2. Particulars of the patient
• Name : Mr. Neyamot ullah
• Age: 46 years
• Sex: Male
• Occupation: Business.
• Address: Mirpur, Dhaka
• Reg no: 216303
• Date of admission: 13.10.2022
• Ward/Bed: Cabin 1224
3. CHIEF COMPLAINTS
• Pain & swelling of right knee following Motor
vehicle accident for 11 days.
• Inability to stand or bear weight on his right
lower limb for the same duration.
4. HISTORY OF PRESENT ILLNESS
According to the statement of the patient he was good
well 11 days back. Then he accidentaly got trauma to his
right knee following MVA.After that He developed sever
pain & swelling of his right knee. He also complaints of
inability to walk or bear weight on his right lower limb for
same duration. Then he got admitted in NITOR.
5. History of past illness
He is normotensive, non Diabetic, non-Asthmatic. He
had history operation of his right lower limb for
multiple trauma 20 years back in NITOR but he could
not submit any documents regarding this.
6. On examination
General examination:-
Appearance: Anxious
Body built: Average
Nutrition: Average
Anaemia: Absent
Jaundice: Absent
Dehydration: Absent
Lynphnode: No palpable lymphadenopathy
Blood pressure: 130/80 mm of Hg
Pulse: 80 b/min
7. Systemic examination
CVS: No abnormality detected
Respiratory: No abnormality detected
Gastrointestinal: No abnormality detected
8. On Locoregional examination:
Look: Patient is found on braun bohler frame. Swelling
present at his right knee. Skin is intact .There are
multiple scar marks on medial and lateral aspect of
thigh and also lateral aspect of right hip.
Feel:
Temperature is normal.
Tenderness is present
Distal neurovascular status – Intact
After removing the traction left lower limb is found 1
cm shortened comparison to opposite lower
Move : Not elicited due to pain.
12. Diagnosis
11 days old post traumatic closed right sided distal
femoral fracture , AO type-33C3 with implant insitu in a
46 years old male patient following MVA.
13. UNIT PLAN
Removal of implant followed by internal fixation with
distal femoral locking plate.
