CASE STUDY

RT HIP DISLOCATION WITH

FRACTURE OF ACETABULUM
RT POSTERIOR CRUCIATE LIGAMENT
AVULSION
FRACTURE LT 3RD & 4TH
METACARPAL BONE

PREPARED BY,
SITIMARIAMBINTI SELATHA
 INTRODUCTION
Fractures of the pelvis and acetabulum are among
the most serious injuries treated. Often the result of a
traumatic incident such as a motor vehicle accident or a
bad fall, these fractures require rapid and precise
treatment and, in some cases, one or more surgical
procedures. People of all ages are vulnerable to these
injuries. In addition, some elderly patients with fragile
bones due to osteoporosis develop pelvic fractures and
fractures of the acetabulum with a lower impact fall.
fracture of the acetabulum is generally not a life-
threatening injury . the surgical reduction and
stabilization techniques, 80-85% of patients, can expect
a good to excellent recovery following surgery, provided
that the hip can be properly aligned and fixed.
(Maheshwari, 1992)
 ANATOMY
PELVIC (HIP) GIRDLE

- The pelvis girdle consists of the two hip bones also called coxal
bones.
- The hip bones unite anteriorly at a joints, pubic symphysis and
posteriorly with sacrum at the sacroiliac joints.
- Functionally, the bony pelvis provides a strong and stable support
for the vertebral column and pelvis organs.

1. Ilium

- the largest of the three components of the hip bones.

- A superior and an inferior body, which enters into formation of the
acetabulum, the socket for the head of the femur.
- Its superior border the iliac crest, ends anteriorly in a blunt anterior
superior iliac spine.
- Below the posterior inferior iliac spine is the greater sciatic nerve,
the longest nerve in the body.
2. Ischium

• The ischium is the inferior, posterior portion of the hip bone.

• Its features includes the prominent ischial spine , a lesser sciatic notch
below the spine, and rough and thicken ischial tuberosity.
• The ramus the pubis surround the obturator foramen, the largest foramen
in the skeleton.

3. PubiS

• The pubis is the anterior and inferior part of the hip bone.
• The pubis symphysis is the joints between the two hip joint.
• It consists of a disc of fibrocartilage.
• The acetabulum is a deep fossa formed by the ileum, ischium and pubis.
• It functions as the socket that accepts the rounded head of the femur.
• The acetabulum and the femerol head from the hip ( coxal ) joint.
• On the inferior side of the acetabulum is a deep indentation, the acetabulur
notch.
• It forms a foramen through which blood vessels and nerves pass, and it
serves as a point of attachment for ligaments of the femur.
ANATOMY & PHYSIOLOGY
 MUSCLE FOUND IN THE HIP

• Psoas muscle
Origin :Transverse process and bodies of the lumbar
vertebrae
Insertion : Femur
Action : Flexes the hip joint

• Illiacus muscle
Origin : Iliac crest and iliac fossa of the innominate bone
Insertion : Lesser trochanter of the femur
Action : Iliacus and psoas flexes the hip joints

• Gluteal mucle
There consist of the gluteal maximus medrus and minimus
Origin : Ilium and sacrum
Insertion : Femur
Action : Extension abduction and medial rotation at the hip
joint
Nerve of pelvis
Anatomy of knee
ANATOMY OF THE KNEE
• The knee is a large synovial joint consisting of three intraarticular
compartment;
1. medial (articulation between the medial femoral condyle and the
medial plateau),
2. lateral ( articulation between the lateral femoral condyle and the
lateral tibial plateau),
3. patellofemoral ( articulation between the patella and the femoral
intercondylar groove).
• Between the medial and lateral tibial plateau is the nonarticular
intercondyler region that provides attachment sites for the anterior
and posterior cruciate ligaments and the medial and lateral menisci.
• Both anterior and posterior cruciate ligaments are considered to be
extraarticular, since they are enclosed by synovium.
• The patella, which is the largest sesamoid bone,
function
- to protect the knee joint,
- to facilitate knee joint lubrication
- to increase the lever arm of the knee extensor mechanism.
• The knee also contain the medial and lateral menisci, each attached
to the tibial by the coronary ligament
MUSCLE THAT FOUND IN THE KNEE
• Quadriceps femoris
- Rectus femoris
- Vastus lateralis
- Vastus medialis
- Vastus intermedius

• Hamstring muscle
- Biceps femoris
- Semitendinosus
- Semimembranosus

• Sortotius
METACARPALS
The skeleton of the hand has three regions:-
• proximal carpus
• intermediate metacarpus
• distal phalanges
The carpus consists of eight small bone, the carpals joint to
one another ligament.
- scaphoid
- lunate
- triquetrum
- pisiform
- Trapezium
- trapezoid,
- capitate
- hamate.
• The five bone of the metacarpus, called
metacarpals constitute the palm of the hand.
• Each metacarpal bone consists of a proximal
base an intermediate shaft and a distal head.
• The metacarpal bones are numbered I to V.
• Starting with the one proximal to the thumb the
base articulate with the proximal phalanges of
the fingers.

• The phalanges or bone of the finger, number 14

in each hand.
• Each phalanx consists of the proximal base, an
intermediate shaft and a distal head..
MUSCLE FOUND IN THE WRIST, HAND
AND FINGERS
Anterior compartment (Flexor)
• Flexor carpi radialis
• Palmaris longus
• Flexor carpi ulnaris
• Flexor digiforum superficialis
• Flexor digitorum profundus
• Flexor policis longus
LITERATURE REVIEW
DEFINATION OF FRACTURE

A fracture is a distribution or break in the continuity of the

structure of bone.

Fractures are caused by direct blow, crushing force,

sudden twisting motion and extreme muscle contraction.

A dislocation of a joint is complete separation of the

surface of the joint.
ON THE BASIS OF DISPLASEMENT OF FRACTURE
•Undisplaced fracture
•Displacement fracture

TYPES OF FRACTURE
•Simple or close fracture
•Compound or open fracture
•Transverse
•Spiral @ Oblique
•Segmental
•Comminuted
•Avulsion
•Crush fracture
•Greenstick fracture
PELVIS FRACTURE

Classification
• Avulsion fracture around the pelvis
• Isolated fracture of the pelvis, sacrum and
coccyx
• Undisplaced disruption of pelvic ring
• Displaced disruption of the pelvic ring
• Acetabular fracture including central
dislocation of the hip
FRACTURE OF THE ACETABULUM
• Fracture of the acetabulum combine the
completes of pelvis fractures with those of joint
disruption.
• An acetabular fracture occurs when the socket
of the hip joint is broken. This is much less common
than most hip fractures, where the ball of the ball-and-
socket joint is broken.
TYPES OF ACETABULAR FRACTURE
• ANTERIOR FRACTURE
• POSTERIOR FRACTURE
• TRANVERSE FRACTURE
• COMPLEX FRACTURES
DISLOCATION OF HIP

Classification
• Posterior dislocation
• Anterior dislocation
• central fracture dislocation
Posterior dislocation of the hip
• The head of femur is pushed out of the
acetabulum posteriorly
Mechanism of injury

The injury is sustained by violence directed

along the shaft of the femur with the hip flexed. It
often occurs in motor accidents. The occupant of
the car is thrown forwards and his knee strikes
against the dashboard and the forces
transmitted up the shaft resulting in posterior
dislocation of hip.
POSTRIOR CRUCIETE
LIGAMENT
The posterior cruciate ligament help hold knee
together, giving it stability. If either ligament is
torn, it may experience pain, swelling and loss of
mobility. Posterior cruciate ligament injury
generally causes less pain, disability and knee
instability than ACL tears do, but it can still
sideline for several weeks or longer.
CAUSE OF PCL

• Motor vehicle accidents.

dashboard injury
• Contact sports.
football or soccer
Sign and symptom of PCL
• Mild to moderate pain at the back of the knee
• Sudden knee swelling and tenderness (within
three hours of the injury)
• Pain with kneeling or squatting
• A slight limp or difficulty walking
• Feeling of instability or looseness in the knee, or
the knee gives way during activities
• Pain with running, slowing down, or walking up
or down stairs or ramps
Diagnose of PCL

• Medical history..
• Physical examination of the knee.
• Posterior drawer test.
• X-ray.
• Magnetic resonance imaging (MRI).
• Arthroscopy.
• Joint aspiration.
Treatment of PCL
• To treat the acute injury :
- Rest
- Apply ice packs to your knee for 20 to 30 minutes every three to four
hours for two to three days or until the pain goes away
- Elevate the knee by placing a pillow underneath it
- Take pain relievers such as ibuprofen (Advil, Motrin, others) as needed
- Wrap an elastic bandage around the knee
- Use a splint or walk with crutches if needed
• Knee devices
knee brace
Using crutches also can decrease strain on knee.
• Rehabilitation
• Surgery
PCL reconstruction surgery uses arthroscopic techniques
MECHANISM INJURIED OF
ACETABULUM
Fractures of the acetabulum are seen after motor vehicle crashes in
which the femur is jammed into the dash board.

Stage:-

• Stable
- Undisplaced fracture and fracture that involved minimal articular
weight bearing
Managed with traction and protective (toe touch) weight bearing.
- Displaced and unstable acetabular fracture is treated with open
reduction, joint debridment and internal fixation or arthrosplasty.
Internal fixation permits early non weight bearing ambulation and
ROM exercise
FRACTURE OF METACARPAL
• Fractures through the bases of metacarpal
usually transverse and Undisplaced
• Fracture through the shaft- transverse or
oblique.
• Fracture through the neck of the metacarpals
commonly effects the neck of fifth metacarpal.
CLINICAL MANISFESTATION

• Edema and swelling

• Pain and tenderness

• Muscle spasm

• Deformity

• Loss of function
TREATMENT FRACTURE OF
ACETABULUM
• TRACTION
Fixed skin traction

• SURGERY
Recon plate
• posterior fractures closed reduction under
anesthesia is attempted. If the this
successful, traction is maintained for a
further 6 weeks. If closed reduction fails
and adequate surgical is available,
operative reduction and internal fixation
with lag screw or a compression plate.
RECON PLATE & CORTICOL SCREW
FRACTURE IMMOBILIZATION

• Fracture 3rd & 4th metacarpal bones

volar slab
Fixed skin Traction
hip dislocation fracture rt acetabulum
COMPLICATION
• Injury to the sciatic nerve
• Avascular necrosis of the femoral head.
• Osteoarthritis
• Myositis ossificans
PATIENT’S BIODATA
• Name : Mr. Z b Z
• Registration number : 480462
• Ward/ Bed no : D2/ K12
• Age : 30 years old
• Sex : Male
• Race : Malay
• Religion : Muslim
• Status : Married
• Doctor : Dr. Z
• Diagnose : - Right hip dislocation with fracture acetabulum
• - Right posterior cruciate ligament (PCL) avulsion
• - Closed fracture left wrist 3rd 4th metacarpal bone.
• Occupation : Pembantu pendaftar
• Time of admission : 21/03/2008 @ 11.40 pm
• Time of discharge : 28/03/2008 @ 5 pm
• Ward : Orthopedic male D2
History on Admission

On 21st March 2008 at 9 pm, he had an alleged MVA while going back
from worksite. On the way back to home, another motorcar from different
way coming in front Mr. Z motorcar when the accident happened. He
alleged from dashboard injury to his right knee and right hip. His left hand
was crushed the handle steering of car.
He was immediately sent to Malacca Hospital accompanied by public.
General Condition on Admission
Mr. Z was immediately seen and examined by the medical doctor in
charge at Accident and Emergency Department and admitted to D2
orthopedic male at 11pm. He had alleged MVA that complain right leg and
right hip and also pain left wrist.
On admission, he was orientated with Glasgow Coma Scale normal 15/15,
both pupils’ equal size and reacting to light having spontaneous.
His vital sign were:-
Blood pressure : 134/ 78 mmHg
Pulse : 71 beat per min
Respiration : 20 per min
Temperature : 37.0 °C
MANAGEMENT OF PATIENT
Patient was immediately seen and attended by
specialist Mr. Z and patient keep nil by mouth.
Administer intravenous line with normal saline.
Then administer IM Voltaren 50mg stat then
TDS. Check patient vital sign and neurovascular
status of limbs was recorded.
Investigation done on admission
X-rays
X-ray left wrist AP/ lateral view
X-ray right leg AP/ lateral view
X-ray pelvis AP
X-ray right tibia AP/ lateral view
Full blood count
X-RAYS RT PELVIS
X-RAY LT METACARPAL BONE
X-RAY RT KNEE
• After reported x-rays
• X-ray left wrist show closed fracture dislocation left wrist
with 3rd and 4th fracture metacarpal bone (MCB)
• X-ray pelvis AP show right hip fracture dislocation with
acetabulum
• X-ray right tibia show PCL avulsion
• Patient was diagnosed as closed fracture right
acetabulum, closed fracture dislocation left wrist with
3rd, 4th fracture metacarpal bones. Posterior cruciate
ligament avulsion after x-ray was done. Doctor orders
KIV CT scan hip coming morning. Patient was
immobolize right lower limb with backslap and left wrist
with closed amputation reduction (CMR) and volar slap
for fracture 3rd, 4th metacarpal to reduce pain. The
laceration scalp and chin dap with flavin.
FULL BLOOD COUNT
Date : 21/3/ 2008

Investigation Result Reference range

Haemoglobin 14.0 g/L 135- 180
TWDC 10.5 10^g/L 4.0-11.0
Platelets 221 10^g/L 150- 400
TRBC 4.71 10^12/L 4.5- 6.5
P.C.V 44 fL 37- 47
MCY 29.7 Pg 76- 96
MCHC 31.8 a/dL 27.0 32.0
Lymphocyte 12.6 10^3/uL 0.96- 4.95
Neutrophil 6 10^3/uL 1.8- 8.25
Monocyte 0.6 10^3/uL 0.08-.10
Eosinophil 0.0 10^3/uL 0.04- 0.66
Basophil 0.0 10^3/uL < 0.04
TREATMENT IN WARD
• 21/03/2008
1st day at ward D2.
Patient admitted to ward D2 by trolley. Patient
accompanied by wife and attended Hospital Malacca.
During admission patient vital sign as below:-
Blood pressure : 137/ 70 mmHg
Pulse : 81 beat per min
Respiration : 20 per min
Temperature : 37.2 0C
Examined by Dr. Z. and x-ray result noted to him.
Patient KIV CT-scan hip coming morning. Patient
complaint of pain right hip, unable to walk due to pain,
IM Pethedine 50mg QID ordered by doctor and also IV
Zinacef 750mg TDS.
INVESTIGATION

19/03/2008
CT- scan pelvis
• Comminuted fracture of the acetabular roof of the
right hip joint. There is also fracture of the posterior lip
of the acetabulum. Fracture fragment noted posterior to
the head (within the right pisiformis muscle) and
posteromedial to the femoral neck (within the obturator
externus muscle) No intra articular fracture fragment
noted. The femoral head is within the acetabulum no
dislocation.
21/03/208
FBC

Investigation Result Reference range

Haemoglobin 14.0 g/L 135- 180

TWDC 10.5 10^g/L 4.0-11.0
Platelets 221 10^g/L 150- 400
TRBC 4.71 10^12/L 4.5- 6.5
P.C.V 44 fL 37- 47
MCY 29.7 Pg 76- 96
MCHC 31.8 a/dL 27.0 32.0
Lymphocyte 12.6 10^3/uL 0.96- 4.95
Neutrophil 6 10^3/uL 1.8- 8.25
Monocyte 0.6 10^3/uL 0.08-.10
Eosinophil 0.0 10^3/uL 0.04- 0.66
Basophil 0.0 10^3/uL < 0.04
• 22/03/2008@8am
2nd day at ward D2.

Seen by Dr. Z, examined by him and general condition

conscious and orientated. Patient a febrile and no
neuromuscular status at right leg is good. Dr. Z ordered
CT-scan hip to look for articular fragment. Continue
antibiotic and analgesic as per chart.
• 23/03/2008 @ 8.10 am
3rd day at ward D2.
Seen by Dr Z, CT-scan hip noted. Mr. Z general condition is
conscious. The vital sign:
Blood pressure : 120/80 mmHg
Pulse : 78 beat per min
Respiration : 20 per min
Temperature : 36.3 0C
Mr. Z neurovascular status is normal. Dr. Z ordered skin fixed
traction. Dr. Z also verbalized that patient for surgery screw fixation
recon plate right acetabulum and screw fixation right PCL on
24/03/2008.
Operation Theater informed. Payments for implant RM570
settled by insurance. Doctor order 2 pine GXM as preparation
before operation and syrup lactulose 15mls STAT for bowel
preparation before going to Operation Theater.
Skin traction applied and check neurovascular status example:
capillary refill, pulse, sensation, movement, temperature and color of
skin.
• 24/03/2008 @ 8 am
Operation day

Seen by Dr Z, Mr. Z for operation as planed. Screw fixation recon

plate right acetabulum and screw fixation for posterior cruciate
ligament (PCL) avulsion.
• Preparation Mr. Z before operation following checklist.
1) Consent taken
2) X-ray- right acetabulum and x-ray tibia
3) Blood investigation- FBC
4) Mr. Z kept NBM (Nil by mouth) and last meal at 12am.
5) Administer intravenous normal saline maintain to maintain fluid and
electrolytes in the body
6) Administer medication before operation, antibiotic IV Zinacef 1.5gm
7) Skin preparation. Clean from anterior superior pubic ramus to mid
shaft of tibia at right leg.
8) Check patient vital sign such as pulse, blood pressure, respiration,
and body temperature
9) Patient remove all material example ring and remove of dentures
10)Change clothing to OT gown and wear OT caps.
• 24/03/2008@ 2pm
Post- operative day
Patient was sent to OT at 10am and was return to ward at 2pm.
Types of operation done: Recon plate of right acetabulum, screw
fixation posterior cruciate ligament avulsion. Mr. Z general condition
was stable and conscious, close monitoring of patient continue
hourly for 6 hours, was stable. Intravenous normal saline maintain.
Patient was on subcutaneous Pethidine 50mg QID and an antibiotic
was continuing. The lower limb, right leg was kept elevated on the
pillow to reduce swelling. Patient having redivac in situ and patent.
Neurovascular status of lower limb was good. Immediate post-
operative investigation full blood count. Dr. Z ordered for wound
inspection post operative day 3 on 27/3/08 and suture to off (STO)
on 7/4/08.
• 25/03/2008 @ 8.30 am
Post Operative Day 2
Mr. Z, general condition has improved post operative
recovery. General condition is conscious and alert. The
vital sign of patient:
Blood pressure : 123/ 71 mmHg
Pulse : 80 beat per min
Respiration : 20 per min
Temperature : 37 0C
Patient vital sign was been monitor 4 hourly. Dr. Z
order Tab Arcoxia 120 mg OD and continue SC
analgesic as per chart. Patient was also started on
subcutaneous Heparin injection 5000 unit in view that he
is not able to mobilize yet to prevent deep vein
thrombosis. Off intravenous drip and allow orally. The
redivac to off drain and the amount of redivac is 100 mls.
POST OP X-RAYS
RT ACETABULUM WITH RECON PLATE
POST OP X-RAYS
PCL AVULSION WITH SCREW FIXATION
• 26/03/2008 @ 8.10 am
Post- operative day 2
General condition Mr. Z comfortable, a febrile and
vital sign is stable. Seen by Dr. Z ordered to off SC
Pethidine and change to Tab PCM 1gm QID.
Physiotherapy was referred for ambulation by wheel
chair.
Physiotherapy attended at 12.30 pm. Mr. Z was straight
leg raising exercise, static quadricef exercise and deep
breathing exercise (DBE).

• 27/03/2008@ 8.30 am
Post- operation day 3
General condition of patient is good. A fibrile and vital
sign are stable. Wound inspection at right hip and knee
is done. The wound are clean and dry. Dressing is done.
Patient is ambulated on wheel chair.
• 28/03/2008@ 8am
Post- operation day 4
Seen by Dr. Z. General condition of Mr. Z was stable and
good. Patients were discharged and follow up at clinic
Dr. Z in 2/52 time. Medication order to take home is Tab
Arcoxia 120 mg OD and Tab Zinnat 250 mg BD.

• Follow up in orthopedic clinic on 11/04/2008

General condition of patient is satisfactory. Looking very
cheerful and come on wheel chair to the clinic with his
wife. No complain of fever and wound healing very well
and clean.
Nursing Care Plan 1
Date : 24/3/2008
Time : 9am
Nursing problem : Alteration in comfort; pain related to
fracture of right acetabulum and right PCL avulsion,
closed fracture left 3rd and 4th metacarpal bone.
Goal : Patient’s is comfortable. Pain will be relieved
within 1 hour
Nursing Intervention
1.Assess patient level of pain such as mild, moderate or
severe and whether related to movement
® To know severity of pain
2.Encourage patient to rest in bed and reduce movement
® To reduce pain
3. Check the fixed skin traction on patient injured leg following the principle
of the traction every shift such as alignment the inline limb; assess
patella and 2nd toe, the traction card string taut and placement the
Thomas splint on the injured limb
® To maintain for effectiveness of the traction
4.Elevate right leg on pillow.
® To promote relaxation and reduced pain.
5.Administer analgesic IM Pethedine
® To reduce pain
6.Check the neurovascular status of right leg and left hand every 4 hourly.
® To detect compartment syndrome that will cause pain.
7.Teach patient to do deep breathing exercise
® To promote relaxation and reduce pain
8.Provide divert ional therapy
® To divert patient mid from pain

Date : 24/03/2008
Time : 10 am
Evaluation : Patient is comfortable, verbalized that pain is reduced.
Nursing Care Plan 2
Date : 24/03/2008
Time : 10am
Nursing Problem : Anxiety related to surgical procedure: Right recon
plating of
acetabulum screw fixation for PCL avulsion
Goal : Patient verbalized he is les anxious and understand
regarding the surgical procedure.
Nursing intervention
1. Reinforce doctor explanation regarding the surgical procedure-
recon plating of acetabulum screw fixation for PCL avulsion.
® To ensure patient understands regarding surgical procedures and
less
anxious
2. Encourage patient to ask questions regarding surgical operation
® To ensure patient fully understand regarding operation
 3. Explain the procedure that will be carried out for the patient pre
operatively
® So that patient prepared for the procedures and less anxious

4.Explain to the patient regarding measures that would be taken to

reduce
post operative discomfort and pain
® Patient less anxious
5. Encourage family members support to the patient
® To reduce patient anxiety

Date : 24/3/2008
Time : 12 noon
Evaluation : Patient verbalizes that less anxious and understand the
Surgical procedures would be carry out
Date : 24/3/2008
Time : 3 pm
Nursing Problem :Discomfort pain related to surgery (plating right
acetabulum and screw fixation for PCL avulsion)
Goal : Patient comfortable, pain is reduce within
1-2 hours
Nursing Intervention:
1. Assess patient’s level of discomfort location and severity of pain
® Act as baseline data
2. Advice patient to rest in bed and reduce movement
® To decrease movement that cause pain
3.Place patient in supine position
® To promote comfort and reduce pain
4. Elevate patient right leg on pillow
® Promote venous return and reduce swelling
5. Administer analgesic, IM Pethidine 50mg stat and 6 hourly
® To reduce pain
6. Encourage patient in doing deep breathing exercise (DBE)
® To promote comfort and reduce pain

Date : 24/3/2008
Time : 4 pm
Evaluation : Patient comfortable, verbalized pain is
reduce
Date : 25/3/2008
Time : 9 am
Nursing Problem : Potential infection related to incision sites
at right hip and right knee
Goal : Incision sites at right hip and knee free from
infection. To detect early sign and
symptom of infection.
Nursing Intervention:

1. Observe the area around the dressing site every shift for any
redness, swelling and warmth
® To detect early sign and symptom of infection
2. Assess body temperature 4 hourly
® High temperature may indicate infection
3. Perform dressing maintaining aseptic technique post wound
inspection on
day 3
® To prevent risk of infection
4. Administer prophylactic antibiotic, IV Zinacef 750mg TDS
® To prevent from infection
5. Encourage patient to maintain personal hygiene
® Prevent from infection
6. Encourage patient to take well balance diet
® To promote wound healing
7. Explain to patient the sign and symptom of infection e.g. redness,
swelling and discharge
® For early detection
8. Give health education regarding wound care such as keep wound
dry, clean, do not open the dressing, do not wet the dressing and do
not put any lotion or oil at the wound site
® To prevent infection

Date : 29/3/2008
Time : 9 am
Evaluation : Patient wound is clean and dry. Patient a febrile and
allow Discharge.
HEALH EDUCATION

• Dressing care
.
• Elevate leg

• Medication

• Exercise

• Complication

• Diet
CONCLUSION
Encik Z was admitted to D2, male Orthopedic ward Melacca
Hospital on 21SD March 2008. after alleged motor vehicle accident.
His left hand and right leg was complaint of pain and unable to
move. After being seen by the specialist, he was diagnosed as Hip
Dislocation Fracture of Right Acetabulum, Right Posterior Cruciete
Ligament Avulsion and Left Wrist Dislocation Fracture 3RD 4TH
Metacarpals Bone.
His was treated conservatively right hand was Closed
Manipulation Reduction (CMR) under sedation and immobilize with
Volar Slab. The check X-Ray done and acceptable X-Ray of right
hand. The right leg was applied skin fixed traction.
The surgically, recon plating of right acetabulum and screw
fixation for posterior cruciete ligament avulsion was performed on
24TH March 2008.
On the 4TH post operative and 8 days of hospitalization, he was
able to ambulate with wheel chair and indulge in his daily activities
without pain. Encik Z was discharged well and follow up review at
orthopedic clinic Melacca Hospital.
BIBLIOGRAPHY
• Apley A.G & Solomon L.(1993), Apley’s System Of Orthopeadics and
Fracture, 7th Edition, Butterworth- Heinmann Ltd & Oxford United Kingdom.

• Maheshwari J, (1992), Essential Orthopeadic, 2nd Edition, Metha

Offsetwork, New York.

• Rockwood Jr.C.A.et al (1996), Fracture in Adults volume 2,4th Edition, J.B

Lippincott Company, United States of America.

• Unwin & Jones K, (1995), Emergency Orthopeadics and Trauma,

Butterworth-Heinemann, United Kingdom.

• Kakkad S, (2005), Practical Orthopedics, 2nd Edition, Taypee Brothers

Medical Publishers (P) TLD,New Delhi.

• Tortora G, (2003), Principles Of Anatomy and Physiology, 10th Edition, John

Wiley & Sons inc, United States of America.