IT FRACTURE CASE femur.pptx case discussion

1. CHIEF COMPLAINTS
• PAIN IN RIGHT HIP SINCE 3 HOURS .
• INABILITY TO BEAR WEIGHT SINCE THEN .

2. HISTORY OF PRESENT ILLINESS
• Patient was bought to casualty on stretcher with alleged
history of slip and fall on road at 03:00 PM at ramannapet
and sustained injury to right hip .
• Pain – Sudden onset
Sharp shooting type
Continuous
Aggravated by movements.
• Patient was unable bear weight / walk since then .

3. • No history of,head injury ,Loss of consciousness , ENT bleed,
Seizures, Vomitings .
• K/C/O pulmonary tuberculosis, on Medications since
5months
1) ATT
2) TAB BENADON 40MG PO od
• Not a K/C/O of DM,HTN, CAD, CVA, ASTHMA .

4. PAST HISTORY
• No similar complaints in past.

5. PERSONAL HISTORY
Diet : Mixed
Appetite: Normal
Bowels and Bladder : Normal
Addictions : Smoker for 20 years,stopped 20years
ago
Occasional Alcoholic,stopped 2years ago
Sleep : Adequate

6. GENERAL EXAMINATION
• Patient is Moderately built and Nourished with PALLOR, No
Icterus , Cyanosis , Clubbing , Lymphedema .
VITALS
TEMP : 98.4 F
PR : 88/MIN
RR : 14/MIN
BP : 130/90 mm hg
Head to toe revivals no Other injuries.

7. Local examination of right Hip
INSPECTION :
No exaggerated Lumbar Lordosis
ASIS appeared to be same level.
Supra trochanteric Hollowness Distorted .
Foot in External Rotation & touching the couch .

8. PALPATION :
• No Local Raise in Temperature .
• Tenderness Present ,Diffuse Around Left Hip .
• Crepitus Present.
MOVEMENTS:
Attempted Movements of Hip are painful and Restricted.
Distal Pulses – felt
Sensations - Intact

9. Provisional Diagnosis
PERTROCHANTERIC FRACTURE OF RIGHT FEMUR

10. RADIOLOGICAL DIAGNOSIS
Right Displaced intertrochanteric femur fracture.

11. FINAL DIAGNOSIS
RIGHT CLOSED DISPLACED INTERTROCHANTERIC FRACTURE
.( BOYD AND GRIFFIN TYPE 2 ) without DNVD

12. INVESTIGATIONS
8/4/2024 14/4/2024 16/7/2023
17/7/2023
• HB : 10.2 gm/dl 7.5gmdl 8.8gm/dl
10.4gm
• Total Counts : 8900 cells/cumm
6500cells/cumm
• Neutrophils : 62%
50%
• Lymphocytes : 28%
30%
• Eosinophils : 02%
05%

13. • Blood Group : B POSITIVE
• BT : 2MINS
• CT : 4MINS
• APTT : 32 SECS
• PT : 15 SECS
• INR : 1.11

14. • RBS - 132 mg/dl
RFT
• Blood urea : 24 mg/dl
• Serum Creatinine : 1.1mg/dl
• Uric acid : 5.1 mg/dl
• Serum Ca : 9.1mg/dl
Serum Phosporus : 2.8mg/dl
Serum sodium : 140mmol/L
Serum Potassium : 3.7mmol/L
Serum Chloride : 105mmol/L

15. LFT:
• T. Bilirubin : 0.80 mg/dl
• D.Bilirubin : 0.19 mg/dl
• AST : 28IU/L
• ALT : 11IU/L
• ALP : 172 IU/L
• Total Proteins : 5.8 gm/dl
• A/G Ratio : 1.36
• Albumin : 3.34gm/dl
Serology Negative

16. INTIAL TREATMENT
• Lower limb was stabilized with skin traction (4 kg weight )
•TAB PCM– 650mg po/TId
•Active Toe and Ankle movements advised .

17. • pulmonology opinion ---ATT Continue as per NTEP
(9/4/2024 ---TAB BENADON 40MG po /od
---neb with budecort and duolin (sos)
• PAC --- review PAC in View of low Hb
(10/4/2024)

18. • Post operative blood transfusion done on 15/04/2024 & 16/04/2024.
• During and post transfusion vitals are uneventful .
• Post operatively patient was treated with iv antibiotics , later
converted to orals on pod 5.
• Regular ASD done on pod 2,pod5,pod 10.
• Wound is healthy , no gaping or discharge seen from surgical site .
• Complete suture removal done on pod 10.

19. • Patient discharged on POD 10.
ADVICE AT DISCHARGE:
1. T. CEFTAS CL 200mg po/bd x5 days
2. ATT as per NTEP (2 tab per day ) to continue .
3. T.BENADON 20 MG PO od to continue
4. T. DOLO 650mg po/bd x 5days
5. T. PAN 40 mg po/od x 5days
6. T. QUADRIS 7 po /od for 14 days
7. T.LIMCEE 500mg po od for 14 days .
8. T.OROFER XT po/od for 14 days.
9. Non weight bearing till further orders.
REVIEW AFTER 2 WEEKS TO ORTHOPEDIC OP .

20. THANK YOU