CLOSED FRACTURE OF

RIGHT FEMORAL NECK

Nuradelia Paramitha Noor C11110307
Medita Aninditia Novianty C11112033
Indira Devi F. H. C11112159
Nurul Hidayah R C11112304
Resident
s:
dr. Handoko
dr. Randy Octavianus
Supervisor:
dr. Henry Yurianto, M.Phil., Ph.D.,
Sp.OT(K)
 CASE REPORT
Closed Fracture of
Right Femoral Neck
PATIENT IDENTITY

Name : Mr. MJ
Sex : Male
Age : 70 y.o.
Admission : 30/04/2017
Hospital : RSUP dr. Wahidin
Sudirohusodo
Reg. Number : 40094
HISTORY TAKING
Chief complaint: Pain on right groin
Sufferred since 2 weeks before admitted to dr.
Wahidin Sudirohusodo General Hospital
Patient fell from 1 meter height when he was
fixing his ceiling
He landed on his right side and was unable to
stand and walk ever since
He went to a bone setter afterwards but did not
feel any better
He then went to Ibnu Sina Hospital and was
treated with painkillers only before referred to dr.
Wahidin Sudirohusodo General Hospital
HISTORY TAKING
There is no history of open wound or fainting after
the fall
There is history of swelling and bruising on the right
groin
There is no history of headache, coughing or
breathing difficulty, nausea or vomitting. There is no
changes in bowel and bladder activity.

History of Past Illness

Patient has a history of high blood pressure and is
consuming 10 mg Amlodipin and 2 x 10 mg
Simvastatin on a daily basis
There is no history of diabetes mellitus, heart
disease, or stroke
PHYSICAL EXAMINATION
General Status

Concious / well-nourished
Vital signs
Blood pressure = 160/90 mmHg
Pulse rate = 84 bpm, regular, strong and
adequate
Respiratory rate = 20 rpm, regular, spontaneous,
thoracoabdominal type,
symmetrical
Temp. (axillar) = 36.5oC
PHYSICAL EXAMINATION
Local Status: Right Hip Region

Look : Deformity (+), swelling (-), wound (-),

hematoma (-)
Feel : Tenderness (+)
Move : Active and passive movement
of right hip and knee joint
could not be evaluated due to pain
NVD : Sensibility within normal limit,
pulsation of posterior tibial and dorsalis
pedis arteries palpable, CRT < 2 secs
PHYSICAL EXAMINATION

True Leg Apparent Leg

Length Length

Right Lower
89 cm 93 cm
Limb

Left Lower
91 cm 95 cm
Limb

Leg Length
2 cm 2 cm
Discrepancy
CLINICAL
FINDINGS
LABORATORY FINDINGS
(30/4/2017)

TEST RESULT REFERENCE

WBC 9,2 4,00 10,0/mm3
RBC 4,12 4,00 6,00/mm3
HGB 12,1 12,0 16,0 g/dL
HCT 36,4 37,0 48,0%
PLT 395 150 400/mm3
CT 700 4 10 menit
BT 300 1 7 menit
Random Blood
108 140 mg/dL
Glucose
LABORATORY FINDINGS
(30/4/2017)

TEST RESULT REFERENCE

SGOT 15 <38 U/L
SGPT 23 <41 U/L
Ureum 36 10-50 mg/dL
Creatinine 1,06 <1.3 mg/dL
Non
HbsAg Non Reactive
Reactive
Natrium 145 136 145 mmol/L
Kalium 4,0 3,5 5,1 mmol/L
Chloride 111 97 111 mmol/L
RADIOLOGICAL FINDINGS
(30/4/2017)

Fracture of base neck of right femoral neck

RADIOLOGICAL FINDINGS
(30/4/2017)

Fracture of base neck of right femoral neck

RADIOLOGICAL FINDINGS
(30/4/2017)

Dilatatio et elongatio aorta

DIAGNOSIS
Closed Fracture of Right
Femoral Neck
MANAGEMENT
IVFD RL 20 drips per minute
Ketorolac 30 mg/8 hours/IV
Ranitidine 50 mg/12 hours/IV
Skin traction on the right limb with 3 kgs
weight
Planned for hemiarthroplasty
 DISCUSSION
Fracture of Femoral
Neck
PREFACE

Femoral neck is the most common site of

fractures in elderly. It associates with
osteoporosis. Incidence of femoral neck
fractures has been used as a measure of
age-related osteoporosis in population
studies.
DEFINITION

Fracture
Fracture is a break in
the structural continuity
of bone. It may be no
more than a crack, a
crumpling or a
splintering of the
cortex. More often, the
break is complete and
the bone fragments are
displaced.
DEFINITION

Fracture of Femur Femoral Neck

Fracture on the Fracture
femur, consisting Fracture on the neck
femoral head, neck of femur, with or
and shaft. without displacement.
 EPIDEMIOLOGY

Incidence of femoral neck fractures (USA) = 63.3 (for women) & 27.7 (for
men) per 100,000 population per year.

The incidence in younger patients is very low and is associated mainly with high-
energy trauma.

The majority occurs in the elderly as a result of low-energy falls.

 White Race
Increasing
Woman Age

RISK
Tobacco
FACTORS Poor Health

Previous Estrogen
Fracture Level

Alcohol Fall History

ANATOMY
ANATOMY
ANATOMICAL
CLASSIFICATION

(a) subcapital (b) transcervical (c) basicervical

GARDENS CLASSIFICATION
PAUWEL CLASSIFICATION
MECHANISM OF INJURY

Cyclicloadin
Low-energy
g-stress
trauma
fractures

High-energy Insufficienc
trauma y fractures
 PHYSICAL EXAMINATIONS
Look

Feel

Move

Neurovascul
ar distal
RADIOGRAPHIC EVALUATION

Magnetic resonance imaging (MRI)

is currently the imaging study of
choice in delineating nondisplaced
or occult fractures that are not
apparent on plain radiographs.
Bone scans or CT scanning is
reserved for those who have
contraindications to MRI.
RADIOGRAPHIC EVALUATION
 Need to note
There are four situations in which a
femoral neck fracture may be
missed, sometimes with dire
consequences
Stress
Undisplaced fractures
Painless fractures
Multiple fractures fractures
TREATMENT
Goals of Initial Operative
treatment are treatment For all others, operative
to minimize consists of pain- treatment is almost
mandatory. Displaced
patient relieving fractures will not unite
discomfort, measures and without internal fixation.
restore hip simple splintage
function, and of the limb. If When should the
allow rapid operation be
operation is performed?
mobilization by delayed, a In young patients
obtaining early femoral nerve operation is urgent;
anatomic block may be interruption of the blood
reduction and helpful. supply will produce
irreversible cellular
stable internal changes after 12 hours
fixation or and, to prevent this, an
prosthetic accurate reduction and
replacement. stable internal fixation is
needed as soon as
possible.
 TREATMEN
T
Young patient with high-
energy injury and normal
bone: Urgent closed or open
reduction with internal fixation
and capsulotomy is
performed. Fixed-angle
implant may be indicated in
these fractures.
Elderly patients:
Treatment is controversial.
High functional demands
and good bone quality:
Almost all should receive a
total hip replacement. Open or
closed reduction and fixation
may be considered, with a
40% reoperation rate in these
patients.
Low demand and poor
bone quality: Perform
hemiarthroplasty using a
cemented unipolar prosthesis.
Severely ill, demented,
bedridden patients:
Consider nonoperative
Total hip replacement
for femoral neck
fractures
may be indicated:
(1) if treatment has been delayed for
some weeks and acetabular
damage is suspected, or
(2) in patients with metastatic
disease or Pagets disease.
POST-OPERATIVE CARE
o Postoperatively, breathing
exercises and early
mobilization are important.
o Early bed to chair
mobilization is essential to
avoid increased risks and
complications of prolonged
recumbency, including poor
pulmonary toilet,
atelectasis, venous stasis,
and pressure ulceration.
COMPLICATIONS
o General complications
o Avascular necrosis
o Non-union
o Osteoarthritis
thankyou