CASE REPORT A boy, 10 years old, came to emergency installation with chief complain pain on his left forearm

after fall accidentally PRIMARY SURVEY Airway & C spine control Snorring (-) Gurgling (-) Speak clearly airway patent

Breathing & Ventilation RR: 24 x per minute regular , trachea on mid line, JVP not increase Thorax : no injury mark Sat O2 98 % Breathing adequate Circulation & haemorrhage controle PR: 90 x / minutes adequate tone and volume BP : 110/70 mmHg No external bleeding stable circulation Disability GCS : E4M6V5 = 15 Equal pupil 3 / 3 mm Light reflex + / +

Exposure Active bleeding (-) Injury mark (-) Left forearm: deformity (+) dorsal angulation, oedem (+), warm, radius artery pulsation (+), ulnaris artery pulsation (+), dorsoflexy/plantarflexy of wirst (+), sensory wnl

Dx : Uncomplicated closed fracture of left antebrachii

SECONDARY SURVEY HOI : 30 minutes before admission, he was falled accidentaly while he was playing with his friends. His left forearm was strucked down by his friend. Mecanism of injury unknown. He felt pain on his left forearm then he was sent to Kariadi General Hospital by the helper.

PHYSICAL EXAMINATION General condition : Conscious Vital sign : BP : 110/70 mmHg RR : 24 x/ min PR : 90 x/min, tone & volume was enough t : 37 oC (A)

Head and neck: Conj palp was pink, equal pupil 3mm Light reflex +/+ Ottorhea -/-, rhinorhea -/JVP not increased, trachea on the mid line.
Chest : No injury mark Heart : I P P A : IC not seen, injury mark (-) : IC palpated 5th ICS 2 cm medially LMCS : Configuration wnl : Pure heart sound I / II

Lung :

I P P A

: SSD, injury mark (-) : Tactile Fremitus left = right : Sonor on all of lungs area. : Basic sound vesicular +/+

Abdomen I P P A

: Flat, no injury mark : Smooth, muscle rigidity (-) , tenderness (-) : Tympanic, LD (+), FD (+), SD( -) : Bowel sound (+)

Pelvis

: Deformity (-), no injury mark stable

Genitalia ext : Male, no perineal hematom

Extremities :

Cyanosis Cold acral Capp refill

Upper -/-/< 2/< 2

Lower -/-/< 2/<2

Left forearm : In : deformity (+) dorsal angulation, oedem (+) Pa : warm, radius artery pulsation (+), ulnaris artery pulsation (+) Mo : dorsoflexy/plantarflexy of wirst (+), sensory wnl

Left forearm x ray AP/L

WDx : Uncomplicated closed fracture of 3rd distal of left radius transverse undisplaced Uncomplicated closed fracture of 3rd distal of left ulna transverse displaced Management : Informed consent Prepare for above elbow circular cast reported to senior onsite & orthopaedic surgeon approved

Cast application : Prepare cast application equipment : gypsona 4 : 3 rolls, softband : 1 rolls Patient laid on supine position Perform local anestatic with ethyl cloride spray on fraktur site Applicated softband along the left forearm circulary, from metacarpophalangeal joint above elbow Dipped gypsona into water, squeezed, applied to left forearm with moulding on fracture site Applicated gypsona along the left upper extremity, from metacarpophalangeal joint above elbow with assistant maintained left forearm on slightly flexion (900) of elbow joint. Evaluated the fingers: pain (-), cyanotic (-), pale (-), cappilary refill < 2 Applied armsling

Dx :

Uncomplicated closed fracture of 3rd distal of left radius transverse undisplaced Uncomplicated closed fracture of 3rd distal of left ulna transverse displaced
Post above elbow circular cast + amrsling Discharge