CASE REPORT

Malunion fracture humeri sinistra + Neglected

fracture proximal radius et ulna sinistra.

Name : Sy. Rugaiyah Alkaf

NIM : 09 777 037
Supervisor : dr. Sri Sikspriani, C.H, SpOT
ORTHOPEDIC & TRAUMATOLOGY
MEDICAL FACULTY
ALKHAIRAAT UNIVERSITY
PALU
2015

Humeral Fracture
Humeral fracture may be occur :
1.

Ephyfiseal humeral fracture

2.

Metaphyseal humeral fracture

3.

Diaphyseal humeral fracture

1. Epiphyseal humeral fracture

It is usually found in children

Trauma mechanism : usually the patient fall

to the hyperextension position, such as fall
when riding a bicycle

2. Metaphyseal humeral
fracture

Usually without displacement

Conservative therapy the first option

treatment

3. Diaphyseal humeral fracture

Diaphyseal humeral fracture occured

cause direct trauma of the humeral

Clinical findings from the case is swelling

and pain

Classification of
ephyfiseal humeral
fracture (Neer-Horowitz)

Malunion

Malunion healing time normal but the bone

grafting a wrong position.

Malunion may be encountered after conservative

treatment or internal fixation of fractures, and
also around a joint prosthesis.

Malunion can involve the greater and lesser

tuberosities, humeral head, bicipital groove, or
the entire epiphysis.

Mechanism of malunion
Three situations may be at the origin of
the malunion :
1.

Problem with the initial reduction

2.

Problem with fixation leading to secondary

displacement

3.

Problem with the protection / stability

leading to secondary displacement

CASE REPORT

I. Identity
Name : Ms. Wiwin Wastuti

Date of
Examination : 26-01-

Age

: 25 years old

2015
Time : 08.00 a.m

Adress : Desa Boya, Baliase Hospital : Anutapura

II. General condition

Mild sickness

Vital Sign : BP : 110/70 mmHg

HR : 82 x/second
RR : 20 x/second
T : 36oC

III. Anamnesis

Chief complaint : Left arm difficult to bent.

Trauma mechanism : This experienced has been 3

months. One years ago the patients had a traffic
accident and she was drived motorcycle by herself with
moderate speed. Suddenly, a motorcycle from her side
make she shocked and finally she was bumped terotoar
untill she fall down to the front and her left hand the
first sustains, and as a result her left arm broken.

The patient was unconscious for half an hour,

but no nausea and vomit. After incident she was
taked to the hospital Wirabuana and received
treatment for 1 day. The patient forced go to the
home for alternative treatment because she
afraid to surgery. But, the patient was bored to
alternative treatment, so this is makes her come
back to the hospital for treatment or surgery.

IV. Physical Examination

Left below arm region :

Look : Swelling (-), scar (-), deformity (+),

tendon expose (-), muscle expose (-),
active bleeding (-)

Feel : Tenderness (-)

ROM : elbow joint flexi and extension

limited of movement

NVD :

Pulse of radial and ulnar artery adecuate

CRT : 2 second

Sensibility : normal

Acral : warm, skin colour same with arround it

Motoric :

Muscle strength 2

N. Radialis : elbow joint limited of movement

N. Medianus : normal

N. Ulnaris : disturbed

V. Treatment Modalities

Laboratory : whole blood

WBC = 7,6
RBC = 4,8
HB = 13,2 gr/dl
HCT = 38,1 %
PLT = 358

HbsAg : non reactive

GDS = 80 mg/dl

X-Ray : elbow joint AP / Lateral before ORIF

X-Ray control elbow joint AP post ORIF

VI. Diagnose

Malunion fracture humeri

sinistra + Neglected
fracture proximal radius et
ulna sinistra.

VII. Therapy

Medicamentous : -

Non Medicamentous
Bedrest

Measure Procedure
ORIF K-Wire, reconstruction, transolecranonosteotomy.

VIII. Prognose

Dubia ad Bonam

IX. Follow Up
No.
1.

Date & Time

Vital Sign

Post op. 27-01-2015 / 17.10 BP : 100/70 mmHg

N : 80 x/second
P : 20 x/second
S : 36,5o C

Follow Up
L : pain (+)
F : tenderness (+)
ROM : difficult to be evaluated
due to pain
P:
- HB test, if the value 8 gr %
presently transfusion 1 bag PRC
- IVFD RL 20 drops/second
- Transamin 1 ampul, Vit.K 1
ampul, Vit.C 1 ampul drips in
500 cc RL
- Cefoperazone 1 gr/8 hours/IV
- Santagesic 1 ampul/12
hours/IV
- Ranitidin 1 ampul/8 hours/IV
- Sohobion 1 ampul/12 hours/IV
- Dialon 2 x 50 mg
- Methylcobalt 3 x 500 mg
- X-Ray control elbow joint AP

2.

28-01-2015 / 07.30

BP : 110/80 mmHg

L : pain (+), numbness (+),

N : 82 x/second

dizziness (-), febris (-)

P : 20 x/second

F : tenderness (+)

S : 36o C

ROM : difficult to be
evaluated due to pain
P:
- IVFD RL 20 drops/second
- Cefoperazone 1 gr/8
hours/IV
- Santagesic 1 ampul/12
hours/IV
- Ranitidin 1 ampul/8
hours/IV
- Sohobion 1 ampul/12
hours/IV
- Dialon 2 x 100 mg
- Methylcobalt 3 x 500 mg

3.

29-01-2015 / 07.30

BP : 120/90 mmHg L : pain (+), numbness (+),

N : 78 x/second

dizziness (-), febris (-)

P : 20 x/second

F : tenderness (+)

S : 36o C

ROM : difficult to be evaluated

due to pain
P:
- IVFD RL 20 drops/second
- Cefoperazone 1 gr/8 hours/IV
- Santagesic 1 ampul/12
hours/IV
- Ranitidin 1 ampul/8 hours/IV
- Sohobion 1 ampul/12
hours/IV
- Dialon 2 x 100 mg
- Methylcobalt 3 x 500 mg

4.

30-02-2015 / 07.30

BP : 120/80

L : pain (+), numbness (+)

mmHg

F : tenderness (+)

N : 80 x/second

ROM : difficult to be

P : 20 x/second

evaluated due to pain

S : 36,2o C

P:
- Aff drain
- Aff infuse
- Home care
- Dialon 2 x 100 mg
- Methylcobalt 3 x 500 mg
- Cefixime 2 x 100 mg
- Meloxicam 2 x 15 mg
- OMZ 2 x 20 mg

TERIMA
KASIH