CASE REPORT

“NONUNION 1/3
TENGAH OS. FEMUR
FRACTURE”

Supervisor :
d r. W i s n u M u r t i , S p . O T
 Fracture os. femur is most often
place affected by traffic accident

There are
several
variations

1/3 distal were more

Femoral neck fracture 1/3 common happened in
fracture 1/3 mid
fractures proksimal traffic acident
 • causes direct pressure on the bone and fractures occur in
Direct trauma the pressure area. Fractures that occur are communicative
and soft tissue is damaged.

• if trauma is delivered to areas farther away from the

Indirect trauma
fracture area and usually soft tissue remains intact
Stage of tissue damage and hematoma formation (1-3 days)

Inflammatory stages and cellular proliferation (3 days - 2 weeks)

Stage of callus formation (2-6 weeks)

Osification (3 weeks-6 months)

Remodeling (6-12 months)

  the edema is found in the
middle of the right thigh
 there is deformity,
 significant pain angulation, external
localized to the thigh rotation
 unable to move his  the right leg is shortened
right foot  tenderness in the middle
of the thigh
 distal artery pulses still
palpable
 Non union fracture cam make
pseudoarthroses.

Types of pseudoarthroses include:

 Hypertrophic pseudoarthrosis
 Oligotrophic pseudoarthrosis
 Atrophic pseudoarthrosis
 Hypotrophic (non-vital) pseudoarthrosis
 Defect pseudoarthrosis
 Infected pseudoarthrosis
• External Fixation

• Intramedullary Nail

• Compression Plate
 IDENTITY

• Name : Mr. S
• Age : 59 years old
• Gender : Male
• Address : Kendal
• Occupation : Unemployment
• Religion : Islam
• Come to Hospital : 4-5-2019
• Room : Kenanga
• No. CM : 488376
 ANAMNESIS

• Main problem : Pain of right thight

• History of present illness
Pasien feel pain on his right thight since 5 days before come to hospital. Patient feel pain after
slipped and fall with his right knee got down first to the floor. After that, his hip got pain
especially when patient move his right leg, deformity, and swelling. Patient also told he used 1
kruk after 3 weeks patient got operated on his right thight. Normal urinate and defecate normal.
Family Medical History
• History of operation :Yes ( ORIF right thight on November 2018)
• History of similar injury : denied
• History of drug allergic : denied
• History of hypertension : No
• History of diabetic : No

Personal History, Social and Environment

• History of similar illnes : denied
• History of diabetic : denied
 PHISICAL EXAMINATION
• GCS : 15
• Awarness : Composmentis
• Vital sign
• BP : 120/80
• HR : 84x/minutes
• RR : 18x/ minutes
• Temp : 37 C

General Status
• Skin : turgor (< 2 “)
• Head : mesochepal, wound (-)
• Eyes : anemis (-/-), icteric (-/-)
• Ear : discharge (-/-)
• Nose : deviation septum (-), discharge (-/-)
• Mouth : sianosis (-)
• Neck : simestris, trachea deviation (-), enlargement of thyroid gland (-)
Thorax

COR
• Inspection : ictus cordis (-)
• Palpation : ictus cordis palpable at SIC 2cm medial to the line midclavicularis, Pulsus sternal (-), pulsus epigastrium (-)
• Percussion : Batas jantung
• Bottom left : SIC V 2 cm medial line midclavicularis
• Top Left : SIC II linea sternalis sinistra
• Top right : SIC II linea sternalis dextra
• Bottom right: SIC III line parasternalis sinistra
• Auscultation : reguler I-II heart sound, gallop (-), murmur (-)
PULMO

• Inspection : normochest, simetris, retraction (-)

• Palpation : vermitus vocal simetris (+), crepitation (-/-)
• Percussion : sonor (+/+)
• Auscultation : vesicular (+/+), Wheezing (-/-), ronchi (-/-)
ABDOMEN

• Inspection : flat (+), simetris (+)

• Auscultation : peristaltic sound (+) normal
• Percussion : thympani (+)
• Palpation : supel, pain (-)
 EXTREMITAS EXAMINATION

Extremity superior Inferior

Oedem -/- +/-

Cold extremity -/- -/-

Physiological reflex +/+ +/+

Sianosis -/- -/-

BACK EXAMINATION
Inspection : kifosis (-), scoliosis (-), gibbus (-)
Palpation : pain (-), proc spinosus (+) straight
 LOCAL STATUS

Right Tight
• Look : eritem (-), wound (-), deformity (+), Swelling (+)
• Feel : painfulness when it given a palpation, numbness (-), sensoric (+), pulse a.
dorsalis pedis (+)
• Move : Dissability of ROM and pain of movement

LLD Right Left

True length 83 cm 84 cm

Apparent length 90 cm 91 cm

Anatomic length 42 cm 43 cm
 RADIOLOGY

Radiology Femur dextra (AP-LATERAL) position

after operation on November 2018
Radiology Femur dextra (AP-
LATERAL) position Mei 2019
 LABORATORY

Hematology Result Normal Value

HB 13,1 11,5-16,5

Leukosit 6,86 4-10

Platelet 431 150-500

Hematokrit 38,4 35-49

Protombin time 14,4 11,3-14,7

APTT 34,2 27,4-39,3

ASSESMENT
• Clinical Diagnosis : nonunion 1/3 medial os. Femur fracture

INITIAL PLAN
Ip. Therapy
• RL infus 20 tpm
• Inj. Ketorolac 1 ampul (30 mg) / 8 hour
• Inj. Ranitidin 1 ampul (50 mg)/8 hour
• Inj. Cefazolin 2 x 1 gram

Ip. Operative
• ORIF + Reconstruction
Ip. Monitoring
• General condition
• Bleeding
• Vital sign
• The result of supporting examination

Education
• Educate patient to reduce body weight after operative treatment
• Educate patient to do some simple exercise after the treatment was received.

PROGNOSIS
• Quo ad vitam : dubia ad bonam
• Quo ad sanam : dubia ad bonam
• Quo ad fungsionam : dubia ad bonam
 CONCLUSSION

• Fracture os. femur is most often place affected by traffic accident.

• There are several variations placed reported, such as: Femoral neck fractures, fracture 1/3
proksimal, fracture 1/3 mid, 1/3 distal were more common happened in traffic acident.
• Management of fractures consists of preoperative, intraoperative and postoperative treatment.
• Patients with fractures may find it difficult to move and fractures should be suspected if there is pain
that creates limitations
• On imaging examination can use the anteroposterior position x-ray (AP) and lateral position of the
tight indicated for cases of suspected nonunion fracture 1/3 tengah os. Femur sinistra.
• Management of nonunion fracture 1/3 tengah os. Femur sinistra is operative theraphy.
• Type of operations are eksternal fixation, intramedullary nail, and compression plate.