- The patient is a 20-year-old female housewife who presented with 11 months of right wrist pain and difficulty performing daily activities for the past 10 months. - She fell from a first floor height 11 months prior, landing on her outstretched right hand and sustaining a distal radius fracture, which was treated conservatively. - On examination, she had prominence of the right ulnar head, muscle wasting of the right hand, tenderness over the wrist, and positive tests indicating distal radio ulnar joint instability. Imaging confirmed a post-traumatic distal radio ulnar joint instability with triangular fibrocartilage complex injury on the right side.

1. Morning Case Presentation
Dr. Md. Rajib mahmud
Resident (Phase - B)
Yellow unit-1
Orthopaedic Surgery , BSMMU

2. Particulars of the patient:
• Name : Jannatul ferdous
• Age: 20 years
• Sex: Female
• Occupation: Housewife
• Address: Chatkhil , Noakhali
• Date of admission: 06/04/22
• Date of examination: 07/04/22
• Right hand dominant

3. Chief Complaints :
• Pain in the right wrist joint for 11 months
• Difficulty in daily activities for last 10 months

4. History of present illness:
• She was reasonably well 11 months back with history of 3 months
pregnancy.
• Then she had a history of fall from height (1st floor) on
outstretched hand and developed severe pain and swelling over
right wrist joint and she was diagnosed as a case of closed fracture
of distal radius (right) for which she was treated at local hospital
conservatively with LABS which was removed after 4 weeks.
• After that she noticed pain over the right wrist joint which was
mild to moderate in nature , aggravated with movement of the
joint during activities and relieved by taking rest and analgesics.

5. History of present illness (Cont):
• She also complained of difficulty in daily activities with her
right hand for 10 months which was gradually worsening for
last 4 months
• She gave no history of other joint pain, cough, hemoptysis,
weight loss, and other constitutional symptoms.
• With these complaints she has got admitted into BSMMU
for better management.
• She is normotensive and non diabetic and her bowel &
bladder habit is normal.

6. History of past illness: Nothing significant
Pregnancy History : para-1 , gravida-1 ,
age of last child- 4 months(BOY)
Immunization History : immunized as per EPI
Socio-economic History : middle class

7. General Examination:
• Appearance : anxious
• Body built: Average
• Anemia: Absent
• Jaundice: Absent
• Dehydration : Absent
• Edema : Absent
• Body weight : 50 kg
• Temperature: 98.5’F
• Pulse: 68 b /min
• BP: 120/80 mm Hg
• Respiratory rate : 18/min
• Lymph nodes : not palpable
Systemic examination:
• No abnormality

8. Look:
 Prominence of the ulnar head (right).
 Apparent muscle wasting present over
right hand (hypothenar)
 Skin condition: normal, no engorged
vein ,no scar mark, no discharge.
Loco Regional Examination:

9. Feel:
 Local Temp: normal
 Local Tenderness: Present
 Muscle wasting : over hypothenar
eminance
 Distal neurovascular status: Intact
 Foveal sign : present
 Press test : positive
 Ballottement test : positive
 Piano key sign : positive
Stability : unstable distal radio ulnar joint

11.  ROM of right shoulder , elbow ,MCP, DIP ,PIP joint found
normal
 ROM of right wrist:
Supination-75°
Pronation-60°
Move:

12. Radiology:
AP and
Lateral
view

13. Radiology:
MRI

14. Diagnosis:
A case of 11 months old post traumatic DRUJ
instability with TFCC injury (right side) of a 20 years
old right hand dominant female .

15. Unit Plan:
Anatomic Reconstruction of Distal
Radio Ulnar Ligaments (TFCC)
(ADAMS and BERGER procedure)