Case Report :

CLOSED FRACTURE OF
LEFT FEMORAL NECK

resented by :
Mentari Nurul Mutmainnah
C111 10 808

Advisors :
dr. MICHAEL HOREB
dr. JANSEN

Supervisor :
dr. HENRY YURIANTO, M.Phil, Ph.D, Sp.OT

O r t h o p a e d i c s a n d Tr a u m a t o l o g y D e p a r t m e n t J a n u a r y 2 0 1 6
 IDENTITY

Name : Mrs. S
Age : 73 years old
Date of Admission : January 21th,
2016
Registration : 736427
 HISTORY TAKING

Chief Complain : pain on the left groin

Suffered since 12 hours before admitted to Wahidin General Hospital

due to slip and fell

The patient was walking in the bathroom using a walker when she
slipped and fell on her left hip

History of loss of consciousness (-), Vomitting (-)

History of operation (+) on her right hip, 1 month ago at Wahidin

General Hospitals, after the operation, patient walked with walker.

The patient admit that she has Diabetes Mellitus and Hypertension
with regular treatment
 PRIMARY SURVEY

A : Clear
B : RR = 16x/min, symmetric,
spontaneous,
thoracoabdominal type
C : BP: 170/100 mmHg, HR: 98 x/min,

regular strong pulse

D : GCS 15 (E4M6V5), light reflex +/+,

pupil isochors, diameter 2,5

mm/2,5 mm
E : T = 36,8o C (axillary)
 SECONDARY SURVEY

Left Hip Region

Look : Deformity (+), swelling (+), hematoma (+), wound
(-), externally rotated
Feel : Tenderness (+)
MOVE : Active and passive movement of hip joint cannot
be evaluated due to pain
Active and passive movement of knee joint cannot
be evaluated due to pain
NVD : Sensibility is good, pulsation of the dorsalis pedis
artery is palpable
Capillary refilling time <2
 SECONDAY SURVEY

Right Hip Region

Look : Deformity (-), swelling (-),hematoma (-),

Incision scar (+), lateral aspect
Feel : Tenderness (-)
Move : Active and passive movement of hip normal
Active and passive movement of knee joint
normal
NVD : Sensibility is good, pulsation of the dorsalis
pedis artery is palpable. Capillary refilling
time <2
 Leg Length Discrepancy (LLD)

Right
Left Leg
Leg
ALL 82 cm 80 cm
TLL 78 cm 76 cm
LLD 2 cm
CLINICAL FINDING
 RADIOLOGICAL FINDINGS

Pelvis AP
(21/01/2016)
Femur AP/Lat (21/01/2016)
 LABORATORY FINDINGS

WBC 7.0 103/mm3

RBC 4.32 106/mm3
HGB 12.4 g/dL
HCT 37 %
PLT 166 103/mm3
HbsAg Reactive
GDS 265 mg/dL
BT 3
CT 8
 RESUME

A 73 year-old female was admitted to the hospital because of

pain at the left groin, suffered since 12 hours before admitted
to Wahidin General Hospital. Patient was stepping on slippery
floor then fell to her left side with the hip contact to the
ground first. From physical examination, general status was
conscious and well-nourished, vital signs BP 170/100 and
others vital signs within normal limit. Based on clinical
findings there was deformity. NVD was within normal limits.
Active and passive motions of the hip and knee joint were
limited due to pain. X-ray of pelvis and right femur showed
fracture of left neck femur. Blood test was GDS 265 with
reactive HbSAg.
 DIAGNOSIS

Closed fracture left neck femur

Post implantation DHS of right proximal

femur

Diabetes Mellitus Type 2

Hypertension Grade II

Hepatitis B
 MANAGEMENT

IVFD Ringer Lactate

Analgetic
Apply Skin Traction load 3 kg
Planning for Total Hip Arthroplasty
 Discussion:
FEMORAL NECK FRACTURE
 ANATOMY

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 OVERVIEW

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 OVERVIEW

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

MECHANISM OF INJURY

Low-Energy High-Energy Stress

Trauma Trauma Fractures
 PHYSICAL EXAMINATION
Look
Presentation, Attitude of the limb, Deformity, Examination of
overlying skin and soft tissue

Feel
Local bony tenderness, Muscle spasm, Crepitus, Distal
neurovascular examination

Move
Patient with fracture may find it difficult to move and fracture
must be suspected if there is painful limitation
 IMAGING

AP and a cross-table lateral view of

the pelvis and involved proximal femur
MRI to diagnose occult femoral neck
fractures in patients with negative
radiographs
Bone scans or CT scanning is reserved
for those who have contraindications to
MRI and is useful for patients with
ipsilateral femoral shaft fractures
 DIAGNOSIS

HISTORY TAKING PHYSICAL IMAGING

Simple EXAMINATION AP
, low- Shortened pelvic
energy and cross-
fall externally table
groin rotated lateral
pain extremity view of
Previo Tendernes hip X-
us s Ray
medica MRI
l CT
Campbell Operative Orthopedics 12 Edition.
proble
th
 CLASSIFICATION

Classification by Anatomic
Location

- Subcapital
- Transcervical
- Basicervical

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition

Campbell Operative Orthopedics 12th Edition.
 CLASSIFICATION

Pauwels
Classification

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition

 CLASSIFICATION

Garden Classification

Thompson, J. Netters Concise Orthopaedic Anatomy 2nd Edition. Kansas : Elsevier.

 TREATMENT GOALS
Goals

Minimize patient Restore hip Rapid

discomfort function mobilization

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition

 MANAGEMENT

Operative preferred
Cannulated screw fixation
Hemiarthroplasty
Total Hip Arthroplasty

Koval, Kenneth J.; Zuckerman, Joseph D, Handbook of Fractures, 3rd Edition

 MANAGEMENT

Cannulated Screw Fixation Hemiarthroplasty

 MANAGEMENT

Total Hip Arthroplasty

FUNDAMENTALS OF MUSCULOSKELETAL F. A. DAVIS COMPANY Philadelphia

IMAGING
COMPLICATIONS
Deep vein
thrombosis
Pulmonary
embolism
Pneumonia
Bed sores
Osteonecrosis
Osteoarthritis
Thank you.