Presentation FORTNIGHTLY 24-11-23.pdf cases

Baqi
Tb Qalsan D
Aik rozana
One month
Aur
Inj Dow D 2 Lacs
7 din k baad
4 pee lyThis image explains Böhler’s angle, which is an important radiographic measurement used to assess for calcaneal fractures on a lateral X-ray of the calcaneus.

How Böhler’s angle is measured:

Draw Line 1: from the highest point of the anterior process to the highest point of the posterior articular facet.

Draw Line 2: from the highest point of the posterior articular facet to the highest point of the posterior tuberosity.

The angle formed between these two lines is Böhler’s angle.

Normal values:

20° – 40° → Normal

< 20° → Suggests depression fracture of the calcaneus (often intra-articular).

Key point:

A reduced Böhler’s angle is a classic radiographic sign of calcaneal fracture.July 2025 Mess Audit

Total Collection 66,500
Total Expenses 48,600

Balance 17,900This image explains Böhler’s angle, which is an important radiographic measurement used to assess for calcaneal fractures on a lateral X-ray of the calcaneus.

How Böhler’s angle is measured:

Draw Line 1: from the highest point of the anterior process to the highest point of the posterior articular facet.

Draw Line 2: from the highest point of the posterior articular facet to the highest point of the posterior tuberosity.

The angle formed between these two lines is Böhler’s angle.

Normal values:

20° – 40° → Normal

< 20° → Suggests depression fracture of the calcaneus (often intra-articular).

Key point:

A reduced Böhler’s angle is a classic radiographic sign of calcaneal fracture.July 2025 Mess Audit

Total Collection 66,500
Total Expenses 48,600

Balance 17,900This image explains Böhler’s angle, which is an important radiographic measurement used to assess for calcaneal fractures on a lateral X-ray of the calcaneus.

How Böhler’s angle is measured:

Draw Line 1: from the highest point of the anterior process to the highest point of the posterior articular facet.

Draw Line 2: from the highest point of the posterior articular facet to the highest point of the posterior tuberosity.

The angle formed between these two lines is Böhler’s angle.

Normal values:

20° – 40° → Normal

< 20° → Suggests depression fracture of the calcaneus (often intra-articular).

Key point:

A reduced Böhler’s angle is a classic radiographic sign of calcaneal fracture.This image explains Böhler’s angle, which is an important radiographic measurement used to assess for calcaneal fractures on a lateral X-ray of the calcaneus.

How Böhler’s angle is measured:

Draw Line 1: from the highest point of the anterior process to the highest point of the posterior articular facet.

Draw Line 2: from the highest point of the posterior articular facet to the highest point of the posterior tuberosity.

The angle formed between these two lines is Böhler’s angle.

Normal values:

20° – 40° → Normal

< 20° → Suggests depression fracture of the calcaneus (often intra-articular).

Key point:

A

1. Dr. Muhammad Ibrahim
Resident Orthopedic Surgery
Services Hospital, Lhr
CASE PRESENTATION

2. CASE : 01
Patient Name: Zahid
Age: 34Y
Gender : Male
Marital status : Married
Resident : Sialkot

3. Presenting Complaint
●Severe back pain - 4 Months
●Radiating pain left leg - 2 Months

4. HOPI
●Patient presented with history of back pain since 4 months.
●Pain was progressive in nature.
●Increase with walking and relieved with rest and medication
initially.
●But now the pain is continuous and little relief with medication.
●Pain worsens with movement & patient unable to lie supine

5. ●With these complaints patient presented many doctors in
periphery , they advised supportive medication. One doctor
advised MRI , after MRI he gave caudal epidural, but symptoms
didn’t settled and worsened with time.
●He visited again the same consultant who advised for repeat
MRI and after MRI he started ATT.
●He visited services hospital with these complaints, where MRI
lumbar spine e contrast was done.

6. ●Past medical/surgical history:
No h/o DM, HTN, IHD, Asthma or chronic illness.
●Personal history:
Non smoker, non addict.
●Family history:
One elder sister and two younger brothers. All are healthy and
alive. No h/o DM, HTN, IHD, Asthma or chronic illness in family.

7. ●Occupational history:
Works abroad
●Drug allergy:
Not significant
●Socioeconomic status:
Middle class family

8. General Physical Examination
Vitals:
BLOOD PRESSURE 120/80 mmHg
PULSE 88/min
RR 18/min
TEMP. A/F
BSR 108 mg/dl

9. ●No pallor, jaundice, clubbing, cyanosis and lymphadenopathy
●Respiratory : B/L normal vesicular breathing
●CVS : S1+S2+ No added sounds
●Abdomen : Soft, non tender, bowel sounds audible
●CNS : GCS 15/15.
●DRE: Anal tone normal.

10. Specific Examination
●At lumbar region, there was mild swelling, with intact skin,
tenderness along the lumbar area was present, distal vessels
were palpable B/L.
●No other obvious deformity.
●Paraspinal muscle spasm.
●Limited range of motion due to pain.
●Left EHL is weak with power ⅘ .

11. Lab Investigation

BLOOD C/E
TEST VALUE
HB 12.2 g/dl
PLT 4.4 x 10^12/l
TLC 7.5 x 10^9/l
HCT 39%

12. TEST VALUE
ESR 50 ( normal < 10 )
CRP 8.56 ( normal < 0.5 )

13. X-Ray
End plate
erosion
Loss of disc
height at
L4-5
segment

14. ●End plate
erosion
●Epidural
abscess
●Stenotic
canal
●Signal
changes in
L4-5
vertebra
MRI e Contrast

15. MRI Report

17. Diagnosis
Pyogenic Discitis L4,L5

18. Procedure
Debridement + L4 L5 TLIF + PSIF was done.

20. BIOPSY

21. Mircobiology Report

25. CASE : 02
Patient Name: Ishfaq
Age: 45Y
Gender : Male
Marital status : Married
Resident : Lahore

26. Presenting Complaint

●Weakness B/L lower limb - 3 months
●Severe back pain - 3 months
●Unable to stand and walk - 3 months

27. HOPI
●Patient presented with back pain which is not relived by medication
or rest and unable to walk
●Initially patient operated in some other setup, short segment fusion
and cage placement done and diagnosis of tuberculous discitis was
made.
●Patient started walking after a week of surgery with support and
while walking he felt a jerk and excruciating pain in the back and
later he was unable to stand & walk.

28. Physical Examination
•Patient lying on bed in right lateral position with prominent
kyphotic deformity at thoracolumbar junction.
•Surgical scar mark
•Localized tenderness over the affected spinal region.
•Movements not possible due to pain.
•Gross weakness B/L lowerlimb with power ⅗

29. Diagnosis
Tuberculous Discitis + Implant Failure

31. 41.7

32. Procedure

Revision Surgery Done
( Debridement + Readjustment of cage + PSIF )

34. CASE : 03
Patient Name: Asghar
Age: 52Y
Gender : Male
Marital status : Married
Resident : Sialkot

35. Presenting Complaint
●Severe back pain - 6 months
●Unable to stand and walk - 6 months
●Weakness B/L foot - 4 months

36. Pre-Op X-Ray

38. MRI e Contrast
●Disc destruction
●End plate erosion
●Epidural and
paraspinal abscess
●Signal changes

41. Diagnosis
Pyogenic Discitis L4,5

42. Procedure
●L4,5 TLIF + L4-S1 TPSF

43. Post-Op X-Ray