CASE REPORT:

FRACTURE OF DISTAL OF RIGHT RADIUS

FRACTURE OF STYLOID OF RIGHT ULNA
BY:
NOR FARHANA BT OMAR
C 111 09 870

ADVISOR:
DR. WIRA/DR.PADLAN

SUPERVISOR:
dr. ZULFAN OKTASATRIA Sp.OT
 PATIENT IDENTITY
Name • Harianti

Age • 42 years old

Sex • Female

Date of • 3rd March 2015

admission

Medical
record • 710663
 HISTORY TAKING
Chief complain

Pain at the wrist of the right hand

History of illness
suffered since 1 hour before admitted to Wahidin
hospital due to traffic accident.

Mechanisme of trauma
Patient drove the motorcycle but suddenly fall by herself to her right
side. . The patient is a secretary and her right hand was a dominant
hand.
History of unconsciousness (-), nausea (-), vomited (-)
 PRIMARY SURVEY
Airwa • patent, obstruction (-)
y

Breat • RR= 18x/minute, spontaneous, thoracoabdominal type

hing
• BP= 100/70 mmHg, PR = 88x/minute regular, strong
Circul
ation
• GCS 15 (E4M6V5), pupil isokor
Disabi
• ϕ 2.5mm/ 2.5 mm, light reflex +/+
lity
Enviro • T= 36.7oC (axillar)
nmen
t
 SECONDARY SURVEY
Inspection Palpation ROM NVD

• Deformities • Tenderness (+) • Active and • Sensibility is

(+), hematoma passive good, pulse of
(+), edema (+), motion at radialis artery
wound (-) elbow joint palpated,
are within capillary refill
normal limit time <2“
and active and
passive
motion at the
wrist joint are
limited due to
pain
sensation.
 Clinical Finding
Regio Antebrachii Sinistra
 Anterior view

 Medial view

 Lateral view
 LABORATORY FINDINGS
RBC 4.75

HGB 11.9

HCT 39.0

PLT 347

WBC 17.8

BT 3’00”

CT 7’30”

HBsAG Non-reactive
 RADIOLOGY FINDINGS

X-ray Antebrachi AP/Lateral view of the right hand

 SUMMARY
• Female, 42 years old was admitted to RSWS with pain at
the wrist right hand. Suffered since 1 hour before admitted
due to traffic acident.
• From physical examination, on the right forearm region,
there are deformity, edema, hematoma, and tenderness.
ROM, Active and passive motion at elbow joint are within
the normal limit and active and passive motion at wrist
joint are limited due to pain sensation. NVD, Sensibility is
good, pulse of radialis artery palpated, capillary refill time
<2“
• Radiographic Antebrachii Dextra AP/Lateral showed
fracture 1/3 distal os radius et ulna dextra
• From laboratory results, there are leucosytosis.
 DIAGNOSIS
• Closed fracture distal of the right radius
• Closed fracture processus styloid of the right
ulna
 MANAGEMENT
• IVFD
• Analgesic
• Apply volar slab below elbow at right upper
extremity and arm sling
 DISCUSSION

CLOSED FRACTURE DISTAL RADIUS

CLOSED FRACTURE PROCESSUS
STYLOID OF ULNA
 ANATOMI

•Thompson, Jon C. Netters Concise Atlas of Orthopedics Anatomy, 1st edition. Learning System LLC, A
Subsidiary of Elsevier Inc. 2001; page 89
•Thompson, Jon C. Netters Concise Atlas of Orthopedics Anatomy, 1st edition. Learning System LLC, A
Subsidiary of Elsevier Inc. 2001; page 106
•Thompson, Jon C. Netters Concise Atlas of Orthopedics Anatomy, 1st edition. Learning System LLC, A Subsidiary of
Elsevier Inc. 2001; page 108
 EPIDEMIOLOGY

• 17% of all ER visits

Frequency • Race: No racial preferences have been reported

• Bimodal age distribution:

• Peaks at ages 5-14 years and at ages 60-69 years.
Age • Elderly patients extra-articular, metaphyseal
• Young patients intra-articular fractures with joint surface
displacement.

• In older postmenopausal women, female-to-male

Gender ratio 4:1
• but In adolescent boys and girls, the ratio is 3:1
 MECHANISM OF INJURY
Mechanism depends on the position of the wrist, the magnitude and direction
of the force, and the physical properties of the bone

A fall on the outstretched hand with the wrist in 40 degree to 90 degree of

dorsiflexion produces a distal radius fracture with dorsal replacement

The lunate can exert a compressive force on the distal radius, producing a so
called die- punch fracture

The ulnar styloid fracture component of the colles fracture result from a force
transmitted through an intact triangular fibrocartilage
 DIAGNOSIS
History of trauma

Clinical examination: look for other injury

Injury should evaluated: open/closed, degree of soft tissue injury, neuravascular

injury-median nerve injury common, tendon injury

Imaging: forearm/ wrist PA, Lat, oblique, CT scan -intraarticular

 RADIOGRAFIC ASSESMENT
• radial inclination is measured
on PA view (normal angle 15-
25 degree)
• volar tilt
• radial length
• Any intra-articular gap or
step
FRYKMAN Classification of distal radius
fracture
OPTIONS FOR TREATMENT
CASTING
• Long arm vs short arm
• Sugar –tong splint
EXTERNAL FIXATION
• Joint spanning
• Non bridging

PERCUTANEOUS PIN

INTERNAL FIXATION
• Dorsal plating
• Volar plating combined dorsal/volar plating
• Focal (fracture specific) plating
 TREATMENT GOAL

Preserve hand Realign normal

Promote bone
and wrist osseous
healing
function anatomy

Allow early
avoid
finger, and
complications
elbow ROM
THANK YOU