Case report about orthopedic (ortho) His family was not satisfied with other hospital treatment. However, patient got severe pain in his wrist joint and distal part of forearm after he fallen on his left palm

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Osamah khaild Alfentokh
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2.  Yousef Alaweed 12 years old male middle school student.
 arrived to KSMC file number 00606648.
Patient’s data
121120030 osamah alfentokh

3.  His family was not satisfied with other hospital treatment.
 However, patient got severe pain in his wrist joint and distal part of
forearm after he fallen on his left palm.
Chief complaint
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4.  Site : distal part of redial and ulnar bone.
 Onset : 20 days ago stat after the fallen down accident.
 Character : dull pain.
 Radiates : to his wrist joint and hand.
History – present illness
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5.  Associated symptoms : mild swelling in his finger and redness.
 Duration : from the beginning, and it goes up and down.
 Exacerbating factors : moving the joint and touching the injured area.
 Reliving factors : holding the hand with his anther hand.
 Severity : high mild to sever.
History – present illness Cont.
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6.  Past surgical history :
 Left ankle varus fracture 4 years ago, Treated conservatively.
 Systemic review :
 Normal.
 Medical history :
 Got poisoning by drinking Clorox 3 years ago.
History Cont.
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7.  Medication and allergies :
 None.
 Socially :
 Living with his grandmother.
 Family history :
 Nothing.
History Cont.
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8.  General appears :
 Patient look stable with forearm cast and holding his left arm by his right
hand.
 Vital signs :
 Heart Rate : 80 bpm
 Respiration : 14 bpm.
 Blood Pressure : 110/70 mm Hg.
 Temperature : 37.5 c
Physical examination
Normal
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9.  Look :
 Short forearm thump cast cover from proximal of forearm.
 Mild swelling of finger.
 Redness of sniff pox area of his thump.
 Feel :
 Can’t feel the injured area. otherwise , there is hotness in the hand.
 No tenderness and pulse normal.
Physical examination cont.
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10.  Move and special tests:
 Normal movement for the elbow joint.
 Can’t do full movement for the wrist joint due to the cast.
 Normal hand muscles movement.
 All sensation area are normal.
Physical examination cont.
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11. Investigation
 X-ray for left forearm after removing the cast.
 AP x-ray .
 Lateral x-ray.
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12.  Dislocation of wrist joint.
 Colle’s and smith fracture.
 Pathological fracture !!
Different diagnosis
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15.  Colle’s fracture : external articular fracture in both distal part of radius
and ulnar.
 Shortening of both bones (over lapping).
 Simple transvers.
 AO fracture classification??
 23A
Diagnosis
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16.  Conservative :
 Close reduction with sedation.
 Then long forearm cast.
 Follow up :
 After 2 weeks to take x-ray.
Plan treatment
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19. The X-ray after 2 weeks :
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21.  Failure of the conservative treatment.
 Next plan :
 Open reduction.
 Then forearm cast.
 follow up after 2 weeks.
Follow up shows :
121120030 osamah alfentokh

22.  12 years boy with left forearm colle’s fracture. And swollen fingers due
to the previous cast from another hospital.
 First treatment by close reduction and cast. But it was not enough.
 Second treatment by open reduction and cast.
Summery
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23.  Beware that even in common fracture the follow plan it is as important
as the first treatment.
Home massage
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