CASE PRESENTATION ON SUPRACONDYLAR HUMERUS

1. Presented by:
DEEPAK KUMAR
Pharm-D

2.  A supracondylar fracture is an injury to the
humerus, or upper arm bone, at its narrowest
point, just above the elbow.
 Supracondylar fractures are the most common
type of upper arm injury in children. They are
frequently caused by a fall on an outstretched
elbow or a direct blow to the elbow. These
fractures are relatively rare in adults.
 Surgery isn’t always required. Sometimes a
hard cast may be enough to promote healing.
 Complications of supracondylar fracture can
include injury to nerves and blood vessels, or
crooked healing (malunion)

3. Patient demographic details :
 Name - xxx.
 Age - 8years
 Gender – Female
 IP no – 181559
 DOA – 3/03/22

4. C/O:
 Fall at home while playing .
 Pain at right side of elbow since 3 days.
 Severe swelling at elbow.
PMHx:
 not known.
Personal history:
 Appetite – decreased.
 Sleep - normal.
 B/B – normal.

5. ONGOING EXAMINATION:
 CVS – s1 s2 +
 Bowel sounds – yes.
 CNS -conscious
 Respiratory system:
Adventitious sounds – Rhonchi
Respiration rate-22/min
 Temp-normal
 Pulse rate-72 beats/min
 BP-100/60 mmHg
 SPO2-99%

6. Hematology:
1. Hb % : 9.8 g/dl (12-16g/dl)
2. RBC : 4.0millions/cumm (4.2-5.4)
3. WBC : 10100cells/cumm (4000-11000)
4. DLC
N : 83% (40-70%)
L : 15% (20-50%)
M : 1% (1-4%)
E : 02% (1-6%)
B ; 00% (0-1)
5. ESR : 30mm/1st hr (1-20mm/1st hr)
6. PCV : 37.6% (37-47%)
7. MCV : 84.9 cub.microns (82-98)
8. MCH : 28.3million/cumm (27-33)
9.MCHC : 33.3% (31-35)
10. platelet count : 3.78 lacks cells/cumm (1-4)
LAB DATA

7.  Serum Creatinine - 0.7 mg/dl 0.6-1.5
 Blood urea - 13 mg/dl 13-45
 RBS - 79 mg/dl 70-160
SERUM ELECTROLYTES:
 Na+ - 142 mmol/lit 135-155
 K+ - 4.5 mmol/lit 3.5-5.5
 Cl- - 100 mmol/lit 98-107
 Ca+ - 9.3 mg/dl 8.5-11.0
Peripheral Smear Examination
NORMOCYTIC/HYPOCHROMIC

8. IMPRESSION:
Displace lateral condyle humerus

9. IMPRESSION: Sinus Tachycardia , Short PR Interval

10. Based on the chief complaints of the patient
and lab data reports doctor diagnosed the
case as Supra Condylar Humerus fracture.

11. S.N
o
Brand Generic Dose Frequency
1. Chymorol CHYMOTRIPSIN 2000units 1/2 -0-1/2
2. Rantac RANITIDINE 150mg 1-0-1
3. Amclav Amoxycilin/clav
ulonic aid
375mg 1-0-1

12.  Drug-LIGNOCAINE - DOSE-20mg/ml
intra SPINE
 Surgery - Procedure :
CRIF/ORIF
Open reduction is setting the bone with open
Surgery to realign the bone into normal
position ones the bones are replace they will
Held together with special implants made of
Stainless steel and titanium

13. S.NO Brand name Generic
name
Dose/Route Fre
q
Day-
1
Day-2 Day-3
1. Inj.Cefuroxim
e
cefuroxime 750mg/IV BD + + +
2. Inj.Amikacin Amikacin 250mg/IV OD + + +
3. Inj.Diclofenac diclofenac 250mg/IM BD - + +
4. Inj.Zofer ondansetron 2mg/IV OD - + +
5. Inj.Pantop pantaprazole 20mg/IV OD + + +
6. IV.Fluids RL 50ml/hr + + +

14. DAY-1 DAY-2 DAY-3
C/O
Pain in rt elbow (+)
GCS -15/15
O/E:
BP – 110/90mmHg
RR –22/min
PR – 92/min
CVS – s1s2(+)
LUNGS – B/LAE +
C/O
Pain in rt elbow (+)
vomiting
GCS- 15/15
O/E:
BP – 120/80mmHg
RR –22/min
PR – 94/min
CVS – s1s2(+)
LUNGS – B/LAE +
C/O
Pain in rt elbow (+)
vomiting
Adv: physiotherapy
O/E:
BP – 110/90mmHg
RR –22/min
PR – 94/min
CVS – s1s2(+)
LUNGS – B/LAE +

15.  From the case review and observing the
treatment chart it was found that she was
with elbow fracture . There is modification
in the treatment given in post operative.

16. DRUG INTERACTIONS
 Amikacin with Cephalosporin class of drugs
may increase the risk of kidney damage in
prolong use.
 Immediate risk of nausea,vomiting,loss of
appetite, increased or decreased urination.
 Patient got nausea and vomiting on day-2.
RESOLUTION
 Amikacin will be stop to prevent this
interaction
Why because we are using cephalosporin it is
a
Broad spectrum antibiotic it will show its

17.  No treatment was given for Anemia.
 No treatment for Tachycardia and as the HR is 116/min
RESOLUTION
Depending upon the type of anemia treatment was
given; Dietary supplements ,Blood transfusion ,Vitamin
B supplements.
PROBLEMS IDENTIFIED
Patient appetite was decreased .
Cefuroxime drug given in RL solution leads to calcium
precipitation in blood.

18.  RESOLUTION
 Tachycardia is treated with Beta blockers.
 Ex: Atenolol , Propanolol .
 To increase Apetite-Eating food rich in
protein or fat.
 Drink water before every meal.
 Exercise before a meal.

19.  Physiotherapy....
 Muscle streatching, joint manipulation joint
mobilastion
 Exercise.....
 Push-ups , sit-up , contra lateral limb raises
 Not to lift weights with surgery arm for few
months.
 Proper hygiene at site of surgery...
 Food that increase blood...
 Red meat , greens , spinach, dry fruits , beans