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    Alvin B. Ramirez

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    I.F.

    44 years old

    Single Filipino

    Roman Catholic

    Residing in Sta. Cruz, Manila

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    Pain on left knee

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    10 hours PTA pulled over service road of EDSA

    lost balance

    motorcycle fell on left thigh

    rushed to hospital

    x-ray: comminuted fx of left tibia

    transferred to our institution

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    No history of previous hospitalizations and surgeries

    Non-Hypertensive

    Non-DM No heart diseases

    No pulmonary diseases

    No allergies to foods and drugs

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    (+) HPN: maternal lineage

    (+) DM: maternal lineage

    No other heredofamilial diseases

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    Patient is an Operations Engineer

    Non-smoker

    Occasional alcoholic beverage drinker Denies illicit drug use.

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    General: no fever, no weight loss

    Skin: no pruritus, no rashes

    Head: no headache, no dizziness Eyes: no blurring of vision, no diplopia

    Ears: no vertigo, no tinnitus, no hearing loss

    Nose: no epistaxis, no colds

    Throat: no dysphagia

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    Respiratory: no cough, no difficulty of breathing

    Cardiovascular: no chest pain, no orthopnea, no

    palpitation GIT: no diarrhea, no vomiting, no nausea

    Genitourinary: no dysuria, no hematuria, no nocturia,no frequency

    Musculoskeletal: (+) pain on left knee area

    Nervous system: no loss of consciousness, no seizures

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    General Survey: The patient is awake, conscious,coherent and not in cardio-respiratory distress.Patient was transferred to our institution viaambulance, stretcher-borne with posterior splint onleft knee area.

    Vital Signs:BP: 130/90 mmHg HR: 88 bpm

    RR: 18 cpm T: 36.7 C

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    Skin: no rashes, good skin turgor HEENT: anicteric sclerae, pink palpebral conjunctiva; no

    nasoaural discharge, no tonsillopharyngeal congestion, nocervical lymphadenopathy. Chest/Lungs: Symmetrical chest expansion, no retraction,

    clear breath sounds

    Heart: Adynamic precordium, normal rate, regularly

    rhythm, no murmur

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    Abdomen: flabby, normoactive bowel sounds, soft,non-tender.

    Extremities: (+) splint on left lower extremity

    (+) limitation of ROM of left knee

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    BUN Creatinine

    Na

    K

    Blood exam

    ECG

    X-ray

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    Closed, complete, comminuted intercondylar fracture

    of left tibia 2 to vehicular accident

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    Break in the continuity of bone, cartilage, or both

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    CLOSED (SIMPLE) Fracture: skin intact

    no communication with outside environment

    OPEN Fracture: disruption of skin

    allows communication with the outside environment

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    COMPLETE Fracture: Entire circumference or cortical surfaces have been

    disrupted.

    INCOMPLETE Fracture: Break in cortex does not extend completely through the

    bone

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    Bowing plastic response, usually to longitudinal stressin a bone

    Greenstick perforates one cortex and ramifies withinthe medullary bone

    Torus (buckling) results from an injury insufficient inforce to create a complete discontinuity of bone butsufficient to produce buckling of the cortex

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    TYPES OF LINEAR FRACTURES

    Transverse

    Oblique

    Oblique-Transverse

    Spiral

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    COMMINUTED Fracture:

    Fracture with more than two fracture fragments

    The greater the applied force and the more rapid itsapplication, the greater the energy absorption by thebone and the more severe the comminution.

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    Butterfly fragment:

    Segmental fracture:

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    Occurs when an osseous fragment is pulled from the

    parent bone by a tendon or ligament.

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    Results when one fragment of bone is driven into an

    opposing fragment

    Types:

    Depression fracture

    Compression fracture

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    PATHOLOGIC Fractures:

    The bone is disrupted at the site of preexistingabnormality, frequently by a stress that would not have

    fractured a normal bone.

    Absence of a history of trauma or fracture pain and thepresence of signs and symptoms of preexisting

    abnormality, such as angular deformity, painlessswelling, or generalized bone pain, are clinical aids todiagnosis.

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    STRESS Fracture:

    Can occur in normal or abnormal that is subjected torepeated cyclic loading with a load less than that whicj

    causes acute fracture of bone.

    TYPES:

    Fatigue fracture application of abnormal stress on abone with normal elastic resistance

    Insufficiency fracture normal stress is placed on a bonewith deficient elastic resistance

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    I. REACTIVE PHASE

    A. Inflammatory phase

    B. Granulation tissue fromation

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    II. REPARATIVE PHASE

    A. Cartilage callus formation

    B. Lamellar bone deposition

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    REMODELLING PHASE

    A. Remodelling to original bone contour

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    A. Delayed Union

    B. Nonunion

    C. Malunion

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    control hemorrhage

    provide pain relief

    remove potential source of contamination closed reduction

    casting

    traction (skin and skeletal)

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    Treatment goals:

    A. Anatomic reduction of the fracture fragments: For thediaphysis, anatomic alignment ensuring that length,angulation, and rotation are corrected is required,

    whereas intra-articular fractures demand an anatomicreduction of all fragments.

    B. Stable internal fixation to fulfill biomechanical demands

    C. Preservation of blood supply to the injured area of the

    extremityD. Active, pain-free mobilization of adjacent muscles and

    joints to prevent the development of fracture disease

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    Open Reduction Internal Fixation (ORIF)

    The objectives of ORIF include adequately exposing

    the fracture site and obtaining a reduction of thefracture. Once a reduction is achieved, it must bestabilized and maintained.

    Use of Kirschner wires (K wires) Use of plates and screws

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    Thank You!