CASE REPORT RSUD Dr.

SOESELO SLAWI

A PATIENT WITH COMPOUND FRACTURES

OF METATARSAL II-V DEXTRA GRADE II

By :
PARASAMYA DEWI CIPTA
G6A098131

MEDICAL FACULTY OF
DIPONEGORO UNIVERSITY
SEMARANG
2004
 PREFACE
Background :
 Mobility of society, industrial, technology 
 accident (traffict’s and job’s)  trauma
(bone, musculus, joint)  fractures,
dislocation, etc 
  10% of all fractures occurred on foot

 physician able to diagnose and treat

properly, so that can avoid complications
and disabilities
REFERENCE
Definition
A metatarsal fracture is a break of one of the long
thin bones of the foot.
Details
Your foot has 5 metatarsals. Metatarsal fractures
range from very minor to severe injuries. It depends on
the pattern of injury and the amount of displacement of
the fracture. At times, these fractures can occur in an
area of the foot with poor blood flow. This makes
fracture healing more difficult. Often, this particular
fracture requires surgery.
Causes
Trauma direct, indirect, over use. Most are
caused by twisting or direct impact (like dropping a
heavy object on your foot). Metatarsal fractures can be
missed sometimes because the symptoms can be
similar to an ankle sprain.
Diagnosis
 By a history of an injury to the foot followed by
pain and swelling. X-rays help to confirm the fracture.
Rarely, a CT scan or MRI is needed to rule out other
injuries.
Treatment
- Immediate Treatment: Elevate, use crutches.
- Nonoperative: Most metatarsal fractures can be
treated with a stiff soled shoe or a walking cast.
More severe fractures may require a non-weight
bearing cast for several weeks.
- Operative: Surgery may be required for
metatarsal fractures that occur in an area of the
foot with poor blood supply or in cases where the
bones are significantly out of place.
Prevention
Excellent balance, coordination and strength of
the foot and ankle may help prevent some metatarsal
fractures.

Complications:

 Compartment syndrome is the most dangerous

acute complication of foot fractures. This
syndrome is associated primarily with midfoot
 fractures sustained as the result of a crush
mechanism. Clinical signs include marked
swelling (early) and neurovascular compromise
(late). Suspicion warrants emergent orthopedic
consultation; treatment is fasciotomy when
diagnosis is confirmed.

 Long-term complications

o Arthritis

o Infection

o Nonunion or instability

o Gait disturbances

Prognosis:

 Generally excellent with appropriate treatment

Patient Education:

 Proper instruction in crutch-walking is required

for those unable to bear weight.
 CASE REPORT
A. Identity
Name : Mr. A
Sex : male
Age : 30 years old
Address : Kedawon, Larangan, Brebes
Occupation : farmer
Religion : islam
Med record : 184201

Pasive
Active No
No. Date proble Date
problem .
m
1. Compoun 06/25/0 1. VL 06/25/0
d fractures 4 regio 4
metatarsal manus
II-V dext dextra
gr II

B. Anamnestic (06/25/04)
Chief complain : pain in the right foot with open
wound

History :  ½ hour before entering Soeselo’s hospital,

the patient had an accident when he was walking. It
was dark, suddenly there was a high speed motorcycle
from the opposite directions and hit him. His right foot
was touched by motorcycle’s chain. He was
unconsciousness for 2’. Whe he regained, he felt pain
in his right foot especially when he tried moving it.
Then, he was taken to the hospital immediately.
 swelling history in the fractures area (-), fractures
frequently since childhood (-), bone’s pain with
movement disturbance (-), tumor in the fractures
area (-)
 family’s history with tumor, fractures frequently (-)
 economic-social : moderate
C. Physical examination (06/25/04)
Internal: normal
Lokalis :
 Regio manus dextra :
I : open wound (+) 7x0,2x0,1cm and 0,2x0,1x0,1cm;
blood (+), lipid base, oedem (+)
Pa : pain (+), sensibility (+) N, krepitation (-)

 Regio pedis dextra :

I : open wound (+) 15x1x0,5cm; blood (+), musculus
and bone base, dirty, deformity (+), swelling (+),
oedema (+), haematom (+)
Pa : pain (+), warm (+), sensibility (+) N, krepitation
(+); a. tib post’s pulse (+).
Movement : pasive  pain, active  pain
ROM : limited motion coz hurt the patient refused
Lab (06/26/04) : normal
X-foto pedis dextra (06/25/04) : metatarsal II-V
fractures
D. Abnormality list
1. compound fractures metatarsal II-V dextra gr II
2. vulnus laceration regio manus dextra
E. Diagnostic
1. compound fractures metatarsal II-V dextra gr II
2. vulnus laceration regio manus dextra
F. Initial plan
1. compound fractures metatarsal II-Vdext gr II
Ass : fracture’s complication
Dx : S : -
O : X-foto pedis dext post op, Hb, diff count,
LED I-II, leuko
Tx : WT, HT
Inf RL 20 gtt/mnt
Inj ceftriaxon 1 gr iv
Inj ketoprofen 100 mg iv
Inj ATS 1500 U im
Inj tranexamat acid 500 mg iv
Debridement, reposition,
fixation ,imobilisaton, rehabilitation
Mx : general condition, vital sign, complication, X-
photo pedis dext post op
Ex : immediately operated
2. vulnus laceration regio manus dextra
Ass : -
Dx : S : -
O:-
Tx : WT, HT
Mx : general condition, vital sign
Ex : don’t get the wound dirty and wet
 DISCUSSION
 Anamnestic, physic exam, X-photo pedis dextra 
compound fractures metatarsal II-V dext gr II
 Complications (-)
 Debridement
 Compound fractures  open repotition and internal
fixation with K-wire.
 Antibiotic, analgetic, NSAID  avoid complication
(infection)
 Optimal result  adaptation, rehabilitation (proper
weight practice)
 CONCLUTION AND SUGGESTION
Conclution
This patient was treated properly as well as
reference. Compound fractures  debridement,
operative repotition and fixation
Suggestion
 Hospital : Informed concent with good
explanation
 Society : more cooperative