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BY: Andi sandra faro C111 06 180 ADVISOR: Dr.Ihsan kitta Dr. Fadil Mula putra SUPERVISOR: Dr.M.

Ruksal Saleh,Ph.D,Sp.OT Orthopaedic and Traumatology Department Medical Faculty of Hasanuddin University Makassar 2012

PATIENT IDENTITY
Name Age Gender :I : 14 years old : Male

Date of admission : September 20th 2012


Medical Record : 569723

History talking
Chief complaint :

Decrease of consciousness, suffered since 8 hours before admission to Wahidin General Hospital due to traffic accident. Mechanism of Trauma : The patient was riding a motorcycle and suddently fell by himself . Prior treatment from Takalar Hospital . History of unconscious (+), nausea (-), vomit (-)

PRIMARY SURVEY
A B
C D E

: Patent, airway obstruction(-) Clear : RR = 23 x/min, spontaneous, thoracoabdominal type. : BP 110/80 mmHg, PR = 88 x/min regular : GCS 14 (E3V5M6), pupil isochor 2,5mm / 2,5mm, light reflex +/+ : T = 36,60 C (axilla)

SECONDARY SURVEY

Maxillofacial Region :
I : wound (+) at mandibula region, deformity (-) ,swelling at the left chik (+), hematoma (-),

: Tenderness dificult to evaluated due to decreased of consciousness.

CLINICAL APPEARANCE

Left arm region :


I P ROM NVD : Deformity(+), swelling (+), hematoma (+), wound(-) : Tenderness (+) : Active and passive motions of shoulder and elbow joint are difficult to evaluated because of decrease consciousness. : Sensibility is difficult to evaluated becouse of decrease consciousness. Radial artery and ulnar artery are palapable, CRT <2

Clinical appearance

Ct scan

CERVICAL LATERAL

Chest X-ray

Radiology finding

Pelvis AP

Laboratory finding
WBC RBC HGB 14,00 x 103 /uL 4,20 x 106 /uL 12 g/dL PT APTT UREUM 14,4 25,9 21 mg/dl

PLT
CT BT

296 x 103 /uL


3,00 8,00

CREATININ
SGOT SGPT

0,6 mg/dl
83 u/l 47u/l

summary
A boy,14 years old ago admitted to hospital with chief

complain decrease of consciosness due to traffic accident since 8 hours before being admitted. hematoma (+),Tenderness (+) of left arm region. ROM : Active and passive motions of shoulder and elbow joint are difficult to evaluated because of decrease consciousness. NVD : Sensibility is difficult to evaluated becouse of decrease consciousness. Radial artery and ulnar artery are palapable, CRT <2

On physical examination : Deformity(+), swelling (+),

on radiologic examination there are fracture 1/3 middle of

the left humerus.

Diagnosis
Mild Trauma Capitis GCS 14 (E4M6V5)
Closed fracture 1/3 middle left of humerus

Management
IVFD RL
Analgesic H2 receptor agonist Apply U Slab at the left forearm Neuro surgery dept : conservatif Planning: 1. ORIF

Introduction
Fracture is break in the structural of the bone involving surrounding soft tissue Different from fractures in adults Pediatric bone has a higher water content and lower mineral content per unit volume than adult bone. Pediatric bone has a lower modulus of elasticity (less brittle) and a higher ultimate strain-to-failure than adult bone. periosteum is thicker and stronger in children

FRACTURE is a break in the structural of bone.


CLOSED (SIMPLE) FRACTURE FRACTURE OPEN (COMPOUND) FRACTURE SKIN OR ONE OF THE BODY CAVITIES IS BREACHED

SKIN INTACT

Contamination and infection

Sorurce: Principles of Fracture, Appleys

Anatomy

Epidemiology
3 % of 5% of all fracture In children, humerus fractures cause 17% of admissions for fracture Midshaft fractures comprise 40% of all humerus fractures

Fracture rate is 2 per 10,000 per year

From the ages of 0 to 16 years, 42% of boys will sustain at least one fracture compared with 27% of girls.

Etiologi
Accidental trauma

Nonaccidental injury

Patologic condition

Mechanism of fracture

Direct

the most common cause is a motorcycle accident transverse, comminuted, displaced fractures commonly occur

Indirect

Lower injury spiral or long oblique fracture

Apleys, System of Orthopaedics and Fractures, Ninth Edition

Tschernes Classification of skin lesion in closed fractures


Grade 0 Grade I Injury from indirect forces with negligible soft tissue damage Closed fracture caused by low-moderate energy mechanisms, with superficial abrasions or contusions of soft tissues overlying the fracture Closed fracture with significant muscle contusion, with possible deep, contaminated skin abrasions associated with moderate to severe energy mechanisms and skeletal injury; high risk for compartment syndrome Extensive crushing of soft tissues, with subcutaneous degloving or avulsion, with arterial disruption or established compartment syndrome

Grade II

Grade III

AO classification of humeral diaphyseal fractures


Type A: Simple fracture

A1: Spiral A2: Oblique (>30) A3: Transverse (<30) Type B: Wedge fracture B1: Spiral wedge B2: Bending wedge B3: Fragmented wedge Type C: Complex fracture C1: Spiral C2: Segmented C3: Irregular (significant comminution)

Diagnosis

Anamnesis

Physical examination

Xray

Management
Non operative treatment Operatif treatment
imobilization Hanging cast over the upper arm and forearm U slab Functional cast brace Collar and cuff bandage

A compression plate and screws using a broad 4.5 mm plate External fixation with a conventional or ring fixator nailing is increasingly favoured

non operative treatment


Cuff and collar sling Hanging cast

Treatment

Complication
Radial nerve injury

Vascular injury Nonunion


Malunion