Arsyi Adliah Anwar

C11109266

Advisor :
dr. Helmiyadi Kuswardhana
dr. Wendelin

Supervisor :
dr. M. Ruksal Saleh, Ph.D, Sp.OT (K)

CASE REPORT
Department of Orthopaedic and Traumatology
Faculty of Medicine Hasanuddin University 2013
Name : G
Gender : Boy
Date of birth : June 11
th
2011
Medical Record : 635528
Date of admission : November 4
th
2013

Chief Complaint : Pain at left arm
suffered since 10 hours before admission to the hospital
after got a traffic accident.
Mechanism of trauma :
The patient was walking at roadside when suddenly got
hit by a car from the back and the patient fell on the
asphalt with the left side of the body.
History of unconscious (-), nausea (-), vomit (-)
Prior treatment in Hospital of Barru.


Airway
Patent, clear

Breathing
Spontaneous, symmetric, thoracoabdominal type
RR : 22x/minute

Circulation
BP : 90/60 mmHg
HR : 88x/minute, regular, adequate

Disability
GCS 15 (E
4
M
6
V
5
), pupils isochoric 2,5mm /2,5 mm, LR +/+

Environment
Temperature 36,8
o
C


Physical Examination
Head and neck region : No abnormality was found
Thoracal region : No abnormality was found
Abdominal Region : No abnormality was found
Back Region : No abnormality was found
Urogenitalia region : No abnormality was found
Upper extremity Region
Lower Extremity Region : No abnormality was found

Physical Examination
Upper Extremity
- Left arm region
Inspection : multiple excoriation wounds on posterolateral of
hand, deformity (+), Swelling (+), hematoma (+)
Palpation : Tenderness (+)
ROM : active and passive motion of shoulder joints could not be
examined due to pain. Active and passive motion of elbow
joints could not be examined due to pain..
NVD :sensibility is difficult to be identified, radial artery is
palpable, Capillary Refill Time <2

- Right Arm Region :No abnormality was found

Physical Examination

TEST RESULT
WBC 18,69 x 10
3
/uL
RBC 3,26 x 10
6
/uL
HGB 9,6 mg/dL
HCT 26,5 %
PLT 169 x 10
3
/Ul
GDS 92
GOT 54 U/L
GPT 20 U/L
Ureum 26 mg/dL
Creatinine 0,4 %
HbsAg Negative
A 2 years old boy admitted with pain at the left arm suffered
since 10 hours ago due to traffic accident. The patient was
walking at roadside and got hit by a car from the back and the
patient fell to the left side.
On physical examination of the left arm region was found
ultiple excoriation wounds, deformity, swelling and hematoma,
with tenderness. Active and passive motion of shoulder and elbow
joints couldnt be examined due to uncooperative patient.
On radiological imaging there was a closed fracture at the
one-third distal of the left humerus.

CLOSED FRACTURE ONE-THIRD
DISTAL OF THE LEFT HUMERUS
Analgesic
Apply slab
Plan for ORIF

Fracture is a break in the
structural continuity of
bone
Fracture of the humeral
shaft is 10% of all
humeral fractures in
children and 2-5.4% of all
childrens fracture

shaft
Proximal
Distal
Direct
Direct blow to the arm
Transverse/comminuted
fracture

Indirect
A fall on an outstreched
arm
Spiral/oblique fracture
History
Taking
Physical
Examination
X-ray
Imaging
ANAMNESIS
Chief complaint
Mechanism of injury
Prior Treatment
IMAGING
X-ray examination
PHYSICAL EXAMINATION
Inspection
Palpation
Range of motion
Neurovascular Distal
Non Operative
Cast immobilization
Sling immobilization
Coaptation splint
Shoulder spica cast
Functional bracing
INDICATION FOR SURGERY
Multiple fracture
Inadequate closed reduction
Open fracture
Segmental fracture
Bilateral humeral fracture
Displaced intra-articular
extension of the fracture

Neurovascular compromise
Unstable fracture fragment

SURGICAL TECHNIQUES
Open Reduction and Plate Fixation
Percutaneous Pinning
External Fixation



Thank You