IDENTITY

Name

: H

Age

: 70 years old / female

Admission : March 29 th, 2015 at 11:44

Registrati
on

: 70 64 61

AUTOANAMNESIS
Chief Complain : Pain at left thigh

Suffered since 25 days before admitted to

Wahidin General Hospital.
Patient was going into the bathroom then
she slipped and fell with her left thigh
hitting the floor.
History of loss of conciousness (-),
vomiting (-).
History of hypertension (-),diabetes (-)
Prior treatment at Haji Hospital.

GENERAL STATUS
Conscious / Well-nourished / Anemic
Vital Signs:
Blood pressure
: 130/70
mmHg
Pulse rate
: 80 x/min
Respiratory rate
: 18 x/min
Temperature
: 36,8 0C

LOCAL STATUS
Left Thigh Region
Loo : Wound (-), deformity (+) ,hematome (-),
k
Swelling (+),
Feel : Tenderness (+)
NVD: sensibility is good, pulsation of dorsalis
pedis artery and tibialis posterior artery are
palpable, CRT < 2
Mov : Active and passive motions of hip joint are
e
difficult to be evaluated due to pain
Active and passive motions of knee joint are
difficult to be evaluated due to pain

ALL
TLL
LLD

R
87 cm
83 cm

L
86 cm
82 cm
1 cm

CLINICAL FINDINGS

RADIOLOGIC FINDING

LABORATORY FINDINGS

WBC : 10.500/ ul
RBC : 2.330.000/ ul
HGB : 6,6 g/dl
HCT : 20 %
PLT
: 164.000/ ul
CT
: 700
BT
: 300
HBsAg : Non-Reactive
Albumin
: 2,8 gr/dL

RESUME

Female 70 y.o admitted to hospital

with chief complain pain at the left,
there
is
deformity,
and
posterolateral displacement. From
X-Ray
finding,supracondylar
fracture of left femur.

DIAGNOSIS

Closed Fracture Left Supracondylar

Femur
Anemia
Hypoalbuminemia

MANAGEMENT

IVFD RL
Analgesic
Apply Skin Traction load 3 kgs at left
lower limb

Transfusion 2 bags of Packed Red Cell

Plan for Open Reduction Internal

Fixation

DISCUSSION
Close fracture Left
Supracondylar femur

Fracture is a break in the structural

continuity of the bone
Closed fracture if the overlying skin
remain intact

Type of fractures

Complete : the bone is completely

broken into two or more fragments
tranverse, oblique, spiral,
comminuted
Incomplete : incompletely divided
and the periosteum remains in
continuity greenstick

Anatomy of thigh

Bones

Compartments

Innervations

The sciatic nerve innervates muscles

in the posterior compartment of
thigh
the femoral nerve innervates muscles
in the anterior compartment of thigh
and the obturator nerve innervates
most muscles in the medial
compartment of thigh.

Vascularisation

The major artery, vein, and lymphatic

channels enter the thigh anterior to
the pelvic bone and pass through the
femoral triangle inferior to the
inguinal ligament.
Vessels and nerves passing between
the thigh and leg pass through the
popliteal fossa posterior to the knee
joint.

Mechanism of injury

Most common severe axial load

with a varus,valgus, or rotational
force
In young adults tipically high
energy
In the elderly minor slip or fall
onto a flexed knee

Deforming force

The deforming forces

from muscular
attachment cause
caracteristic
dispalacement patterns
gastrocnemius : flexes
the distal fragment
posterior displacement
and angulation
Quadriceps and hamstring
: exert proximal traction
shortening lower
extremity

Clinical evaluation

Patient typically are unable to

ambulate with pain,swelling, and
variable deformity in the lower thigh
and knee
Assest of neurovascular usual sign
of pallor and lack of pulse rupture
of a major vessel

Treatment

Non Operatif treatment

Indication :
Patient with nondisplaced fracture
Significant medical comorbidities
Relatif indication : nonambulatory
patients,significant underlying medical
diseases,infected fracture and lack of
internal fixation devices

Non operatif treatment for distal

femur fracture include :
Close reduction with skeletal
traction with or without cast-bracing

Operative treatment
Indications :
Close reduction fails
Large articular fragment
Avulsion fractures
Associated injuries

Complications
Early

Late

Local Visceral
Injury
Vascular Injury
Compartment
Syndrome
Nerve Injury

Malunion

Infection

Non-union
Avascular
Necrosis
Musculare
Contracture
Joint Instability

Thank you