The document presents a case of a 25-year-old male named Badal who has experienced painless abnormal movement and difficulty bearing weight on his right leg for the past 10 months following a road traffic accident that resulted in an open fracture of the right tibia and fibula. Despite previous surgeries, including the application of an Ilizarov external fixator, he has developed a non-union of the right tibia. The management plan includes refreshing the fracture site and reapplying the Ilizarov ring external fixator along with fibulectomy and distal corticotomy.

1. Dr. Md.Saker
Phase B - resident
Pink –II
WELCOME TO MORNING
SESSION CASE PRESENTATION

2. Particulars of the patient:
• Name: Badal
• Age : 25 years
• Sex : Male
• Address: Comilla
• Date of admission : 20.11.2024
• Ward/Bed- EF-18

3. Chief Complaints :
• Painless abnormal movement of right leg for
10months
• Difficulty to bear weight on his right leg for same
duration.

4. History of present illness:
According to the statement of the patient,he was
reasonably well 3 years back. Then he got injured by
road traffic accident followed by injury to his right
leg. Then he was taken to emergency department of
NITOR where he was diagnosed as a case of open
fracture shaft of right tibia fibula (G-IIIB) and
treated with

5. Surgical toileting, wound debridement &
application of uniaxial external fixator. After
repeatative surgical toileting he was undergone
sural flap coverage & then split thickness skin graft
was given. Then he was discharged. After 8
months Ilizarov ring external fixator was applied
with proximal corticotomy.

6. After that the radiological evidence of union
ilizarov was removed about 7 month after the
application. But for last 10 months he complained
painless abnormal movement of right leg and
difficulty in walking with right leg for same
duration. Then he came to NITOR OPD & again
admitted in NITOR for further management.

7. • History of past illness: H/O RTA 3 years back
• Socio-economic status: lower socio-economic
condition, pt is smoker

8. • Appearance : Anxious
• Body built: Average
• Nutritional status: Average
• Anaemia : absent
• Jaundice: absent
Oedema : absent
• Dehydration : absent
• Blood presure: 130/80mm of Hg
• Pulse:76 beats/min
General examination:

9. Systemic examination
• Systemic examinations reveal no abnormality

10. Locoregional examinations:
Look:
• Scar mark present in right leg, right thigh
• Wasting of right calf muscle.
• No discharging sinus is present.

11. Feel:
• Local temperature- Normal
• Tenderness- Absent.
• Painless abnormal movement is present at right leg.
• Distal neurovascular status -Intact
• Limb length discrepancy- 2cm
• Calf muscle wasting-1cm

12. Latest X-ray film

13. Move
• Movement of the knee joint is normal
• Movement of ankle joint-slight restricted

14. Xray at 20.11.24

15. After application of ilizarov

16. After removal of ilizarov

17. Diagnosis:
10 months old non-union shaft of right tibia of
a 25 years old male patient

18. Unit Plan:
Refreshening of fracture site, application of
Ilizarov ring external
fixator with fibulectomy and distal
corticotomy.