Case Report

OPEN FRACTURE 1/3 MIDDLE LEFT TIBIA GRADE I AND

OPEN FRACTURE1/3 MIDDLE LEFT FIBULA GRADE I

Mohamad Nizwan Sham

C111 10 839
ADVISOR:
dr. Nur Rahmansyah
dr. Shandy Limansyahputra
SUPERVISOR:
dr. W Supriyadi, Sp.OT
Orthopaedic and Traumatology Department
Medical Faculty of Hasanuddin University
Makassar
2015

PATIENTS IDENTITY
Name
: Mr. A
Register no.
: 73 55 97
Sex
: Male
Age
: 30 years old
Date of admission : 4th December 2015

HISTORY TAKING
Chief complain

: pain at the left leg

Anamnesis

Suffered since 2 hours before admission. History of

loss consciousness (-), vomiting (-)
Mechanism of trauma :
The patient was working on the waterway when one
of the concrete water pipe accidentally slipped and
hit the patient left lower leg

PRIMARY SURVEY
Airway
Breathing
Circulation
Disabilty
Exposure

Patent, clear

20x/min, thoracoabdominal,
spontaneous, symetric.
BP 110/70mmHg, HR 88x/min, regular,
strong on palpation
GCS 15(E4M6V5), light reflex +/+ ,
pupil isochors, : 2.5mm/2.5mm,

Temp 36.8C (axilla)

SECONDARY SURVEY
LEFT LEG REGION
Look

Pin point wound at anteromedial aspect at 1/3

middle left cruris. Deformity (+), Hematoma
(+), Swelling (+)

Feel

Tendernes (+)

Move

Active and passive movement of knee joint

can not be evaluated due to pain
Active and passive movement of ankle joint
can not be evaluated due to pain

NVD

Sensibility is good,
Pulsation of the dorsalis pedis artery and
tibialis posterior artery are palpable.
CRT <2

LEG LENGTH DISCREPANCY

ALL
TLL
LLD

Right (cm)
Left (cm)
98
97
93
92
1 cm

CLINICAL FINDINGS

LABORATORY FINDINGS
WBC
RBC
HGB
HCT
PLT

: 20,3 X 103/UI
: 4,13 X 106/UL
: 12,5 GR/DL
: 38 %
: 415 X 103/UL

RADIOLOGY FINDINGS

Left Cruris AP + Lateral

RESUME
Male, 30 years old, admitted with open fracture
left cruris, suffered since 2 hours before
admission. From the physical examination there is
pin point wound at anteromedial aspect at 1/3
middle left cruris, deformity (+), hematoma (+),
swelling (+). tenderness (+). from the radiology
finding, there are oblique fracture at 1/3 middle
left tibia and fibula.

DIAGNOSIS
OPEN FRACTURE 1/3 MIDDLE LEFT TIBIA GRADE I
OPEN FRACTURE 1/3 MIDDLE LEFT FIBULA GRADE I

MANAGEMENT
IVFD
Antibiotic
Analgesic
Tetanus prophylaxis
Apply long leg back slab at left lower limb
Plan for ORIF elective

DISCUSSION
TIBIAAND FIBULA SHAFT
FRACTURE

DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC MEDICAL FACULTY OF HASANUDDIN UNIVERSITY

INTRODUCTION
Fracture a break in the structural continuity of
bone
If overlying skin remains intact
: Closed
fractured
If skin not intact
: Open fractured

Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York:
Lippincott Williams & Wilkins. 2006.

EPIDEMIOLOGY
Fractures of the tibia and fibula shaft are the
most common long bone fractures.
Male: incidence being about 41 per 100,000
per year.
Female: incidence about 12 per 100,000 per
year.
Usually due to traffic accident & sports injury.

Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York: Lippincott
Williams & Wilkins. 2006.

Fibula and Tibia Bone

Thompson JD. Netter's Concise Atlas of Orthopedic Anatomy 2004

Anterior Compartment

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Lateral Compartment

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Superficial Posterior Compartment

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Deep Posterior Compartment

Thompson,JD. Netter's concise atlas of orthopedic anatomy.2004.

Diagnosis
Physical
Examination
Radiological
Examination

History
Open
Fracture
oblique 1/3
middle left
cruris

Clinical Features of Tibia and Fibula Fracture

Deformity

Pain

Swelling

Bruising

Decrease
range of
motion

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

Classification of Open Fracture

Koval, K., Zuckerman, J. Tibia Fibula Shaft in Handbook of Fractures Third Edition. New York:
Lippincott Williams & Wilkins. 2006.

Goals Of Fracture Management

Recognize
Reduction
Retain
Rehabilitation

Fracture site, types of fracture

For adequate apposition and
normal alignment of bone
Maintain the reduction

Restore function

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

Initial Treatment

Apply long leg back slabonly for temporary

stabilization
To minimize pain
To limit soft-tissue damage
To obtain and hold fracture alignment
To prevent or at least observation a compartment
syndrome

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

Treatment
Operative
The indications for operative :
Open fractures.

Multiple fracture

Neurovascular compromize.

Unstable fracture

Solomon. L. et al. Injurys of the Knee and Leg in Apleys System of Orthopaedics and
Fractures 9th Edition. UK: Arnold. 2010.

COMPLICATION
EARLY COMPLICATION

LATE COMPLICATION

Neurovascular injury

Delayed Union

Compartment Syndrom

Non Union
Malunion
Infection
Joint Stifness

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

THANK YOU
DEPARTEMENT OF ORTHOPAEDIC AND TRAUMATIC
MEDICAL FACULTY OF HASANUDDIN UNIVERSITY