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Open Type III-S Complete Comminuted Fracture D3-L Femur
A Case Study
Helen Ferriols. MAN
East Avenue Medical Center
In Partial fulfillment of the Requirements
in the Related Learning Experience
Baquilar, Lorielyn D.
Caloza, Anivill B.
Cantor, Christopher C.
De Vega, Joyce M.
Echevarria, Adora S.
Lovedioro, Vergel C.
Lozada, Rose Ann Shayne F.
Madredeo, Ronalyn B.
Natividad, Brian C.
Pring, Bernardino L.
Salvador, Charles V.
We choose this case because it requires a broader scope of research which will benefit us
We chose this case to learn orthopedic in advance
To have a study to share to our fellow student
A Fracture is a break in the continuity of bone and is defined according to its type and
extent. Fractures occur when the bone is subjected to stress greater than it can absorb. Fractures
are cause by direct blows, crushing forces, sudden twisting motions, extreme muscle
contractions. When the bone is broken, adjacent structures are also affected, resulting in soft
tissue edema, hemorrhage into muscles and joints, joint dislocations, ruptured tendons, severed
nerves, and damaged blood vessels. Body organs maybe injured by the force that cause the
fracture or by fracture fragments.
TYPES OF FRACTURE
Greenstick fracture: an incomplete fracture in which the bone is bent. This type occurs
most often in children.
fracture: a fracture at a right
angle to the bone's axis.
Oblique fracture: a fracture in which the break has a curved or sloped pattern.
fracture: a fracture in which
An impacted fracture is one whose ends are driven into each other. This is commonly
seen in arm fractures in children and is sometimes known as a buckle fracture. Other
types of fracture are pathologic fracture, caused by a disease that weakens the bones, and
stress fracture, a hairline crack
A depressed fracture results from a force that drives a piece of bone down. This
fracture may effect the outer table of the skull, the inner table, or both if the force is
strong and localized. This is a depressed fracture on the left parietal part of a skull.
An avulsion fracture is a bone fracture which occurs when a fragment of bone tears
away from the main mass of bone as a result of physical trauma
which the fractured ends of
A spiral fracture (also called a torsion fracture) is a bone fracture in which the bone has
been twisted apart
fracture occurs when the
normal vertebral body of the spine is squished, or compressed, to a smaller height
fracture: A fracture in
which the bone is sticking through the skin. Also called an open fracture.
57 years old
Date of Birth:
July 7, 1952
Batasan Hills Quezon City
Date of Admission: December 24, 2009
Time of Admission: 8:15 am
Admitting Diagnosis: Fx Open III-S Complete Comminuted D3-L Femur
Past Medical History
Breast Mass at Lateral aspect of the left Breast
January 18, 2010
57 years old
Primary Language: Tagalog
BP- 110/80 mmHG
Temp- 36.9 C
PR- 82 BPM
- Black and White
Overall hygiene and grooming
- Clean and neat
Note Body and Breath Odor
- No Body odor; No Breath odor
Signs of distress in posture or facial Expression
- no distress noted
Note obvious signs of Health/ Illness
- Weak and with fractured at left Leg
- Cooperative and able to follow instructions
Client’s affect/mood; appropriateness of the responses
- Appropriate to situation
Quantity of Speech, Quality and Organization
- understable, clear tone; exhibits thought association
Relevance and organization of thoughts
- makes sense; has sense of reality
ASSESSED FINDINGS I. Gross general appearance 1.1 Height 1.2 Weight 1.3 Body Build 1.4 Posture/ Gait 1.5 Skin Color 1.6 Personal Hygiene/ Grooming 1.7 Body Breath Odor 1.8 Nutritional Status 1.9 Age appropriateness 1.10 Sensory status
fair skin color neat and clean
No Body and Breath Odor BMI: 21.1 Her face is Appropriate to her age Well developed 1.6 m 54 kg normal posture fair skin color
no foul smelling odor BMI: 18.5-24.9 Appropriate to Age Well developed Normal Normal Ectomorphic Normal Normal Normal Normal Normal Normal Normal 2. Physiologi cal Cues 2.1 Temperature 2.2 Pulse 2.3 Respiration 2.4 Blood Pressure 36.9 C 82 bpm 22 cpm 110/80 mmHG 36.5-37.5 C 60-100 bpm 16-22 cpm 120/80 mmhg Normal Normal Normal Normal
3. Behavior 3.1 Verbal (Speech-quality; quantity; coherence; relevance; pattern; organization of thought) -good speech quality -understable, clear tone; exhibits thought association - good speech quality -organized the thought Normal 3.2 Non-verbal Body language Gesture Movement Facial expression Attitude Affect/ mood Appropriateness of response -can response to a body language -can do facial expression -can response to a body language -can do facial expression -Normal HEAD TO TOE PHYSICAL EXAMINATION TECHNIQUE NORMAL / STANDARD ACTUAL FINDINGS ANALYSIS Head
1. Skull Size, shape, Palpation contour, any lumps, deformities -rounded -smooth skull contour -absence of nodules or masses -symmetrical in shape -smooth skull contour -absence of nodules or masses Normal
2. Scalp / hair Inspection Appearance, hair color, distribution,
texture, presence of lice, nits and
-hair evenly distributed -hair black in color
-silky hair -no presence of nits
and lice -no presence of tenderness -even distribution of hair -black and white hair color -silky -no presence of nits and lice -not tender Normal 3. Face Inspection
shape, expression, Appearance and movements slightly asymmetric facial features -symmetric facial movements facial movements
4. Eyes/Vision Eye Structures
a. Eyeball - note Any protrusion b. Lid margins Observe scaling Secretions, position, Symmetry, ability to blink and frequency c. Conjunctiva note color, appearance d. Sclera – note Color, appearance e. Pupils – size, Shape, symmetry, Reaction to light, and accommodation f. Eyebrows/lashes Color, symmetry, quantity of hair, placement g. Eye movement in all directions -no protrusion -lids close symmetrically -no secretion -symmetrical -15-20 blinks/min -transparent; shiny, smooth, and pink or
red -sclera appears
white in color -pupil equally round
reactive to light accommodation
-evenly distributed hair
-black and white in color -symmetrically aligned -curled slightly outward -both eyes coordinated (cardinal movement/s) -no protrusion -symmet rical closeness of lids -no secretion -symmetrical -can blinks 16/min -pinkish in color -shiny -white in color -pupil equally round -even distribution of hair -black and white -aligned symmetrical -coordinates by movement Normal Normal Normal Normal Normal Normal Normal
5. Ears/hearing a. Pinna Inspection Parallelism, size, shape, appearance, placement. Palpation Palpate for firmness of the cartilage and for
tenderness. b. External canal Inspection Check color, appearance, and any discharge. e. Hearing acuity Whisper from clients ear at a distance of 2 feet
away from the clients back
-symmetrical; aligned with outer
canthus of eye, about 10 from
verical -mobile, firm, and
not tender; pinna recoils after it is
folded -grayish tan color
-presence of wet cerumen in various
shades of brown -no discharge
-able to hear ticking in both ears -normal voice tone
(audible) -symmetrical -firm -not tender - grayish an in color -wet cerumen -able to hear on both ears Normal Normal Normal Normal 6. Nose Inspection Placement, discharges and Patency -symmetric and straight -no discharge -air moves freely as
the client breaths through the nares
-midline alignment -no discharge -air moves freely Normal
7. Mouth / lips Inspection Color, shape, moisture and symmetry, appearance Gums Color, appearance Teeth
-uniform pink color -soft, moist, smooth
texture -symmetry of
contour -ability to purse lips
-pink gums -moist, firm texture
to gums -no retraction of gums -smooth, white, -pinkish in color -soft, moist, smooth -ability to purse lips -pinkish in color -firm and moist Normal Normal
Color, arrangement, general condition,
Size, color, shape, symmetry, moisture, movement Palate – Hard / soft Color, texture, shape Soft Palate – (w/ penlight) pink, smooth uvula
Oropharynx / tonsil
Color, texture, elicit gag reflex
present shinny tooth enamel, -pink color -moves freely -moist; slightly rough -symmetrically aligned -lighter pink hard
palate -light pink,
smooth-soft palate -more irregular texture -symmetrical in shape -pink in color -uvula positioned in midline of soft palate -pink and smooth
posterior wall -gag reflex present
-No more Tooth -pinkish -symmetrical -moist -pinkish in color -smooth -symmetry of the shape -pinkish -uvula present in midline -pinkish -smooth -presence of gag reflex Normal Normal Normal Normal 8. Cheeks Inspection
Color, appearance -pink in color -Fair color Normal
9. Neck (Inspection) Symmetry, position, movement (chin to chest, ear to shoulder) (Palpation)
Palpate for lumps,
-symmetrical (muscles equal in size) -coordinated, smooth movements with no discomfort -complete range of motion
-lymph nodes not palpable
nodes, tenderness -not palpable 10. Chest Anterior Posterior (Inspection) Note symmetry, color, deformities, breathing pattern (Palpation) Any lumps, masses Inspection Symmetry, retractions, deformities
Palpate for vocal
-skin intact -quiet, rhythmic and
-chest wall intact -spinal column is
straight -right and left shoulders and hips
are at the same height -bilateral symmetry of vocal fremitus -vasicular and bronchovesicular breath sounds -rhythmic respirations Normal 11. Heart Inspection Check for lifts, heaves, pulsation Palpation 2nd ICS (right) Aortic valve 2nd ICS (left) pulmonic valve 5th ICS (left sternal
border) tricuspid mid-clavicular – below the nipple)
Check cardiac rate at apical area
Jugular Veins for distention
-complete pulsation of the heart, normal
-normal heart rate -usually heard at all
sites -no distention -veins not visible
Normal 12. Breast Inspection
Size, Shape, symmetry, color, any dimpling, discharges in the nipples Palpation
Note any mumps, masses, tenderness, (clockwise borders
-skin uniform in color; skin smooth and intact; no nipple
discharge -no tenderness, masses/nodules -Presence of Breast Mass(7x5 cm) at Lateral Aspect of the Left Breast Normal Abnormal 13. Abdomen Inspection Color, contour, symmetry, skin integrity, scars Auscultate for bowel sounds, vascular sounds, peritoneal friction rub Palpation Palpate 4 quadrants, note areas of tenderness, lumps, masses, distention in circular motion using finger pads.
Percuss 4 quadrants from LQD clockwise, note any tympany
or dullness -unblemished skin; uniform in color; symmetric contour -audible bowel sound -absence of arterial bruits -absence of friction rub -no tenderness; relax abdomen with
smooth, consistent tension
-tympany over the stomach and gas
filled bowels, dullness especially
over the liver and spleen, or a full bladder Normal Normal Normal Normal 14. Upper
Extremities Symmetry, size, Inspection length, deformities, skin
-equal in size, both
lesions, scars, ROM movement Hands Size, number of fingers, color of nail, capillary refill, hygiene movement -range of motion varies -5 fingers in 1 hand -pinkish color, able
to return after the capillary refill -able to return capillary refill within 2-3 seconds -5 fingers in 1 hand Normal 15. Lower
Extremities InspectionSymmetry, size, length, deformities, hair distribution, scars, lesions, movement (flexion, extension, rotation) Feet Inspection Color, symmetry, deformities, number of toes, scars, lesions, hygiene. Movement (flexion, extension, rotation) -no deformities, no skin lesion and
-fair skin color -no scars/lesions -can extend, flex
and rotate -skin intact -presence of Gun shot wound at Left femur -fair skin color -presence of gun shot wound at Left femur -can’t extend and flex Left
Course in the ward
1) Maintain Tractions
Inspect Integrity of Tractions
Inspect for Infections
Daily wound Dressing
Educate Patient for proper
Ensure Client’s Safety
Side rail’s Up for safety
Put Client’s belongings within reach
Educate significant others about safety
1) Refer for OR schedule
Assess patient’s financial status
Refer for Social service( PCSO, Phil
Educate patient regarding operation
Anatomy and Physiology
The skeleton has six main functions
Support- It provides the framework which supports the body and maintain its shape.
Movement- The bones are the levers that help the body move in different directions and in
The skeleton protects many vital organs
Cranium protects the brain.
Ribs/Sternum protects the lungs, heart and some digestive organs.
Pelvis protects and supports the digestive and reproductive organs.
Spinal column protects the spine.
Blood cell production
Inside of the long bones in our bodies, there is a cavity that is filled with a substance called Bone Marrow. In this tissue, new blood cells are produced, and damaged blood cells are repaired. Red bone marrow produces red blood cells, white blood cells and other blood elements.
The skeleton is the site of hematopoiesis, which takes place in red bone marrow. Marrow is
found in the center of long bones.
Mineral is a substance that the body needs to carry out all of our bodily functions like thinking, breathing and moving around. One of the minerals that the body needs is calcium. Calcium is a major part of bone, and this is where the body stores its calcium.