PRESENTED BY:

JOEL GUNTER SINURAT, MD

ADVISOR
DR.FELIX BATUNA
DR.ARIEF FAISAL
SUPERVISOR
dr. Henry Yurianto, M.Phil, Ph.D, Sp.OT (K)

Orthopaedic and Traumatology Department

Medical Faculty of Hasanuddin University
Makassar
2014

IDENTITY
Name
Age
Sex
Admission
Registration

: Ny.H
: 39 years old
: Female
: November 6th, 2014 at 16:47
: 68 80 20

HISTORY TAKING
Chief Complaint: wound at the left leg
History of illness
Suffered since 12 hours before admitted to
Wahidin Sudirohusodo General Hospital. The
patient was riding a motorcycle and got hit by
another motorcycle from opposite direction.
History of unconsciousness (-), Nausea (-),
Vomiting (-).
Prior Treatment at Takalar Hospital

PRIMARY SURVEY
A
B
C
D
E

: Clear
: RR 22 x/min, spontaneous, thoracoabdominal
type
: BP 110/70 mmHg, HR 88x/min strong,
regular
: GCS 15 (E4M6V5), Pupil isochoric, diameter
2.5mm/2.5mm, light reflex +/+
: T: 37oC

SECONDARY SURVEY
Left Leg Region
Look : Stitched wound at anteromedial aspect 1/3 middle size 3 cm,
Deformity (+) at 1/3 middle, Hematoma (+), Swelling (+)
Fell : Tenderness (+)
NVD: Sensibility is good, pulsation of dorsal pedis artery and
tibialis posterior artery are palpable, CRT < 2
Move :Active and passive motion of the knee joint not be evaluated
due to pain
Active and passive motion of the ankle joint not be evaluated
due to pain

LEG LENGTH DISCREPANCY

Right

Left

ALL

91 cm

90 cm

TLL

84 cm

83 cm

LLD

CLINICAL FINDINGS

CLINICAL FINDINGS

RADIOLOGIC FINDINGS
Cruris AP/Lateral
(November 9th, 2014)

LABORATORY FINDINGS
WBC

14,1

4,00-10,0

CT

700

4-10

RBC

12.5

12,0-16,0

BT

200

1-7

HCT

38.0

37,0-48,0

Na

142

136-145

PLT

230

150-400

4,0

3,5-5,1

GOT

21

< 38

Cl

106

97-111

GPT

16

< 41

HbsAg

Non Reactive

Non Reactive

DIAGNOSIS
Open Fracture 1/3 middle left tibia grade IIIa
Open Fracture 1/3 middle left fibula grade IIIa

RESUME
A 39 years old female was admitted to the
Wahidin Sudirohusodo General Hospital due to
vehicular accident.
In physical exam, there was Stitched
wound at anteromedial aspect 1/3 middle left leg
size 3 cm, deformity, hematome, Swelling and
tenderness, active and passive motion of knee
and ankle joint cannot be evaluated due to pain.
There is no neurovascular compromised.
In radiologic finding, there is an fracture 1/3
middle left tibia-fibula.

MANAGEMENT
Intravenous fluid drips
Antibiotic
Analgetic
Tetanus Toxoid
Debridement
Plan for Open Reduction Internal Fixation

(ORIF)

FRACTURE OF
THE TIBIA
AND FIBULA

INTRODUCTION

A fracture is a break in the

structural continuity of bone.
Classification of fractures:
1. open vs close
2. Complete transverse,
oblique, spiral, comminuted
Incomplete greenstick,
buckle or torus

Salomon L., Warwick D., Nayagam S. Apleys System of Orthopaedics and Fractures 9 th
ed. UK.2010.23:688

ANATOMY

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

COMPARTMENT
OF LEG

Anterior
compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

COMPARTMENT
OF LEG

Lateral
compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

COMPARTMENT
OF LEG

Superficial
posterior
compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

COMPARTMENT
OF LEG

Deep posterior
compartment

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

EPIDEMIOLOGY
Fractures of the tibia and fibula shaft are the most

common long bone fractures.

In an average population, there are about 26 tibial
diaphyseal fractures per 100,000 population per year.
Men are more commonly affected than women, with the
male incidence being about 41 per 100,000 per year and
the female incidence about 12 per 100,000 per year.
The average age of a patient sustaining a tibia shaft
fracture is 37 years, with men having an average age of 31
years and women 54 years.

CLASSIFICATION OF
FRACTURE
Clinical types:

open fracture / close fracture

Etiology :

traumatic fracture/ stress fracture/

pathologic fracture
Configuration classification:

Thompson JC. Netters Concise Orthopaedic Anatomy 2nd ed. 2010

Gustilo & Anderson Classification of Open

Fracture
Grade Woun Contamin Soft tissue
d size ation

Bone injury

<1cm

Clean

Minimal

-Simple (transverse, short

oblique)
-minimal comminution

II

>1cm

Moderate

Moderate

-moderate comminution
(transverse, short oblique)

III A

>10 cm High

-extensive soft tissue

laceration
- Adequate soft
tissue coverage

-minimal periosteal
stripping
-soft tissue coverage of bone
is possible

III B

>10 cm Massive

-Extensive soft tissue -moderate to severe

injury
comminution
- Need soft tissue
-poor bone coverage
reconstruction

III C

>10cm

-severe loss of soft

tissue
-need NV
reconstruction

Massive

-poor bone coverage

-moderate to severe
comminution

MECHANISME OF INJURY

TREATMENT

Kenneth J. Koval, Joseph D. Zuckerman Handbook of Fracture 3rd edition,

DIAGNOSIS

Solomon. L. et al. Apleys System of Orthopedics and Fractures 9th Edition. New York :
Arnold. 2010

COMPLICATION

Early
complications

Late complication

Neurovascular injury

Malunion, non- union

Compartment
syndrome

Joint stiffness

infection

Osteoporosis

THANK
YOU