This document discusses the examination of patients presenting with long bone nonunions or limb length discrepancies. It outlines the key components of history taking including chief complaints, history of presenting illness, and relevant medical history. The physical examination is described in detail, including inspection of the bone and surrounding soft tissues, palpation of the bone focusing on sites of tenderness, irregularity and mobility, assessment of range of motion, measurements, and deformity. Relevant investigations including laboratory tests, x-rays and potential special investigations like MRI are also mentioned. The document provides guidance on documenting anatomical location of involvement and pathological diagnosis.

1.
Page1
EXAMINATION OF CASE OF LONG BONE
[NONUNIONS/LLD]
CHIEF COMPLAINTS ;‐
1. Pain and inability to walk, or perform a function(U/L)
2. Deformity of long bone – angular and bowing /LLD‐shortening or lengthening.
3. Abnormal mobility of long bone/long standing infection.
HISTORY OF PRESENTING ILLNESS;‐ ELOBORATE ON chief complaints
Pain and inability to wallk‐(SOCRATES), since when is he not able to walk or perform a function, how
does he walk, does he use crutches or aids, how did it happen etc
Deformity‐onset .duration ,progressive or not,any correction attempted, associated symptoms.
Presence of infection, since when,is it active or healed, discharging sinuses
ADI:‐( UL‐inability to lift objects , do household work, In LL‐inabilty to walk, bicycle, etc)
NEGATIVE HISTORY:‐H/O‐high energy trauma, compd #s, smoking, gutka, alchohol intake, improper
imobilisation(native treatment), Chronic Debiliating conditions –anemia, malnutrition, liver cell
failure, DM,TB,HIV, Malignancy. and repeated surgeries(periosteal stripping),Drugs‐steroids used in
asthma, skin diseases, malignancy, Radiation history,Vit‐D resistant rickets ,blue sclera .etc
GPE; ‐ PICKLE
LOCAL EXAMINATION
ATTITUDE:‐Its position of ease,(UL‐start from level of shoulders, position of elbow, wrist, fingers and
for LL‐start from level of ASIS, position of hip, knee, ankle and foot.)
DEFORMITY:‐Look for Angular deformities and bowing, shortening,lengthening.
INSPECTION:‐Antrly , postrly and from Sides.
Antrly:‐(eg‐ in a case of tibia it goes like this –there is a antr bowing of lower end tibia extending
from metaphysis to about 5 cm distally, there is a visible irregularity of the bone , and a linear scar
about 10 cm healed by primary intention, skin is shiny, stretched, and puckered to underlying bone)
Look for scars , sinuses, hyper pigmentation, puckering of skin, and condition of skin ,
Examine in same fashion Postrly and from Sides.

2.
Page2
PALPATION:‐
Superficial: ‐Look for local rise in temparture, and tenderness.
Deep palpation:‐ soft tissue – look for musce fibrosis, induration
Bony palpation ‐ palpate the whole bone and comment of following points(TTICAT) ‐6
POINTS.
1.THICKENING
2.TENDERNESS‐painful‐delayed union, painless –nonunion(keep in mind the time elapsed since
fracture
3.IRREGULARTIY‐
4.CREPITUS
5.ABNORMAL MOBILITY (Pls check in two planes or u will fail in exam)
6.TRANSMITTED MOVEMENTS and telescopy .
MOVEMENTS :‐
ROM‐ Active and passive , painful or not, FFDs, contractures‐CHECK IN A JOINT ABOVE AND BELOW .
MEASUREMENTS :‐LINEAR: –True and segmental –to check shortening /lengthening .
CIRCUMFERENTIAL:‐to look for wasting of thigh and calf muscles.
DEFORMITY ASSESMENT :‐ Asses the deformity in Saggital, Coronal and Axial plane .
EXAMINATION OF DISTAL NEUROVASCULAR DEFECITS AND LYMPH NODE EXAMINATION.
ILLIAC REGION –INSPECTION FOR TAKING BONE GRAFTS LATER.
DIAGNOSIS:‐ ANATOMICAL ‐ Which part is involved –humerus, femur , tibia, and diaphseal ,
metaphyseal.
PATHOLOGICAL‐ painless(nonunion), painful (delayed union)
INVESTIGATIONS :‐
LABORATORY:‐Hb, Wbc, TcDc, Esr, CRP, LFT‐s‐albumin level.
RADIOLOGICAL:‐ plain x ray‐AP and LAT views, special views to asses 4 cortical union
SPECIAL INVESTIGATIONS:‐ MRI‐ to look for soft tissue impingement , bony vascularity,

3.
Page3
SELF NOTES