Case presentation.pptxneck of femur fracture without dnvd

neck of femur fracture without dnvd

1. CASE PRESENTATIO N D r . Sashidhar FIRST YEAR POSTGRADUATE DEPARTMENT OF ORTHOPAEDICS

2. Case A 36yr old Patient brought to causality on stretcher with Chief complaints of right hip pain since 2 days developed after sustaining injury after A/H/O fall from Bed 2 days back. No Head injury, LOC, ENT bleed, vomitings,loose stools. No H/o fever, vomiting, loose stools. H/O PRESENT ILLNESS: Patient was apparently asymptomatic 2 days back then his attendant found him fell on floor bedside at night after which he started complaining of right hip pain, inability to bear weight and difficulty in the moving the right lower limb.

3. Past history H/o accidental fall and right clavicle fracture which was left untreated 2yrs back. Left Hemi-arthroplasty surgery done 2yrs back. Treated as in-patient for alcohol and tobacco dependence syndrome in De-addiction center for about 2 months duration 1year back. Not a k/c/o DM/HTN/ASTHMA/EPILEPSY/CVA/CAD

4. PERSONAL HISTORY MARRIED APPETITE: NORMAL DIET: MIXED BOWEL AND BLADDER: REGULAR KNOWN ALLERGIES: NO ADDICTIONS: - ALCOHOLIC since 15 yrs - TOBACCO-SMOKING since 15 yrs

5. General examination Patient conscious, coherent and co-operative Thin built and looks malnourished BP: 100/90 mm Hg PR: 82 bpm RR : 21/ min SPO2: 97% at room air TEMP 98.3 ⁰F PALLOR ICTERUS CYANOSIS CLUBBING LYMPHEDINOPATHY EDEMA PRESENT ABSENT ABSENT ABSENT ABSENT ABSENT

6. LOCAL EXAMINATION OF RIGHT HIP INSPECTION: ATTITUDE: Patient in supine, both ASIS at same level , externally rotated. Diffuse swelling present around the groin region. Skin : normal, no sinuses and scars PALPATION No local rise of temperature Tenderness + over the GT and groin region. ROM : restricted and painful Abnormal mobility present Sensations intact Distal pulses present.

7. PROVISIONAL DIAGNOSIS : Closed displaced Right fracture neck of femur ? ICNF/INTERTROCHANTERIC Fracture

8. On the day of admission HAEMOGLOBIN 9.0 gm/dl TOTAL COUNT 7,400 cells/ cumm NEUTROPHILS 66 % LYMPHOCYTES 23 % EOSINOPHILS 01 % MONOCYTES 10 % BASOPHILS 00 % PLATELET COUNT 1.3 laks /cu.mm SMEAR- Normocytic , normochromic anemia with thrombocytopenia Total Bilurubin 1.19 mg/dl Direct Bilurubin 0.38 mg/dl SGOT(AST) 24 IU/L SGPT(ALT) 12 IU/L ALKALINE PHOSPHATASE 127 IU/L TOTAL PROTEINS 4.9 gm /dl ALBUMIN 2.3 gm/dl A/G RATIO 0.94 CBP LFT

9. UREA 18 mg/dl CREATININE 0.8 mg/dl URIC ACID 3.3 mmol /L CALCIUM 8.9 mg/dl PHOSPHOROUS 2.7 mg/dl SODIUM 137 mmol /L POTASSIUM 3.2 mmol /L. CHLORIDE 105 On the day of admission RFT E S R 30 mm/ 1st hour C-Reactive Protein : Positive(2.4 mg/dl)

10. RADIOLOGICAL FINDINGS NORMAL SHENTON’S LINE Shenton’s line  disruption BREAK IN NECK OF FEMUR 1. Shenton’s line   disruption: loss of contour between normally continuous line from medial border of femoral neck and inferior border of the superior pubic ramus. 2. Transverse Fracture line seen along neck of femur. INTRACAPSULAR NECK OF FEMUR FRACTURE

11. DIAGNOSIS : Closed displaced Right IC neck of femur fracture Left Hemi-arthroplasty 2Yrs back 2yr old malunited right clavicle lateral1/3rd fracture SURGERY DONE : ORIF WITH CC screw fixation for right intracapsular fracture neck of femur.

12. Post op POST OP XRAY CC SCREW FIXATION INSITU HAEMOGLOBIN 10.1 gm/dl TOTAL COUNT 7,800 cells/ cumm NEUTROPHILS 72 % LYMPHOCYTES 18 % EOSINOPHILS 01 % MONOCYTES 09 % BASOPHILS 00 % PLATELET COUNT 1.1 lakhs /cu.mm SMEAR Normocytic normochromic anemia with thrombocytopenia POST-OP CBP