left and right stem fremitus equal, Palpation crepitation (-) : sonor on both side Percusion Auscultation : vesicular, rhonki -/- , wheezing -/ Inspection : ictus cordis not seen : ictus cordis palpable at ICS V left Palpation midclavicular line Percussion :

    Left : left midclavicular line Upper : ICS II Right : right sternal line : heart sound regular, murmur (-), gallop Auscultation (-)

    Physical Examination (4)

    Abdomen:
    Inspection : convex, no lesion Auscultation : Bowel sound +; 6 x/min Palpation : tender, pain (-) , liver and spleen arent palpable Percussion : tympanic in all quadrant

    Pelvic : deformity (-), pain (-) Genital : not checked Extremities upper, lowerleft : within normal limit

    Right Leg I : Visible deformity of the right leg(+), swelling (+), blood (-), hematom (-)

    Local status

    An open wound 17cm x 15cm x 3cm on right leg, irregular shaped, irregular border, muscle based, pain (+), bleeding (+)

    (-)

    P : Tenderness (+), crepitation (+), ROM limited, warm, cap.refill <2 sec, Pulsation a. dorsalis pedis +/+ (equal right and left foot) ROM : hip, knee, ankle joint cannot be assesed toe flexion, extension : Active & passive (+), pain

    Sensoric of hip, leg and toes (+)

    Local status

    08/17/11

    copyright (your organization) 2003

    17

    X-RAY

    Diagnosis
    Closed multiple fracture at the 1/3 distal right fibula closed fracture at the 1/3 distal right tibia, complete undisplaced Vulnus laceratum of right leg

    19

    Treatment
    Wound toilette Immobilization Ketorolac 1 x 30 mg IV ATS 1500 IU IM, TT 0.5 cc IM

    X-ray right leg


    Referred to orthoped preparation to ORIF plate

    THANK YOU

    FRACTURE

    Fracture

    discontinuity of the bone

    CLA SSI FIC ATI ON

    EXAMINATION
    Look Feel Movement
    R u l s o f Tw o e 2 p ro j cti n s o f p o si o n e o ti 2 j i ts o f extre m i e s on ti 2 extre m i e s ti 2 tra u m a s 2 o cca si n s o

    PRINCIPLES IN TREATMENT

    PHYSIOLOGIC PROCESS OF FRACTURES HEALING


    Haematome phase Proliferation phase Callus formation phase Consolidation phase Remodelling phase

    Upper limb Callus visible on 2-3 weeks x-ray Union (fracture 4-6 weeks firm) Consolidation (bone secure) 6-8 weeks

    Lower limb 2 - 3 weeks 8 - 12 weeks 12 - 16 weeks

    29

    Treatment of closed fracture


    Manipulation improve the position of the fragments Splint age to hold them together until they unite Joint movement and function must be preserved

    30

    Indications of ORIF
    Cant be reduced except by operation Unstable and prone to redisplacement after reduction (#mid shaft forearm) Unite poorly and take long time (# femoral neck) Pathological fracture Multiple fracture In patients who present nursing difficulties (paraplegics, multiple injuries and very elderly)

    32

    Complications of ORIF
    INFECTION NON UNION IMPLANT FAILURE REFRACTURE

    33

    OREF (open reduction external fixation) ; Indications


    Fracture + severe soft tissue damage Fracture + nerve or vessel damage Severely comminuted and unstable Fr. pelvis Infected fr.
    34

    OREF ; Complication
    Over distraction Reduced load transmission trough bone, which delays fracture healing causes osteoporosis (EF should be removed after 6-8 wo, and replace) Pin tract infection
    35

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