CLOSED FRACTURE OF

RIGHT FEMORAL NECK

Nuradelia Paramitha NoorC11110307
Medita Aninditia NoviantyC11112033
Indira Devi F. H. C11112159
Nurul Hidayah R C11112304
Residents:
dr. Handoko
dr. Randy Octavianus
Supervisor:
dr. Henry Yurianto, M.Phil., Ph.D.,
Sp.OT(K)
 CASE REPORT
Closed Fracture of Right
Femoral Neck
PATIENT IDENTITY

Name : Mr. MJ
Sex : Male
Age : 70 y.o.
Admission : 30/04/2017
Hospital : RSUP dr. Wahidin Sudirohusodo
Reg. Number : 40094
HISTORY TAKING
Chief complaint: Pain on right groin
Sufferred since 2 weeks before admitted to dr. Wahidin
Sudirohusodo General Hospital
Patient fell from 1 meter height when he was fixing his
ceiling
He landed on his right side and was unable to stand and
walk ever since
He went to a bone setter afterwards but did not feel any
better
He then went to Ibnu Sina Hospital and was treated with
painkillers only before referred to dr. Wahidin
Sudirohusodo General Hospital
HISTORY TAKING
There is no history of open wound or fainting after the fall
There is history of swelling and bruising on the right groin
There is no history of headache, coughing or breathing
difficulty, nausea or vomitting. There is no changes in bowel
and bladder activity.

History of Past Illness

Patient has a history of high blood pressure and is
consuming 10 mg Amlodipin and 2 x 10 mg Simvastatin on
a daily basis
There is no history of diabetes mellitus, heart disease, or
stroke
PHYSICAL EXAMINATION
General Status

Concious / well-nourished
Vital signs
Blood pressure = 160/90 mmHg
Pulse rate = 84 bpm, regular, strong and
adequate
Respiratory rate = 20 rpm, regular, spontaneous,
thoracoabdominal type, symmetrical
Temp. (axillar) = 36.5oC
PHYSICAL EXAMINATION
Local Status: Right Hip Region

Look : Deformity (+), swelling (-), wound (-),

hematoma (-)
Feel : Tenderness (+)
Move : Active and passive movement of right hip
and knee joint could not be evaluated due to pain
NVD : Sensibility within normal limit, pulsation of
posterior tibial and dorsalis pedis arteries
palpable, CRT < 2 secs
PHYSICAL EXAMINATION

Apparent Leg
True Leg Length
Length

Right Lower
89 cm 93 cm
Limb

Left Lower Limb 91 cm 95 cm

Leg Length
2 cm 2 cm
Discrepancy
CLINICAL
FINDINGS
LABORATORY FINDINGS (30/4/2017)

TEST RESULT REFERENCE

WBC 9,2 4,00 10,0/mm3
RBC 4,12 4,00 6,00/mm3
HGB 12,1 12,0 16,0 g/dL
HCT 36,4 37,0 48,0%
PLT 395 150 400/mm3
CT 700 4 10 menit
BT 300 1 7 menit
Random Blood
108 140 mg/dL
Glucose
LABORATORY FINDINGS (30/4/2017)

TEST RESULT REFERENCE

SGOT 15 <38 U/L
SGPT 23 <41 U/L
Ureum 36 10-50 mg/dL
Creatinine 1,06 <1.3 mg/dL
HbsAg Non Reactive Non Reactive
Natrium 145 136 145 mmol/L
Kalium 4,0 3,5 5,1 mmol/L
Chloride 111 97 111 mmol/L
RADIOLOGICAL FINDINGS
(30/4/2017)

Fracture of base neck of right femoral neck

RADIOLOGICAL FINDINGS
(30/4/2017)

Fracture of base neck of right femoral neck

RADIOLOGICAL FINDINGS
(30/4/2017)

Dilatatio et elongatio aorta

DIAGNOSIS
Closed Fracture of Right
Femoral Neck
MANAGEMENT
IVFD RL 20 drips per minute
Ketorolac 30 mg/8 hours/IV
Ranitidine 50 mg/12 hours/IV
Skin traction on the right limb with 3 kgs weight
Planned for hemiarthroplasty
 DISCUSSION
Fracture of Femoral Neck
PREFACE

Femoral neck is the most common site of

fractures in elderly. It associates with
osteoporosis. Incidence of femoral neck fractures
has been used as a measure of age-related
osteoporosis in population studies.
DEFINITION

Fracture
Fracture is a break in the
structural continuity of
bone. It may be no more
than a crack, a crumpling
or a splintering of the
cortex. More often, the
break is complete and the
bone fragments are
displaced.
DEFINITION

Fracture of Femur Femoral Neck Fracture

Fracture on the femur, Fracture on the neck of
consisting femoral head, femur, with or without
neck and shaft. displacement.
 EPIDEMIOLOGY

Incidence of femoral neck fractures (USA) = 63.3 (for women) & 27.7 (for men) per 100,000
population per year.

The incidence in younger patients is very low and is associated mainly with high-energy
trauma.

The majority occurs in the elderly as a result of low-energy falls.

 White Race
Increasing
Woman Age

RISK
Tobacco
FACTORS Poor Health

Previous Estrogen
Fracture Level

Alcohol Fall History

ANATOMY
ANATOMY
ANATOMICAL
CLASSIFICATION

(a) subcapital (b) transcervical (c) basicervical

GARDENS CLASSIFICATION
PAUWEL CLASSIFICATION
MECHANISM OF INJURY

Cyclicloading-
Low-energy
stress
trauma
fractures

High-energy Insufficiency
trauma fractures
 PHYSICAL EXAMINATIONS
Look

Feel

Move

Neurovascular
distal
RADIOGRAPHIC EVALUATION

Magnetic resonance imaging (MRI) is

currently the imaging study of choice in
delineating nondisplaced or occult
fractures that are not apparent on plain
radiographs. Bone scans or CT
scanning is reserved for those who have
contraindications to MRI.
RADIOGRAPHIC EVALUATION
 Need to note
There are four situations in which a
femoral neck fracture may be missed,
sometimes with dire consequences
Stress
Undisplaced fractures
Painless fractures
Multiple fractures fractures
TREATMENT
Goals of Initial treatment Operative
treatment are to consists of pain- For all others, operative
minimize patient relieving measures treatment is almost
mandatory. Displaced
discomfort, restore and simple fractures will not unite
hip function, and splintage of the without internal fixation.
allow rapid limb. If operation is
mobilization by delayed, a femoral When should the
obtaining early operation be performed?
nerve block may In young patients operation
anatomic reduction be helpful. is urgent; interruption of
and stable internal the blood supply will
fixation or produce irreversible
prosthetic cellular changes after 12
hours and, to prevent this,
replacement. an accurate reduction and
stable internal fixation is
needed as soon as
possible.
 TREATMEN
T
Young patient with high-energy
injury and normal bone: Urgent
closed or open reduction with
internal fixation and capsulotomy is
performed. Fixed-angle implant
may be indicated in these
fractures.
Elderly patients: Treatment is
controversial.
High functional demands and
good bone quality: Almost all
should receive a total hip
replacement. Open or closed
reduction and fixation may be
considered, with a 40%
reoperation rate in these patients.
Low demand and poor bone
quality: Perform hemiarthroplasty
using a cemented unipolar
prosthesis.
Severely ill, demented,
bedridden patients: Consider
nonoperative treatment or
prosthetic replacement for
intolerable pain.
Total hip replacement for
femoral neck fractures
may be indicated:
(1) if treatment has been delayed for some
weeks and acetabular damage is
suspected, or
(2) in patients with metastatic disease or
Pagets disease.
POST-OPERATIVE CARE

o Postoperatively, breathing
exercises and early mobilization
are important.
o Early bed to chair mobilization
is essential to avoid increased
risks and complications of
prolonged recumbency,
including poor pulmonary toilet,
atelectasis, venous stasis, and
pressure ulceration.
COMPLICATIONS
o General complications
o Avascular necrosis
o Non-union
o Osteoarthritis
thankyou