CASE REPORT

Open Fractur Complete

Metatarsal Digiti 1 Pedis Sinistra

By : Muchlis Zainuddin
10542019110

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 Case Report
Patient Identity
 Name : Mr. R
 Age : Seven years old
 Sex : Male
 Religion : Mouslim
 Address: Majannang
 Admission: Twenty fourth June two thousand sixteen

History
 Alloanamnesis of the patient's mother:
 The main complaints: Open Abration of the left leg after a traffic accident,

The left leg got hit by the car.

 Guided anamnesis:
 Patients admitted to hospital with complaints of Open Abration of the left

leg after got hit by a car, it was happen at nine am, nausea (-), vomiting
(-), fainting (-).
 Physical Examination
 General appearance : being sick
 Blood pressure : 100/60 mmHg
 Pulse : 112x / min
 Breathing : 32x / min
 Temperature : 38.2ºC
 GCS : E4 V5 M6 = 15
 Localist Status : Regio cruris sinistra
 Inspection : Visible wound (+), deformity (+)
 Palpation : tenderness (+)
 Support Examination
 Laboratory Examination  X-RAY
 WBC : + 12.900
 RBC : 3.700.000
 HGB : - 10.2 g/dl
 PLT : 278.000
 Hct : 28.7% 

 Open Fractur Complete

Metatarsal Digiti 1 Pedis
Sinistra
 Post surgery
 Diagnosis, Management and
Prognosis

DIAGNOSIS OF WORK PROGNOSIS

 Open fracture digiti 1 sinistra  Quo ad vitam :

bonam
MANAGEMENT  Quo ad functionam:
 IVFD RL 20 drops / minute
 Iv cefotaxime 1/2 g / 12 hours
bonam
 Iv Metronidazole 250 / 8

hours
 Iv Gentamicin ½ amp /8 hours
 Iv Ketorolac 1/2 amp/8 hours
 Iv ranitidine ½ amp / 12 hours
 Operative plan
 LITERATURE REVIEW
 1. Definition and Cause Fractures
 Fracture is a break of continuity of bone tissue,
cartilage and the epiphyseal cartilage or joints.
 Most fractures are caused by the force of sudden
and excessive, which may include beatings,
destruction, bending, twisting, or withdrawal.
 Anatomy
 Most cruris fracture is the result of a traffic
accident. This is due to the arrangement anatomy
of the cruris which covered only by subcutaneous
tissue, causing easy fractures.
 Anatomically there are 4 important muscle groups
in cruris:
 Muscles Arteries Nerve

1. extensor muscles - Anterior tibial artery 1. n.tibialis n.peroneus

2. abductor muscles - The posterior tibial supplies the anterior and
3. triceps surae artery the extensor and abductor
muscle - Peroneal artery muscle.
4. flexor muscles 2. n.tibialis n.poplitea to
supply the posterior and
flexor muscles and triceps
surae muscle.
 CLASSIFICATION OF FRACTURES
• Complete Fracture: fracture line through the entire cross-section through
both cortical bone or bone as seen in the photos.
Complete - incomplete • -Fractures not complete: no broken lines through the entire cross section of
the bone, : Hairline, buckle, greenstick

The form of broken • Transverse fracture line

lines and their • Oblique broken line
relationship to the • Spiral fracture line
• Compression fracture
mechanism of trauma

• Cominutif fractures: fracture line is more than one and interconnected

The number of broken • Segmental fractures: fracture line more than one but not related. When two
lines broken lines is also called bifocal fracture.
• Multiple fractures: fracture line more than one but on different bone place.
CLASSIFICATION OF FRACTURES

• Undisplaced fracture (not shifting): Complete fracture line but

Displaced- the second fragment is not shifted. Periosteumnya still intact.
• Fractures displaced (shifted): shift fragments also called

undisplaced dislocation fracture fragments,: dislocation ad longitudinam cum

contractionum, ad axim, ad latus

• Closed fracture: if there is no fracture wounds that connects with

Open - closed the outside air or the surface of the skin.
• Open fracture: if there is a wound that connects the fractured
bone with the outside air or the surface of the skin.
 Management

Recognition

Rehabilitation Reduction

Retention
In general, there are four principles of fracture treatment:
 1. Recognition, diagnosis and assessment of fracture

The first principle is to know and assess the state of the fracture with the
history, clinical examination and radiological. At the beginning of treatment
should be considered: Localization fracture, Shape fracture, Determining a
suitable technique for treatment, Complications that may occur during and after
treatment

 2. Reduction; fracture reduction if necessary

Restoration fracture fragments do to get an acceptable position. In the intra-
articular fracture anatomical reduction is required and where possible restore
normal function and prevent complications such as stiffness, deformity, and
changes in osteoarthritis later in life.
A good position is: Perfect alignment, Perfect apposition

 3. Retention; immobilization of fractures

 4. Rehabilitation; restores functional activity as much as possible

 Therapeutic Option
Conservative Operative

Open Reduction and

Protection course Internal Fixation

Immobilization Excisional arthroplasty

without repositioning

Excisional Fragmen
  Therapy in open fractures
Pre-hospital Emergency hospitals
• Splinting • The value of the degree of
• Stop the bleeding with a injury,
bandage press • then cover the wound with
• Stop the bleeding with a sterile gauze and splinting
bandage clamps limbs,
• then the limb elevated.
• Send to radiology
• Give ATS or human tetanus
globulin
Open repositioning action
• Installation torniquet in
anesthesia in the operating
room was good.
• Swab for examination and
culture microorganisms
• the entire limb washed for
5-10 minutes and shaved.
• The wound was irrigated
with fluid Naci sterile
• Cover the wound with a
sterile doek
• Surgeons washing hands
and so on
• Disinfection limbs
• drapping
• The wound debridement
• Fixation
 Prognosis
 Prognosis of Cruris fracture to life is bonam.
but it really depends on the picture of the
fracture, the selected therapies, and how the
body's response to treatment.
 Fracture healing

Inflamation
Hematom Formation of Consolidation
and Cellular Remodelling
Phase callus phase phase
proliferation
 Fracture Healing Complications

• Malunion is a state where the fracture heal in time, but are shaped
angulation deformity, varus / valgus, rotation, short or union as a
Malunion cross, for example in a fracture of the radius and ulna.

• Delayed Union are fractures that do not heal after an interval of 3-5
months (3 months for the upper limbs and 5 months for the lower
Delayed limbs)
Union

• Called when the fracture does not heal nonunion between 6-8
months and not obtained consolidated so that there pseudoartrosis
Nonunion (false joint).
THANKS