CASE REPORT

INTODUCTION
• CLOSED TIBIAL SHAFT FRACTURES ARE THE MOST COMMON LONG-BONE
FRACTURES, RESULTING IN APPROXIMATELY 77,000 HOSPITALIZATIONS, 569,000
HOSPITAL DAYS (AVERAGE LENGTH OF STAY, 7.4 DAYS), AND 825,000 OFFICE
VISITS PER YEAR. CLOSED TIBIAL SHAFT FRACTURES MOST COMMONLY
SPORTRELATED INJURIES OR TRAFFIC INJURY, BUT A SIMPLE FALLS CAUSE MOST
OF THE CLOSED TIBIAL SHAFT FRACTURES IN THE ELDERLY. THE FRACTURE
PATTERN OF CLOSED TIBIAL FRACTURES IS USUALLY SIMPLE, WITH LESS SEVERE
SOFT-TISSUE INJURY THAN IS SEEN WITH OPEN TIBIAL SHAFT FRACTURES. THE
MORE COMPLEX FRACTURE CONFIGURATIONS ARE FREQUENTLY SEEN IN OLDER,
LESS FIT PATIENTS WITH OSTEOPOROTIC BONE.
ANATOMY OF OS. RADIUS
TRAUMA MECHANISM
• A TWISTING FORCE CAUSES A SPIRAL FRACTURE OF BOTH LEG BONES AT
DIFFERENT LEVELS; AN ANGULATORY FORCE PRODUCES TRANSVERSE OR SHORT
OBLIQUE FRACTURES, USUALLY AT THE SAME LEVEL.
• INDIRECT INJURY IS USUALLY LOW ENERGI, WITH A SPIRAL OR LONG OBLIQUE
FRACTURE ONE OF THE BONE FRAGMENTS MAY PIERCE THE SKIN FROM WITHIN.
• DIRECT INJURY CRUSHES OR SPLITS THE SKIN OVER THE FRACTURE; THIS IS
USUALLY A HIGH-ENERGY INJURY AND THE MOST COMMON CAUSE IS A
MOTORCYCLE ACCIDENT.
MULLER CLASIFICATION
MANAGEMENT

ORIF

CRIF
MANAGEMENT
OPEN REDUCTION AND INTERNAL FIXATION (ORIF) IS SURGERY TO REPAIR A BROKEN BONE. OPEN REDUCTION
MEANS THE DOCTOR MAKES AN INCISION (CUT) TO REACH THE BONES AND MOVE THEM BACK INTO THEIR
NORMAL POSITION. INTERNAL FIXATION MEANS METAL SCREWS, PLATES, SUTURES, OR RODS ARE PLACED ON THE
BONE TO KEEP IT IN PLACE WHILE IT HEALS. THE INTERNAL FIXATION WILL NOT BE REMOVED.

THIS SURGERY IS DONE ON AN ARM OR A LEG TO REPAIR FRACTURES THAT WOULD NOT HEAL PROPERLY WITH A
CAST OR SPLINT ALONE. YOUR SURGEON MAY RECOMMEND ORIF IF:

• THE BONE IS BROKEN INTO MANY PIECES

• THE BONE IS STICKING OUT OF THE SKIN

• THE BONE IS NOT LINED UP CORRECTLY

• A CLOSED REDUCTION (WITHOUT OPENING THE SKIN) WAS DONE BEFORE AND IT DIDN’T HEAL PROPERLY

• A JOINT IS DISLOCATED

THIS SURGERY SHOULD ALLOW YOUR BONE TO HEAL PROPERLY. WHEN IT DOES, YOU WILL HAVE LESS PAIN AND BE
BETTER ABLE TO MOVE AND USE YOUR ARM OR LEG
ORIF SURGERY BENNEFITS:
• DECREASE PAIN AND HELP YOUR BROKEN ARM OR LEG HEAL CORRECTLY
• RESTORE THE BONE TO ITS NORMAL FUNCTION
• PREVENT FURTHER INJURY
COMPLICATION
RISKS ASSOCIATED WITH ANY SURGERY:

BLEEDING THAT WOULD REQUIRE A BLOOD TRANSFUSION; INFECTION; ALLERGIC REACTION TO ANESTHESIA.

RISKS ASSOCIATED WITH ORIF:

– NERVE DAMAGE THAT REDUCES FEELING IN THE ARM OR LEG

– HARDWARE IN THE ARM OR LEG MOVING OUT OF PLACE

– PAIN, SWELLING, OR TROUBLE MOVING THE ARM OR LEG

– INCOMPLETE HEALING OF THE BONE

– INCREASED PRESSURE IN THE ARM OR LEG (COMPARTMENT SYNDROME) WHICH CAN DAMAGE MUSCLES AND
TISSUE

– BLOOD CLOT, POSSIBLY TRAVELING TO THE HEART (PULMONARY EMBOLISM)

– MUSCLE SPASMS
• SUPERFICIAL INFECTION AND IMPAIRED WOUND HEALING WERE
CONSIDERED MINOR COMPLICATIONS. DEEP INFECTION, RESIDUAL PAIN, OA,
MALUNION, ARTHROFIBROSIS, COMPLEX REGIONAL PAIN SYNDROME (CRPS),
AND IMPLANT BREAKAGE WERE CONSIDERED MAJOR COMPLICATIONS.
CASE REPORT
PATIENT STATUS
IDENTITY

• NAME : TN. S
• AGE : 46 YEARS 2 MONTH
• GENDER : MALE
• ADDRESS : PODOSARI
• JOB :-
• RELIGION : ISLAM
• AT HOSPITAL : JUNE 16TH 2019
• ROOM : KENANGA
• NO. CM : 581862
 PATIENT STATUS
ANAMNESA PRIMARY SURVEY

SYMPTOM : PAIN IN LEFT LOWER LEG

1. AIRWAY : PATENT, CLEAR
PATIENT HISTORY : 2. BREATHING : NORMAL, 20X/M
PATIENT COMES TO THE HOSPITAL POST STRUCK DOWN 3. CIRCULATION : BP 140/90 MMHG, HR
BY A MOTOR CYCLE. PATIENT DIDN’T KNOW POSITION 80X/M
WHEN SHE FALLED FROM THE MOTOR CYLE BUT THE 4. DISABILITY : COMPOS MENTIS GCS 15
PATIENT DID REMEMBER ABOUT HIS LEFT FOOT 5. EXPOSURE : NORMAL, NOTHING
OVERWEIGHT BY THE MOTORCYCLE. PATIENT FELT PAIN LESSION
IN REGIO CRURIS SINISTRA, AND DIFFICULT TO MOVE.
PATIENT STATUS
• MEDICAL HISTORY
HISTORY OF SIMILARY INJURY : DENIED
HISTORY ALLERGY DRUG AND FOOD : DENIED
HISTORY OF LONG COUGH : DENIED
• FAMILY MEDICAL HISTORY
HISTORY OF SIMILARY SYMPTOM : DENIED
HISTORY OF HEART DISEASE : DENIED
HISTORY OF DIABETICS MELITUS : DENIED
• PERSONAL HISTORY, SOSIAL, AND ENVERONMENT
PATIENT USED HEALTH INSURANCE BPJS
PHYSICAL EXAMINATION
GCS : E4 M6 V5
VITAL SIGN
HR : 70X/M
RR : 18X/M
BP : 130/90 MMHG
T : 37OC
STATUS GENERALIS
SKIN : TURGOR (N)
HEAD : MESOCEPHAL
EYES : ANEMIS -/-
EAR : DISCHARGE -/-
NOSE : DEVIATION -/-, DISCHARGE -/-
MOUTH : BLEEDING (-)
NECK : SIMETRIS, DEVIATION TRACHEA (-)
THORAX : NORMAL
ABDOMEN : NORMAL
EXTREMITAS
Superior Inferior

Akral -/- -/-

Oedem -/- -/+
Capilary Refill <2” <2”
Lession -/- -/-
Hematom -/- -/-
STATUS LOCALIS OF UPPER EXTEMITTY
IN SINISTRA WRIST
LOOK FEEL
• SKIN COLOR : NORMAL • SKIN TEMPERATURE : NORMAL
• EDEMA : (+) • TENDERNESS : (-)
• PALE AND WINKLED : (-) • KREPITATION : (+)
• VULNUS : (-) • ARTERY PULSATION : (+)
• DEFORMITY : (+) • SENSIVITY : (+)
 MOVEMENT
• AKTIF ( -)
• PASIF (+)
LABORATORY TEST
Pemeriksaan Hasil Normal

HB 15.7 13.0-18.0
Leukosit 12.8 4.00-10.00
Trombosit 224 150-500
Hematokrit 45.2 39.0-45.0
Waktu protrombin 12.8 11.3-14.7
APTT 34.0 27.4-39.3
RADIOLOGY
BEFORE ORIF AFTER ORIF
DIAGNOSE PLANNING Education PROGNOSIS
• Closed fracture epifisis THERAPHY • Describe of the trauma • Quo ad vitam : ad
os. radius sinistra • Ip Terapeutic and the prognosis to bonam
the family • Quo ad sanam : ad
• Inf RL 20 tpm
• Explane the possible bonam
• Inj ketorolac 30 mg/8
complication taht can • Quo ad fungsionam : ad
jam
happen to family bonam
• Inj cefazolin
igr/12jam
• Inj ranitidin 5 gr
• Ip operatif
• ORIF
• Ip Monitoring
• General situation,
Vital sign, the result
of supporting
examination
 CONCLUSION

DISTAL TIBIA FRACTURE IS A COMMON LEG INJURY AND THE INCIDENCE

APPEARS TO BE INCREASING IN INDONESIA ESPECIALLY IN MOTORCYCLE
ACCIDENT. THE FRACTURE IS REDUCED BY TRACTION ANTERO POSTERIOR AND
LATERAL OF THE ANKLE AND CRURIS REGIO. X-RAYS SHOULD BE TAKEN TO
ENSURE THE FRACTURE HAS NOT SLIPPED. OPERATION TREATMENT OF
FRACTURE DISTAL RADIUS DEPEND ON RESULT ON RADIOLOGICAL. IT COULD BE
TREAT BY OPEN REDUCTION OR CLOSE REDUCTION DEPEND ON CLINICAL AND
RADIOLOGICAL INDICATION THAT HAS BEEN SHOWN.