Professional Documents
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FEMORAL FRACTURE
SGD B01:
NI PUTU RANI APSARI DEWI (1402005001)
HANANYA DWI ANGGI MANURUNG (1402005002)
KOMANG CHANDRA SURYA DIKA (1402005003)
YOSEFANY SAMUDRA SATYA (1402005004)
JESSICA YUWONO (1402005009)
NI PUTU OMASIH KIANTIMI (1402005010)
NI NYOMAN KANTA KARMANI (1402005011)
YOSI WANDA KUSUMA (1402005016)
MAYA PARAMITA WIJAYA (1402005017)
TIFANIA MELUCHA MIGUEL LEONG (1402005254)
FLORENCE DIANA THOMAS (1402005164)
GANESHWARY GANASAN (1402005165)
THAM HONG YUAN (1402005166)
FAKULTAS KEDOKTERAN
UNIVERSITAS UDAYANA
2014
CONTENTS
Cover............................................................................................................i
Contents......................................................................................................ii
Foreword.....................................................................................................iii
CHAPTER
I...................................................................................................................1
Introduction
CHAPTER
II..................................................................................................................3
Review of Literature
CHAPTER
III...............................................................................................................20
Conclusion
Bibliography..............................................................................................21
Foreword
Praise the all mighty God for all of his might the author can finish
this Student Project titled "Anatomical Aspects of Femoral Fracture" in
time. This project is written for the requirements to pass the Studium
Generale block, first semester of the medical studies of faculty of
medicine, Udayana university.
In this chance, the Author will say thanks to all of the helping hand
that was given during the writing of this project, from the dosen, from all of
the friend whom cannot be mention all by name. The Author also
acknowledge that the writing of this project is still far from perfect. So that
that's why critique and advice will be most appreciated for the
improvement od the Student Project. And the Author will hope that this
Student Project will be somewhat helpful for others.
CHAPTER 1.
INTRODUCTION
Bones are one of the most important organ system in the human
body; it is used for support, movement, protection of vital organs, to act as
the reservoir of calcium ions, and blood producer1. Bones could be used
as protection because bones can withstand a lot of force, the maximum
tibiofemoral compressive force reached an average load of 3.9 times
body-weight2. Excess force to the bone could cause cracks called
fractures. Fractures is a break or rupture in the bone3, it occurs in normal
bone because of abnormal load or stress, in which the bone gives way1.
The most common fracture is the fractures that take place in femur.
II.1 Definition
A fractured femur is a breakage in the thigh bone (femur), the longest,
strongest and heaviest bone in the human body. The strength and size of
the femur means that under typical circumstances, a large force or
extensive trauma is needed in order to result in a fracture. The femur is
the largest and strongest bone and has a good blood supply9. Because of
this and its protective surrounding muscle, the shaft requires a large
amount of force to fracture. Once a fracture does occur, this same
protective musculature usually is the cause of displacement, which
commonly occurs with femoral shaft fractures. A thigh bone (femur)
fracture is a break in the upper bone of the leg. Femur fracture most
commonly occurs after a motor vehicle accident, a collision playing a
sport, a fall from a high place, or as the result of a gunshot wound and
underlying tumor (neoplasm)7,8 .
Generally Femur Fracture can be classified into three types :
II.2 Etiology
Osteoporosis
Tendency to fall
II.5 EXAMINATION
Diagnose of fracture is depends on the history and the examination of
fracture. Diagnostic accuracy of history means that there’s an interview
between patient and doctor to get information about the patient’s history of
fracture. When a patient has a trauma about fracture before, then doctor
has to check correctly where and when the fracture happened 11. Doctor
also has to know about kind of fracture that the patient had before and
examine another part of body such as thorax, abdomen, head, pelvis and
etc, in this case the doctor will examine a femoral fracture. There are three
types of fracture’s examination12,
1. General Examination
In general examination, doctor is looking for opportunity of general
complication. For the example shock of fracture pelvis, open
fracture and signs of infection that happened on open fracture.
2. Physical Examination
A physical examination is an evaluation of the body and its
functions using inspection, palpation (feeling with the hands),
percussion (tapping with the fingers), and auscultation (listening).
Physical examinations of fracture are:
Inspection
In inspection the examiner or the doctor
will observe the patient's a-ppearance. So, the doctor will check
if there’s an edema and deform-ities.
Palpation, Percussion & Auscultation
Is a method of feeling using one’s hand or finger when body is
examine. In fracture, the examiner will press the part of body
where fracture happened and the patient will tell about what
they feel to the doctor. The doctor can easily know which one
part of join or bone where the pain, effusion and crepitation
happened.
3. Supporting Examination
The important of supporting examination that has to be done is
Rontgen using X-Ray to get the three dimensions picture or image
of the position and the condition of the bone where the fracture
happened. So, supporting examination needs to use minimal two
projections anterior and posterior. In a special condition, sometimes
supporting examination needs more than two projections. The
function is to show the pathology that the doctor looking for,
because of superposition. For the new fracture, X-Ray has function
to see the type and position of fracture and it needs to show the
both sides of bone. The another supporting examination is bones
scanning to identify about the position of fracture and the condition
of soft tissues13.
Not all these signs and symptoms present in each fracture. Most
just do not exist in linear fracture, fissure and fracture impaction (fracture
surface pushed each other to each other). Diagnosis of fracture depends
on symptoms, physical signs, and rays - x patient. Usually patients
complained of an injury in that area.
External Fixation
This is one of the operations for the femur bone fracture, this
operation using metal pins or screws which placed into the bone
above and below the fracture sites, the device is attached to a bar
outside the skin. The function of this device is to stabilizing the
bones in a proper position so that the bone can heal. External
fixation is a good treatment for temporary femur fracture until the
patient is ready for the final surgical, but in some cases the external
fixation left until the femur is fully healed, but this isn’t common
case.
Hip Pinning
Hair pinning is a surgical procedure for femoral neck
fracture. This procedure is done by placing several screws across
the fractured bones, this screws will keep the bone together in a
proper place until the bone is healed. When a hip pinning is
performed, the patient usually under go general or spinal
anesthesia, then the doctor made a small incision on the outside of
the thigh to put the screws into the broken bones.
Hip Hemiathroplasty
Hip hemiarthroplasty is half of a hip replacement. This
procedure is use to replace the fractured head of femur. In this
procedure, the ball of the ball-and-socket joint is removed, and a
metal prosthesis is implanted into the joint. A hip hemiarthroplasty
is performed under general anesthesia or spinal anesthesia. An
incision is made over the outside of the hip. The fractured femoral
head is removed, and replaced with a metal implant.
Intramedullary nailing
Intramedullary nailing is currently the method that most
surgeons use for treating femoral shaft fractures. This method
requires a special designed rod which will inserted to the marrow
canal of femur. This rod will passed through the femur fracture, to
keep the bone in their proper position. This intramedullary nail
inserted into the canal either from the hip or the knee through a
small incision. The intramedullary nailing will be screwed to the both
ends of the femur bone, this will keep the intramedullary nail and
the bone in the proper position until the bone is fully healed.
Plates and screws
3. Passive Exercise
Passive exercise is movements that come from external power and
this is a kind of unrealizing muscle movements. The external power
comes from gravity,machines, or a body part of an individual
(Kisner, 1996). This treatment divides into 2 kinds of movements :
a. Relaxed Passive Exercise: In this treatment, the physiotherapist
will give some movements to the patients but the
physiotherapist do not allow the patients to do movements (all
that the patients need to do is stay at the right position and
receive the movement from the therapist). The purposes of this
treatment are to treat the muscle using passively and
automatically the muscle will be relax and it avoids the decreas
of muscle elasticity.
b. Force Passive Exercise: In this treatment, the physiotherapist
will give some movements and at the end of each movements,
the physiotherapist give pressure to the fracture femur. The
purposes of this treatment is to avoid stickiness of each tissues.
4. Active Exercise
Active exercise is a treatment which is using inside power (power
from the patients’ bodies,patients’ muscles and patients’ energies)
without helps. This treatment will make movements and
contractions that against gravity (Basmajian, 1978). The purposes
of this treatment are to maintain and increase the strength of
muscles, decrease swelling on the fracture, and also it helps
patients to get their motoric abilities again therefore they can do
their activities well.
5. Walking Exercise
Walking exercise is the most important aspect of all treatments.
This treatment will help the patients to be healed as soon as
possible. The physiotherapist will do this treatment step by step, it
starts by doing some movements on the bed with sprawl position
and start to make the femur move, and then the second step is high
sitting and the last exercise is trying to stand up and walking.
6. Installation of Gypsum
The doctor will give gypsum to the patient’s femur to avoid the
femur moves again to the wrong position.
1. Infection: in case the femur fracture can be infection when the bone
breaking in the skin. The infection can be decreased when has
prevention with the antibiotic.
2. Nerve Damage: it can be happened but sometimes. The Nerve
damage can be lead persistent numbness weakness in the part of
lower leg.
3. Bone Healing Problems: if the bones cannot stable with each other,
it can be have an irritation to the bone that has infection, so that the
healing process can be stopped and required further surgery.
4. Surgical Complications: it can be happen an irritation and pain that
cause by the failure of the hardware that use to stabilized the bone
or prominence of a piece of hardware. Nerve damage has
possibility to surgery complication.
II.10 Prognosis
Patients who survive the initial trauma associated with the injury typically
heal well. Early mobilization following intramedullary nailing greatly
reduces complications associated with prolonged immobilization. Age
affects the speed and quality of recovery. Fractures may be caused by
underlying medical conditions such as osteoporosis or cancer metastasis;
these conditions may complicate recovery further16. Patients older than 60
years with closed fractures of femur have a mortality rate of 17% and a
complication rate of 54%17.
CHAPTER III
CONCLUSIONS
Femoral Fracture is the fracture that take place in the our body's
strongest, longest, and heaviest bone in the human body; the Femur.
Femoral fracture, depended on the place of fracture, can be divided into
three types: Proximal Femoral, Femoral Shaft, Supracondylar Femur
fracture. Because of its toughness, the femur must be given a strong force
to be fractured, usually comes from motorcycle accidents, but can also be
weaken by other thing like cancer. Other internal factor include age, diet
and hormonal; all of the internal factor is subsequently lead to
osteoporosis, which is the weakening of the bone cause by the reduced
mass of the bone. External factor include the quantity of impact and
pressing to the femur. To examine femoral fracture, it needs to be done
with three types of examination: General, which is looking for a sign of
infection; Physical, examining with physical touch; and supporting, which
is the use of tools like x-ray. Femoral fracture could manifest into an
ongoing pain, deformity, shortening of the bone, kreptasi, and local
swelling. The methods to which the femoral fracture is treated is divided
into two treatment, the medicalmentosa and non-medicalmentosa. The
medicalmentosa is the use of medical technique to treat patients.
Medicalmentosa for the femoral fracture is divided into the surgical way
and the nonsurgical way; the nonsurgical way is by the use of casting to
correct the position of the bone, but this is rarely done; and there is the
surgical way, which is the use of implants to correct the position of the
bone. Nonmedicalmentosa uses therapy in their action, like
physiotherapy. But if there is complication for the patient of femoral
fracture, like infection, nerve damage, bone healing problems and surgicla
complication.
DAFTAR PUSTAKA