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DEPARTMENT OF ORTHOPAEDICS, TRAUMATOLOGY & REHABILITATION
KULIYYAH OF MEDICINE

Case write-up 1:

CLOSED FRACTURE OF DISTAL THIRD OF LEFT TIBIA AND FIBULA

HISTORY
Chief Complain Patient, Sonia a/p Bacik, a 36 years old single mother, orang asli, with a history of fracture at the left leg following industrial accident treated conservatively 1 month prior to admission, was referred from Hospital Pekan 4 days ago with a chief complain of pain at same side of the fracture. History Of Presenting Illness She was apparently well until 1 month and 3 days ago when she was involved with an accident during working at a papaya plantation estate. While she was working, she accidentally slipped and fell prone on a dirt road. Unfortunately, at that time a tractor was moving on that road and she was run over by it. The point at which the tyre of the tractor run over her body were at both her calf and also her back.

Full blood count was done and the haemoglobin level was 12.1g/dL and total white cell count was 13.33 x109/L which was increased and may be suggesting infection. Imaging of the left femur was done and showing midshaft left femur fracture. Intravenous drip of four pints of normal saline over 24 hours was secured. Skin traction weighing 3kg was done. Laceration wound of the upper lip was managed by referring to dental. Otherwise, he is able to tolerate orally. He was treated with C. Cloxacillin 500mg QID and intramuscular Voltaren 50mg TDS for pain management. Daily Bactigrass with normal saline dressing was planned for abrasions wound at the foot. He was planned to undergo plating of the left femur later. For the meantime, his family was advised to buy crutches and told on how to use them.
Figure 1. Abrasion wound of the toes of left foot.

Figure 2. X-ray of the left femur showing midshaft fracture.

Discussion Trauma is a

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