Professional Documents
Culture Documents
I/C NO
930421-14-5875
REG NO
18774
Greetings
PPW (Program Penempatan Wajib) Group 17
Hospital Kepala Batas, Pulau Pinang
Assalamualaikum w.b.t.
First of all I wish to say deepest gratitude because given the opportunity to
finish this assignment namely "Long Bone Fracture- femur fracture" in Malaysia
especially.
This assignment give a guide to me and all other PPWs to promote or implement the
most proper way based on latest clinical practice guidelines on management of
femur fracture. This assignment will be more concentrate to Assistant Medical
Officer Responsibility in managing femur fracture.
It is hoped so that this assignment becoming guide and jumping-off point in
realizing Lembaga Pembantu Perubatan Malaysia dream to strengthen organization
through build potential process.
Muhd Hafiz
MUHAMMAD HAFIZ BIN KAMARUDDIN
Assistant Medical Officer U29
Hospital Kepala Batas, Pulau Pinang
Sept 2016 Feb 2017
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Telefon: 019-xxxxxxx
KEMENTERIAN KESIHATAN
MALAYSIA
Perkhidmatan
Kesihatan
Kawal: MINEHEALTH
Mental
MINISTRY OF HEALTH
MALAYSIA
ACKNOWLEDGEMENT
With The Generous name of Allah with generosity. Alhamdulillah, thank God
that has awarded His blessing until I could complete this assignment prior
to compulsory component in completing PPW's programme. First I would like
to wish highest appreciation and gratitude to my supervisors Mr. Sazali bin
Ishak U32 and Mr. Mohamad Fikrie bin Mohd Noor U29 above all guidances,
reprimand and advice given along completing this assignment. Millions of
thanks also is expressed to my parents, which never idle in guiding and
give coaching that was beneficial.
Deepest gratitude also to all of my friends, PPW's team and also to
individual people that also help directly or indirectly in succeeding this
assignment. Finally, once more again I climb benediction to God existence,
so that all efforts contributed blessed by Allah s.w.t in the world and
afterworld.
Thank you
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Telefon: 019-xxxxxxx
KEMENTERIAN KESIHATAN
MALAYSIA
Perkhidmatan
Kesihatan
Kawal: MINEHEALTH
Mental
MINISTRY OF HEALTH
MALAYSIA
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Patients who survive the initial trauma associated with the injury
typically heal well. Early mobilization following intramedullary
nailing greatly reduces complications associated with prolonged
immobilization.
Age affects the speed and quality of recovery. Fractures may be caused
by underlying medical conditions such as osteoporosis or cancer
metastasis; these conditions may complicate recovery further.
Patients older than 60 years with closed fractures of femur have a
mortality rate of 17% and a complication rate of 54%.
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1.3 Abstract
that
exceed
the
bone
capacity.
By
epidemiology,
more
regular
fractures
happened
due
to
bone
cannot
hold
excessive
pressure
1Kumar V, Abbas AK, Fausto N, Aster JC. Bones, joints, and soft-tissue tumors. In:
Robbins and Cotran pathologic basis of disease 8 th edition. Philadelphia:
Saunders Elsevier; 2010. pg. 1219-1220.
22
American Academy of Orthopedic Surgeons. Thighbone (femur) fracture.
[Online]. 2008 [cited 2011 March 3]; Available from: URL:
http://orthoinfo.aaos.org/topic.cfm?topic=a00364.
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2.0 INTRODUCTION
2.1 Definition of closed fracture
A closed fracture is a broken bone that does not penetrate the skin. This
is an important distinction because when a broken bone penetrates the skin
(an
open
fracture)
there
is
need
for
immediate
treatment,
and
an
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Sports injuries
Falls
Osteoporosis
Cancer
Indirect force
it
more
difficult
to
tell
if
the
bone
is
broken
or
dislocated.
Dislocations usually occur in the joints. The following are signs and
For closed bone fractures that involved nerve damage, there can be
feeling of
of closed
tingling
sensation on the area and sometimes numbness
symptoms
fractures
Bruising due to internal haemorrhages, clotting of the blood or due to
damaged tissues
Swelling around the injured area
A breaking or cracking sound heard or felt
Severe pain, especially in attempting to move, at or near the site the
injury
Difficulty moving or impossible normal movement
Loss of power/ normal function
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CASE CLERKING
Name
Reg. No.
18774
Year
Placement
Registration number:
KB00241754
930411075463
Race:
Occupation:
Age:
Male
Malay
Student
23 years old
Address:
No. Tel:
Hospital/Clinic:
Date:
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24 December 2016 @
4:50pm
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Time out
: 4:23 p.m.
On scene
: 4:35 p.m.
: 4:50 p.m.
Airway
clear
Breathing
Tachypnea 26 / min
Circulation BP 149 / 59
- PR 115 / min (tachycardia)
- Spo2 95
Skin
Pale, sweating
Pupil
GCS
E 3, V 4, M 5
- 12/15
LUNG
CVS
Bilateral clear
DRNM
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: 149/59 mmHg
Pulse
: 115/min
Spo2
Pupils
: 12/15
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4.0 MANAGEMENT
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Look and feel for the skin colour, condition, and check
patients temperature to determine sign and symptom of
hypovolemic shock.
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Allergic
Medication
Nil
Nil
Last meal
Around 12noon
MB skidded.
Event
Inspection:
- No hematoma or swelling.
- No wound or scar noted
- No abnormality detected
(Laceration wound at chin)
Palpation:
No abnormality detected
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2. Eye (Bilateral):
Inspection: - No jaundice
- No discharge
- Pupil: both equal reacting to light.
- Size: both eye 3mm
- No Raccoons eyes
Palpation:
- No abnormality detected
3. Ears (Bilateral):
Palpation:
- No abnormality detected
4. Nose:
Palpation:
- No abnormality detected
5. Neck:
Palpation:
- No neck stiffness.
- No bruit felt
- Trachea not shifted
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Palpation:
Percussion:
Auscultation:
- Good heart sound, No crepitation sound, Lungs clear and good air
entry
Palpation:
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Inspection:
Percussion:
- No abnormality detected.
Palpation:
Soft, non-tender
Nervous System:
A) Glasgow Coma Scale
EYE OPEN
SPONTANEOUSLY
TO VERBAL COMMAND
TO PAIN
NO RESPONE
SCORE
4
3
2
1
VERBAL RESPONE
ORIENTATED
CONFUSED
IN APPRORIATED WORD
IN COMPREHENSIBLE SOUND
NO RESPONE
5
4
3
2
1
MOTOR RESPONDE
OBEYS COMMAND
LOCALIZED PAIN
WITHDRAWAL TO PAIN
6
5
4
PATIENT SCORE
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ABNORMAL FLEXION
EXTENSION TO PAIN
NO RESPONE
3
2
1
TOTAL SCORE PATIENT
5
12/15
Pelvic Region:
Spine Region:
**Log roll done **
Palpation:
- No deformity or tenderness
Muscular System:
(Include hands and legs)
A. Upper Extremities:
Palpation:
B).Lower Extremities:
Inspection:
-
Palpation:
multiple abrasion
No active bleeding.
- Femoral and dorsalis pedis pulse palpable
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1)
(X-Ray of extremities- To find out any abnormality of the upper and lower
extremities, assist in the diagnosis of fractures.)
Chest x-ray
HB
- 7.3
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WBC
- 11.4
PLT
- 128
3)
Buse / Creatinine
(Bl
Sodium
138
Potassium
Chloride
Urea
3.7
101
2.5
Creatinine
67
ood Urea/Creatinine - To assess the blood urea and serum electrolyte level
and Serum Electrolyte (BUSE) renal function.)
IM ATT 0.5ml
IM Voltaren 75mg
IV
Iv zinacef 1.5g
Flagyl 500mg
Final diagnosis:
Closed communited 1/3 midshaft right femur fracture
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Treatment:
Open Reduction Internal Fixation (ORIF)
Follow up on 25/12/2016
S Right thigh immovable, painful if driven.
O Pulse: 82 bpm, RR: 20 br/min, Temp: 37c, BP: 120/80mmHg
Status of right inferior extremity:
Look: Swollen, deformity at 1/3 midshaft femur, seems shorten
compared to left part, tarsal part edema
Feel: Dorsalis Pedis is palpable, crepitation (-), feel warm when
palpate at right femoral region
Move: Limitation of active movement or passive movement.
A Closed communited 1/3 midshaft right femur fracture.
P Plan for ORIF
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6.0 DISCUSSION
6.1 Complication
The
ends
of
broken
bones
are
often
sharp
and
can
cut
or
tear
This
pressure
can
decrease
blood
flow,
which
prevents
nourishment and oxygen from reaching nerve and muscle cells. Unless
the pressure is relieved quickly, permanent disability may result.
This is a surgical emergency. During the procedure, your surgeon
makes incisions in your skin and the muscle coverings to relieve the
pressure.
Immobilize the injured area. Do not attempt to push back the bone
thats visibly sticking out or misplaced. If one is trained to apply
splint, apply a splint above and below the fractured area. Pads may
be added to add comfort.
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Apply ice packs on the injured area to limit swelling and reduce
pain. Ice should not be applied directly to the skin. Wrap the ice in
towel or cloth.
Remove
any
tight
clothing
and
jewelleries
to
avoid
impeding
circulation.
Though it is the least dangerous type of fracture, first aid should still
be administered to give comfort to the victim.
The physician makes the diagnosis with physical examination and diagnostic
tests. During the examination the physician obtains a complete medical
history
of
the
patient
and
asks
how
the
injury
occurred.
Diagnostic
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of
large
magnets,
radiofrequencies,
and
computer
to
produce detailed images of organs and structures within the body. This
test is done to rule out any associated abnormalities of the spinal cord
and nerves.
procedure
that
uses
combination
of
x-rays
and
computer
Treatments of closed fractures are highly dependent on the extent and type
of injury. Since closed fractures happen internally, they do not pose risks
of having infections thus making surgery as the last treatment option. This
type of fracture is also treatable and professionals encourage application
of first-aid since they do not need immediate emergency treatments. In
applying first aid for people with closed fractures, the injured individual
should be immobilized first by having him in a lying and unmoving position.
The injured area should be raised in an angle in order to minimize the
swelling. Ice packs should be applied to moderate the pain.
Most cases of closed fractures only need external fixation or the use of
slings, casts, or crutches as their treatment. However, surgery can be
immediately required in situations when there is internal bleeding on the
tissues and when the bones have been shattered into small pieces. Internal
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fixation uses devices like rods, screws, and plates that are implanted
inside the body and used to hold bones together that are fragmented.
Physical therapy is also added to the treatment regardless if the patient
had an internal fixation or external fixation. In physical therapy, range
exercises are conducted to help condition the affected body parts back into
its normal condition.
Splint/cast - immobilizes the injured area to promote bone alignment and healing to protect
the injured area from motion or use.
Traction - the application of a force to stretch certain parts of the body in a specific
direction. Traction consists or pulleys, strings, weights, and a metal frame attached
over or on the bed. The purpose of traction is to stretch the muscles and tendons
around the broken bone to allow the bone ends to align and heal.
Surgery - required putting certain types of broken bones back into place. Occasionally,
internal fixation (metal rods or pins located inside the bone) or external fixation devices
(metal rods or pins located outside of the body) are used to hold the bone fragments in
place to allow alignment and healing.
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7.0 CONCLUSION
Treatment depends on the part of the femur that is fractured. Traction may
be useful for femoral shaft fractures because it counteracts the force of
the muscle pulling the two separated parts together, causing the two halves
to rip through otherwise undamaged tissue.
Traction is contraindicated in femoral neck fractures and also when there
is any other trauma to the leg.
or
after
administering
without
adequate
neurovascular
analgesia.
injury,
can
be
Well-aligned
immobilized
fractures,
by
using
traction device. Hare or Thomas traction splints are most commonly used.
Apply wet sterile dressings over an open fracture. If the wound is grossly
contaminated,
sterile
saline
irrigation
may
be
used
to
remove
large
contaminants.
7.2 Fracture reduction and immobilization
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emergency
extent
that
physician.
respiratory
Use
and
parenteral
opiate-type
circulatory
parameters
analgesics
allow.
to
the
Intravenous
administration allows for the most reliable titration to pain relief while
providing ready access for reversal agents (i.e., naloxone) if necessary.
Infection
prophylaxis:
With
open
fractures,
administer
tetanus
toxoid
and
good
tissue
penetration.
Often,
first-generation
7.3 Complications
7.3.1 Hemorrhagic shock
Closed fractures of the femur can result in significant blood loss (eg,
1
L)
within
the
thigh.
Open
fractures
have
the
potential
for
even
Injuries
to
the
neurovascular
bundle
are
rare
because
of
the
large
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Infection: While open fractures are at high risk of soft-tissue and bony
infection,
postoperative
infection
is
rare
following
repair
of
closed
fractures.
of
the
extremity,
or
malrotation,
resulting
in
permanent
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8.0 REFERENCES
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