Case Presentation

MALUNION FRACTURE 1/3 MIDDLE LEFT

FEMUR

FITRA NURUL HUDAYA

111 2016 2103

SUPERVISOR:
dr. Ariyanto Arief, Sp.OT,M.kes

ADVISOR
dr. Pierre
 Patient’s Identity

Name : Harun
Age : 14 years old
Sex : Male
Address : Paria duampanua
Work : Student
Date of admission : January 24th, 2018
Medical record : 14.31.91
 History Taking

•Chief Complain : Limping Gait

• History Taking : Suffered since 2 months before
admitted to Andi Makkasau Hospital due to falling
from 2 meters height
• Mechanism of Trauma : falling from height
•History of loss of concisiousness (-), history of nausea (-),
vomiting (-), and fever (-).
 Generale Status

General Status • Composmentis/ Well Nourished

BP • 110 / 70 mmHg

HR • Pulse 90x/Minutes

RR • 20x/Minutes

Temp • Temp 36.7°C.

 Local Status

Left Thigh Region

Look Deformity (+), Edema (-), hematom (-), wound (-)
Feel Tenderness (-), crepitus (-)
Move Active and passive movement hip joint is within normal limit
Active and passive movement of knee joint is within normal
limit
NVD Good sensibility, pulsation A. Tibialis Posterior and A Dorsalis
Pedis(+), CRT <2 seconds
Radiology Finding

Femur PA/Lateral
January 2018
 Laboratory Finding
Items Result Unit N Value
Hematology:
WBC 8,69 103/ul 4-12
Eosinofil 0,34 103/ul 2-4
Basofil 0.20 103/ul 0-1
Netrofil 56,9 % 50-70
Limfosit 28,8, % 25-50
Monosit 8,1 % 1-6
RBC 5,96 106/ul 3,8-5,2
Hemoglobin 15,2 g/dl 12,8-16,8
Hematokrit 44,0 % 35-47
MCV 73,8 Fl 80-100
MCH 25,4 Pg 26-34
MCHC 34,4 g/dl 32-36
PLT 247 103/ul 150-450

Items Result Unit N Value

Kimia darah:
Glukosa Sewaktu 86
Mg/dl <140
Imuno-Serologi: Non reaktif
Non reaktif
HBsAg (Kualitatif)
Hemostasis: 10’’ Minutes
< 15’00”
CT 2’
Minutes 1’00” – 3’00”
BT
 Resume
• 14-years-old boy with chief complain of limping gait, suffered
since 2 months before admitted to Andi Makkasau Hospital due
to falling from 2 meters height. From the local status at left
thigh region, there is deformity. The leg length discrepancy
measured 4 cm. from radiographic evaluation, there is
malunion as level as 1/3 middle left femur
 Diagnosis

Malunion Fracture 1/3 Middle Left

Femur
 Planning of Diagnosis

Non Operatif Non • Education for the patient about

Medikamentosa his condition

Operatif Open Reducation Internal Fixation (ORIF

Reconstruction)
Pre - Post Operative
LEG LENGTH DISCREPANCY

PRE OPERATIVE
• Apperant length D 83 cm S 82cm
• True Length D 81 cm S 80,5 cm

POST OPERATIVE
• Apperant length D 83 cm S 86 cm
• True Length D 81 cm S 84,5 cm
•ANATOMI
DEFINITION

• malunion is a condition the circumstances in which the fracture heals

in time, but there is a deformity in the form of angulation, varus /
valgus, rotation, or shortening.
• Malunion  healing from the fracture but in an abnormal
position.
ETIOLOGY
• Fracture without treatment
• Improper reduction and immobilization
• Decision making is technically wrong at the beginning of
treatment
• Treatment is wrong or not at all treated
• Incomplete internal fixation
• Less vascularization at the ends of fragments
• Infection
• Tumor
 CLINICAL MANIFESTATION
• Patients have a history of fractures that may or may not
have been treated
• Deformity with varied shapes
• Impaired motion function
• Pain and restricted joint movement
• Edema (swelling) in the fracture area
• Instability
• When it occurs in the inferior extremity the patient will
complain that it is difficult to lift his extremities
• Bursitis or skin necrosis of bone deformity
PHYSICAL EXAMINATION

• Physical examination showing deformity (angulation, varus / valgus,

rotation, abbreviation). When the malunion affected area is touched,
the patient will feel pain
RADIOLOGY FINDING

• In the X-ray there is a fracture connection but in a position that is not

in accordance with normal circumstances
Ex. Malunion fracture 1/3 distal of femur
TREATMENT

• Conservative
Refracted with general anesthesia and immobilization
according to the new fracture
 Operative
• Corrective osteotomy (osteotomy Z) and bone graft are accompanied
by internal fixation
• Osteotomy with gradual elongation, for example in children
• Malunion that has been long (months) should be traction first before
done ORIF. This is because if it has been for a long time, the soft
tissue has shortened. So it needs to be lengthened with traction so
that soft tissue is not damaged when done ORIF.
• Most malunions require surgery to restore fracture fragments to
normal / anatomical position and stabilize fractures by using metal
plates, screws or wires.
Installation of plate and screw on Malunion the middle
1/3 femur fracture
Prognosis

• Ad Vitam : ad bonam
• Ad fungsionam : Dubia ad Bonam
• Ad sanationam : Dubia Ad Bonam
Summary

• Malunion is a condition in which the fracture heals in time, but there

is a deformity in the form of angulation, varus / valgus, rotation,
abbreviation. In other words malunion is the healing of the fracture
but in an abnormal position.
• The causes of the malunion itself include poor reduction and
immobilization of faulty technical decision making at the beginning of
treatment, incorrect treatment or completely no treatment,
incomplete internal fixation
• Treatment can be conservative (immobilization according to new
fracture), and surgery (osteotomy, ORIF)
THANK YOU