1) A 20-year old male patient presented with severe pain in his right arm following a road accident two days prior. 2) X-rays revealed a proximal fracture of the right humerus bone. 3) The patient underwent an open reduction internal fixation surgery to reduce the deformity and restore the bone to its original shape using metal rods, screws, and plates. He is being treated with analgesics, antibiotics, anti-emetics and proton pump inhibitors.

1. CASE PRESENTATION ON
FRACTURE OF HUMERUS
PRESENTED BY: SALAMAH ZAHEER
ROLL NO: 170819882027
PHARM-D 4TH YEAR

2. DEMOGRAPHICS
•NAME : XYZ
•AGE : 20 Years
•SEX : Male
•UNIT : MOW
•IP NO. : 11652
•DATE OF ADMISSION : 27/10/2022

3. REASON FOR ADMISSION
C/O SEVERE PAIN THE RIGHT ARM

4. PATIENT HISTORY
o H/O ROAD ACCIDENT TWO DAYS AGO
o NO SURGICAL HISTORY

5. PHYSICAL EXAMINATION
•PT : C/C/C
•TEMPERATURE : 98.8o F
•PULSE RATE : 80 per min
•BLOOD PRESSURE :110/70 mm/hg
•RESPIRATION RATE : 17/min
•CVS : S1 , S2 +ve
•RS : BAE +ve

6. BIOCHEMICAL REPORTS
TEST RESULT NORMAL RANGE
ALBUMIN NIL
SUGAR NIL
HEMAGLOBIN 13.5gms 10-14gms
RBC 5.01x106 3.7-5.6x106
MCV 79.6 75-95cu.mc
MCH 26.9 26-32pg/cells
MCHC 33.8 30-35gm%
BLEEDING TIME 02 min 03 sec 2-9 min
CLOTTING TIME 04 min 20 sec 8-15min
RBS 88 70-120mg/dl

7. SOAP ANALYSIS
SUBJECTIVE EVIDENCE :
Patient was brought to hospital with complaint of injury
two days ago with pain in right arm.
OBJECTIVE EVIDENCE :
Swelling ,Pain, Loss of function in injured area ,
Deformity in right arm in the humerus region. X-RAY of
complete right arm including shoulder and elbow is
advised.

8. ASSESSMENT & X-RAY
DIAGNOSIS
The patient had been
diagnosed with proximal
fracture of right Humerus
Bone.

9. PLANNING
• GOALS OF THE TREATMENT
• To reduce the deformity of the arm by performing
ORIF(Open Reduction Internal Fixation) Surgery.
• To bring the shape and structure of the bone into it’s
original form

10. ORIF(OPEN REDUCTION
INTERNAL FIXATION)
SURGERY
• Open reduction internal fixation (ORIF)
is a surgery to fix severely broken
bones. It’s only used for serious
fractures that cannot be treated with a
cast or splint.

11. PROCEDURE OF ORIF
ORIF is a two-part procedure. The surgery can take several hours, depending on the fracture.
An anesthesiologist will give the patient general anesthesia. This will put the patient in a deep sleep during
the surgery so the patient won’t feel any pain. Patient might be put on a breathing tube to help you breathe
properly.
• The first part is open reduction. The surgeon will cut the skin and move the bone back into the normal
position.
• The second part is internal fixation. The surgeon will attach metal rods, screws, plates, or pins to the
bone to hold it together. The type of hardware used depends on the location and type of fracture.
• Finally, the surgeon will close the incision with stitches or staples, apply a bandage, and may put the limb
in a cast or splint depending on the location and type of fracture.

13. TREATMENT CHART(PRE-OPERATIVCE)
NAME OF
THE DRUG
DOSAGE ROUTE FREQUENC
Y
DAYS
Inj T.T
(Tetanus
Toxoid)
IV
Ceftriaxone 1G IV BD

14. TREATMENT CHART (POST-OPERATIVE)
NAME OF
THE DRUG
DOSAGE ROUTE FREQUENC
Y
1 2
Ibuprofen 200MG IV Every 4
hours
+ +
Acetamino
phen
650MG IV TID + +
Ondastero
n
4MG Oral OD + +
pantoprazo
le
40MG Oral OD + +

15. DISCHARGE MEDICATION
Patient not yet discharged.

16. MONITORING PARAMETERS
* Monitor temperature.
* Monitor the blood pressure.
* Monitor heart rate.
* Monitor site of injury.

17. TOXICITY OF DRUGS
1.Ibuprofen: Abdominal pain, sour stomach,belching, bloating cloudy urine, decrease urine
output.
2.Acetaminophen: NAUSEA , VOMITING , SKIN ALLERGIES , FATIGUE.
3.Ondasteron: headache, Diarrhea, Constipation, Dizziness, Drowsiness.
4. Pantoprazole: Blurred vision, Nausea, Vomiting, Increased thirst, Increased urination, Stomach
pain.
5. T.T(Tetanus Toxoid): Swelling, Redness, Loss of appetite, Fever.
6. Ceftriaxone: Chest pain, Chills, Cough, Fever, SOB, Sore throat.

18. PATIENT COUNSELLING
*Keep the plaster part raised to prevent swelling, especially for the first 48 hours. For
example, use a sling to keep an arm raised.
*Don’t stick objects down the plaster, as this will damage the skin.
*Don’t lift anything or drive until the fracture is healed.
*After the removal of plaster take care of your hand for at least another month.
*Maintain Hygiene.
*Rest more.
*Eat on time.

19. DIET
* Include high calcium rich foods(beans, milk, cheese, fish, dry fruits)
* CEREALS AND CEREAL PRODUCTS: ragi, bajra, whole wheat flour.
* FRUITS AND VEGETABLES: custard apples, chiku, apple, white jamun, grapes, lemons
and oranges, carrots, beetroots, bottle gourd, spinach, garlic, ginger.
* MILK AND MILK PRODUCTS: curd, milk liquid, cheese ghee.
* MEAT, FISH AND POULTRY: Egg, chicken, sweet and salty fish.
* NUTS AND OILS: Almonds, pista, walnut, vegetable oil, mustard oil.
* Avoid consumption of caffeinated products.
* Do not consume iron rich foods along with calcium rich foods as that might lead to
malabsorption.

20. EXERCISE
Do small exercise of hand like
Handgrip exercise.
Wrist range of motion.
Wrist and forearm strengthening exercise.

21. THANK YOU FOR YOUR
ATTENTION.
PRESENTED BY: SALAMAH ZAHEER