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    Case Report Presentation

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    This document presents a case study of a 43-year-old male patient who was admitted to the hospital with a closed fracture of the left tibial plateau, classified as a Schatzker type VI injury. The patient sustained the injury after jumping 2 meters from a ship and landing on both feet. On examination, deformity and swelling were observed on the left leg, with tenderness and intact neurovascular function. X-rays revealed a fracture of the left tibial plateau. The patient was given IV fluids, analgesics, and a long leg back slab. The management plan was for open reduction and internal fixation surgery. The discussion section provides details on the anatomy, epidemiology, mechanisms of injury, clinical presentation, diagnostic evaluation,

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    Case Report Presentation

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    lukitanining
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    This document presents a case study of a 43-year-old male patient who was admitted to the hospital with a closed fracture of the left tibial plateau, classified as a Schatzker type VI injury. The patient sustained the injury after jumping 2 meters from a ship and landing on both feet. On examination, deformity and swelling were observed on the left leg, with tenderness and intact neurovascular function. X-rays revealed a fracture of the left tibial plateau. The patient was given IV fluids, analgesics, and a long leg back slab. The management plan was for open reduction and internal fixation surgery. The discussion section provides details on the anatomy, epidemiology, mechanisms of injury, clinical presentation, diagnostic evaluation,

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    This document presents a case study of a 43-year-old male patient who was admitted to the hospital with a closed fracture of the left tibial plateau, classified as a Schatzker type VI injury. The patient sustained the injury after jumping 2 meters from a ship and landing on both feet. On examination, deformity and swelling were observed on the left leg, with tenderness and intact neurovascular function. X-rays revealed a fracture of the left tibial plateau. The patient was given IV fluids, analgesics, and a long leg back slab. The management plan was for open reduction and internal fixation surgery. The discussion section provides details on the anatomy, epidemiology, mechanisms of injury, clinical presentation, diagnostic evaluation,

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    107 views41 pages

    Case Report Presentation

    Uploaded by

    lukitanining
    This document presents a case study of a 43-year-old male patient who was admitted to the hospital with a closed fracture of the left tibial plateau, classified as a Schatzker type VI injury. The patient sustained the injury after jumping 2 meters from a ship and landing on both feet. On examination, deformity and swelling were observed on the left leg, with tenderness and intact neurovascular function. X-rays revealed a fracture of the left tibial plateau. The patient was given IV fluids, analgesics, and a long leg back slab. The management plan was for open reduction and internal fixation surgery. The discussion section provides details on the anatomy, epidemiology, mechanisms of injury, clinical presentation, diagnostic evaluation,

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    CLOSED FRACTURE OF LEFT TIBIAL

    PLATEAU SCHATZKER VI

    Presented By:
    Anneke Holly C111 09 004
    Advisors:
    dr. Hendra Hermanto
    dr. Shandy Limansyahputra
    Supervisor:
    dr. Zulfan Oktasatria Siregar, Sp.OT
    ORTHOPAEDIC AND TRAUMATOLOGY DEPARTMENT
    MEDICAL FACULTY
    HASANUDDIN UNIVERSITY
    2014

    PATIENTS IDENTITY
    Name

    : Mr. KT

    Age

    : 43 years old

    Admitted

    : April 10th 2014

    Registratio : 658646
    n

    AUTOANAMNESIS

    Chief Complain : pain at left leg


    Suffered since 5 hours before admitted to Dr. Wahidin
    Sudirohusodo hospital.
    Patient jumped 2 meters-high out from a ship, and landed with
    both his feet stepped on the ground. The patient could stand
    for a moment, and then felt pain at his left leg and fell down.
    History of unconsciousness (-), vomiting (-)
    Prior treatment at Akademis Hospital

    PRIMARY SURVEY
    Airway
    Breathin
    g
    Circulati
    on
    Disabilit
    y
    Exposur
    e

    : Clear, patent
    : RR 20 x/min, symmetric, spontaneous,
    thoracoabdominal type.
    : BP 120/70 mm/Hg, HR 88x/min, regular,
    strong
    : GCS 15 E4V5M6, pupil isochor, diameter
    2.5mm/2.5mm, light reflex (+/+)
    : 36.7 C (axillary)

    SECONDARY SURVEY
    Left Leg Region
    Look

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


    shiny skin (-)

    Feel

    : Tenderness (+), NVD: sensibility is good, dorsalis pedis


    artery and tibialis posterior artery are palpable, CRT
    <2
    Pain on passive stretching (-)

    Move

    : Active and passive motions of knee joint are not


    evaluated.
    Right of ankle
    Left
    Active and passive motions
    joint are normal.
    ALL

    81 cm

    81 cm

    TLL

    71 cm

    71 cm

    LLD

    0 cm

    Clinical Presentation of Anterior View of Left Leg

    Clinical Presentation of Lateral View of Left Leg

    RADIOLOGY FINDINGS
    (From Akademis Hospital)

    RADIOLOGY FINDINGS

    LABORATORY FINDINGS

    RBC : 4,15 x 103/mm3


    HGB : 12,8 g/dL
    HCT : 38,6 %
    WBC : 16,7 x 103/mm3
    PLT : 270 x 103/mm3
    CT
    : 800
    BT
    : 300

    GDS
    : 102 mg/dL
    Ureum
    : 22 mg/dL
    Creatinine
    : 1.0 mg/dL
    GOT
    : 29 U/l
    GPT
    : 44 U/l
    Na
    : 142 mmol/L
    K
    : 3.9 mmol/L
    Cl
    : 110 mmol/L
    HbsAg
    : Non-reactive

    RESUME
    Man, 43 years old, admitted to Dr. Wahidin Sudirohusodo
    Hospital with chief complain pain at left leg since 5 hours. Prior
    treatment at Akademis Hospital. Mechanism of trauma is the patient
    jumped 2 meters-high out from a ship, and landed with both his feet
    stepped on the ground. The patient could stand for a moment, and
    then felt pain at his left leg and fell down.
    Physical Examination, on left leg region there is deformity (+),
    swelling (+), tenderness (+), NVD: sensibility is good, dorsalis pedis
    artery and tibialis posterior artery are palpable, CRT <2, active and
    passive motions of knee joint are not evaluated due to pain, active
    and passive motions of ankle joint are normal.
    Radiology findings from X-Ray of anterior and lateral view of
    Left Leg is fracture at left tibial plateau.

    DIAGNOSIS

    MANAGEMENT

    IVFD
    Analgesic
    Apply long leg back slab at left lower extremity
    Plan for ORIF

    CLOSED FRACTURE OF
    LEFT TIBIAL PLATEAU
    DISCUSSION

    INTRODUCTION
    The tibial plateau is the proximal weightbearing surface of the
    tibia.
    It is articulated with the femoral condyles to form the knee
    joint and can be divided into medial and lateral components.
    A tibial plateau fracture involving the proximal articular
    surface of the tibia.
    Schatzker divided the classifications into 6 types,.
    Neurovascular injury and compartment syndrome may occur

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

    EPIDEMIOLOGY
    1% of all fractures and 8% of fractures in eldery persons.
    Isolated medial plateau fractures about 10-23% of these
    injuries
    Isolated lateral plateau fractures about 55-70% of these
    injuries
    The combined medial and lateral plateau fractures about
    11-31% of these injuries.

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

    ANATOMY

    Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

    Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

    www.eorthopod.com

    Thompson JC. Leg and Knee. Netter Concise Orthopaedic Anatomy. 2nd ed. Saunders Elsevier. p. 286-322.

    ETHIOPATHOMECHANISM
    Fractures of the tibial plateau are caused by a
    varus or valgus force combined with axial
    loading.
    This is sometimes the result of a car striking a
    pedestrian (bumper fracture)
    More often it is due to a fall from a height in
    which the knee is forced into valgus or varus.

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

    Associated Injury:
    Cranial Injury
    Thoracic Injury
    Abdominal Injury
    Spinal Injury
    Pelvic Injury
    Skeletal Injury
    Soft tissue injury

    CLINICAL PRESENTATION

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7

    SCHATZER CLASSIFICATION

    Type 1

    Type 2

    Type 3

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    Type 4

    Type 5

    Type 6

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    DIAGNOSTIC TEST
    Radiography:
    Used to identify the fracture
    lines and estimate displacement
    Oblique radiographs may be
    helpful in assessing fracture
    lines.

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    CT:
    Obtain scout views to ensure the
    images are tangent to the
    articular surface.
    Helps plan surgery and assess
    the articular surface of the joint

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    MRI:
    Useful in identifying soft-tissue injury, including
    ligamentous and meniscal injury
    Also useful for diagnosing nondisplaced fractures

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    DIAGNOSIS

    TREATMENT

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7
    Miller MD, Stephen RT, Jennifer AH. Review of Orthopaedics. 6th ed. Elsevier Saunders. 2012. p. 757-8

    Frassica, Frank J, Paul DS, John HW. The 5-Minute Orthopaedic Consult. 2nd ed. New York: Lippincott Williams & Wilkins; 2007. p. 456-7
    Miller MD, Stephen RT, Jennifer AH. Review of Orthopaedics. 6th ed. Elsevier Saunders. 2012. p. 757-8

    Type 1

    Type 2

    Type 3

    Type 4
    www.netterimages.com/image/3280

    Type 5

    Type 6

    www.netterimages.com/image/3280

    www.eorthopod.com

    The postoperative x-ray


    shows that perfect
    reduction has been
    achieved

    Significant depression and some lateral


    displacement of the lateral condyle; Open
    reduction and internal fixation with a
    buttress plate

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    COMPLICATION

    Solomon L, Warwick D, Nayagam S. Principle of Fracture. Apley's System of Orthopaedics and Fractures. 9th ed. London: Hodder
    Arnold; 2010. p. 890-5

    Thank You

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