Case Presentation

OPEN COMMUNITIVE FRACTURE

LEFT PATELLA

ANDI AZIZAH NOOR

111 2 0 1 6 2 0 8 6

S U P E RV I S O R :
D R . A R I YA N TO A R I E F,
S P. O T, M . K E S
A D V I S O R : D R . S T E FA N
 Patient’s Identity

Name : Tn. N
Age : 35 years old
Sex : Male
Address : Wajo
Work : Entrepreneur
Date of admission : January, 15th 2018
Medical record : 142699
 History Taking

•Chief Complain : Wound at the left knee

•Anamnesis :
Sufferes since 4 hours admitted to Andi Makkasau
Hospital due to traffic accident.
•Mechanism of Trauma :
Patient was riding a motorcycle at passsanger site, and
then being hitted by a car from opposite direction.
•History of loss of concisiousness (-), history of vomiting
(-)
•Priortreatment at Wajo hospital
 Primary Survey
Airway and C-spine • CLEAR
control

• Inspection: Symmetrical chest

movement, spontaneous breath, no
lesion, RR: 20x / min
Breathing • Palpation: Tenderness (-), crepitation (-)
• Percussion: Sonor
• Auscultation: Vesicular S/D

• BP 120/80 mmHg, Breathing 20x /min,

Circulation Pulse 80x /min strong, regular.

• GCS E4V5M6 Composmentis, pupil isokor

Disability Ø 2,5mm/2,5mm.

Exposure • Temp 36.0°C.

 Secondary Survey
Left Knee Region
Look Deformitas (+), swelling(+), hematoma (-), stitched
wound (+) at anterior aspect sized 10cm
Feel Tenderness (+)
Move Active and passive movement of motion knee joints can
not be evaluated due to pain
NVD Good sensibility, pulsation A. Brachial, CRT <2 seconds
Clinical Photo

Left Knee
Radiology Finding

Photo Genu PA/Lateral

 Resume

 Male, 35th years old arrived to Andi Makkasau Hospital

with wound in his left knee since about 4 hours before.
Patient was riding a motorcycle at passsanger site, and then
being hitted by a car from opposite direction.
 Primary survey clear.
 Secondary survey:
Left Knee region : deformitas (+), swelling(+), hematoma
(-), stitched wound (+) at anterior aspect sized 10 cm.
 Neurovascular distal within normal limit.
 Investigations of Left Knee AP/Lateral photos: a
comminutive fracture of os patella.
Post operative

Photo Genu PA/Lateral

 Diagnosis
OPEN COMMINUTIVE FRACTURE
LEFT PATELLA
 Planning of Diagnosis

Non Operatif Non • Education for the patient about

Medikamentosa his condition
• Stabilize the patella to prevent
Medikamentosa neurovascular injury.

• Intravenous Fluid Drips

• Intravenous Antibiotic
• Analgetik

Operatif Open Reducation Internal Fixation (ORIF)

ANATOMY
 Fracture
Fracture → a break in the structural continuity of bone, cartilage,
joint and growth plate
If overlying skin remains intact: closed fracture
If skin not intact : open fracture
 EPIDEMIOLOGY

• Patella fracture are serious injuries with a broad

range of subtypes. These injuries account for about
1% of all skeletal injuries and are most prevalent
within the age group of 20-50 years.
 ETIOLOGY

NON
TRAUMA TRAUMA
Classification of Gartland
 MECHANISM OF INJURY

Patella fractures are caused by direct trauma to knee

 Diagnose
History and Mechanism of Trauma

Physical Examination

X-ray Genu AP-Lateral sinistra

 Anamnesis

 History of trauma
- Trauma can occur due to a traffic accident, fall
(e.g., football,hockey)
 Pain
 Swelling
 Impaired limb function or motion abnormality
 Deformity
 Physical Examination
• Inspection: deformity, swelling, hematoma.

• Present with tenderness, crepitus

• Decreased range of motion at the arm,

depending on the location of the fracture

• NVD evaluation
 Treatment
OPERATIVE

open reduction with internal

fixation (ORIF).
 Complication

EARLY COMPLICATION LATE COMPLICATION

- Compartement syndrome
- Neurovaskular injury -Mal union
- Severe displacement - Non union (rarely)