Ortho ธมลวรรณ
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This document summarizes an extern conference case involving a 74-year-old female patient who presented with left thigh pain after her leg was pinned under a motorcycle. On examination, she had tenderness and limited movement of her left leg. X-rays revealed a closed fracture of the left femoral neck. The fracture was classified as Garden type 4, indicating a complete displacement. Given the patient's age of over 65, the recommended treatment was arthroplasty to restore hip function and allow rapid mobilization, while minimizing discomfort. Complications of this type of injury can include blood clots, bone death, and non-healing of the break.
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This document describes an elderly Thai woman who fell and injured her left hip. She was unable to walk after the fall. Physical examination found shortening and external rotation of her left leg with tenderness over the proximal thigh. Imaging showed an intertrochanteric fracture of the left femur. She was admitted and placed on skin traction. Surgical treatment options for this type of hip fracture include dynamic hip screw or intramedullary hip screw depending on fracture stability. Complications can include implant failure, perforation of the distal femur, nonunion, or malunion.
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- She was placed in a thumb spica cast to immobilize the fracture.
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- Treatment options include casting or surgery depending on the fracture type and degree of displacement. The goal is to restore the elbow
Case conference extern ortho ed1
This case conference discusses a 48-year-old Thai man who presented to the hospital after falling and injuring his right hip. On examination, he had tenderness and swelling of the right hip and thigh with limited range of motion due to pain. X-rays revealed a closed fracture of the right femoral neck. The attending physician provided a provisional diagnosis and treatment plan involving admission, skin traction, pain medication, and monitoring. The discussion then reviewed femoral neck fractures, including risk factors, mechanisms of injury, imaging, classifications, complications, and treatment options such as internal fixation, hemiarthroplasty, or total hip arthroplasty.
Ortho
A 19-year-old Thai male presented to the emergency room after his motorcycle was hit by a car. He reported left knee pain for 30 minutes. On examination, he had a 4x6cm laceration wound on his left knee with exposed bone and active bleeding. Imaging showed an open left patellar fracture. He was diagnosed with an open left patellar fracture and treated empirically with antibiotics. He underwent debridement and tension band wiring in the operating room.
Nearly amputation extern conference
This document describes the case of a 13-year-old Thai boy who was in a motorcycle accident, resulting in a near amputation of his left index finger. Upon initial examination, he was conscious and coherent with a laceration on his left eyebrow and active bleeding from his injured left index finger. X-rays showed no fractures. He was referred to another hospital, where he underwent surgery to close the stump of his amputated left index finger. The document then provides definitions, classifications, and management guidelines for traumatic finger amputations.
Extern.con.anklefx.chaipat
- 17-year-old Thai female presented to the hospital with right ankle pain and swelling after twisting her ankle 3 hours prior while playing football.
- Physical examination revealed swelling and tenderness of the right ankle which was held in plantarflexion. X-rays showed a bimalleolar fracture of the right ankle.
- Bimalleolar fractures involve fractures of both the medial and lateral malleoli. Non-displaced fractures are typically treated conservatively with immobilization while displaced or unstable fractures require open reduction and internal fixation surgery followed by non-weightbearing and rehabilitation.
Ext.conference..
1. An 82-year-old Thai man presented to the emergency room with right knee pain for 3 hours after tripping and falling on his right knee.
2. Examination found marked swelling and tenderness of the right knee with a palpable patella defect and joint effusion. X-rays showed a closed comminuted fracture of the right patella.
3. The patient was diagnosed with a closed comminuted fracture of the right patella. His treatment plan included immobilization with a cylindrical slab and observation for compartment syndrome, with plans for open reduction and internal fixation using a tension band construct.
Noon conference hangman
A 35-year-old man fell and hit the back of his head on the ground after drinking alcohol. He was brought to the emergency room 4 hours later with pain in his head and neck. On examination, he had a 2 cm laceration on the back of his skull but was neurologically intact. Imaging showed a hangman's fracture. He was placed in a hard cervical collar, the wound was sutured, and he was started on skull traction and a Philadelphia collar for the hangman's fracture.
Extern conference ortho
This document describes the case of a 69-year-old Thai man who presented to the emergency department with right thigh pain after falling 1.5 meters from the roof of his house. On examination, he had swelling and tenderness of the left thigh with limited range of motion. Radiographs revealed an intertrochanteric fracture of the left femur. Intertrochanteric fractures occur between the greater and lesser trochanters and are common in elderly patients, often resulting from low-energy falls. Treatment depends on the stability of the fracture but may involve internal fixation with screws or cephalomedullary nails. Complications can include malunion, nonunion, and loss of fixation.
Ortho con
1) A 14-year-old boy was in a motorcycle accident where his left hip hit the ground, causing left hip pain and deformity.
2) Examination and x-rays revealed a posterior dislocation of the left hip.
3) The patient was taken to the operating room for closed reduction of the hip dislocation under general anesthesia with skeletal traction.
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- 1. Extern Conference Extern Thamolwan Padthaisong
- 2. Case : ผูปวยหญิงอายุ 74 ป U/D HT, DLP HN 545148 •Chief complaint : ปวดตนขาซาย 5 ชั่วโมง PTA •Present illness : 5 ชั่วโมง PTA นั่งครอมรถ MC เอื้อมมือกําลัง ปดประตูบานแตเสียหลักรถลมทับขาขางซาย ปวดบริเวณตนขา ซายมากราวไปตนขา ไมสามารถยืนเดินได ไมมีขาชา ไมมี ศีรษะกระแทกพื้นหรือหมดสติ
- 3. Primary survey •A : Patent airway, no stridor, no posterior cervical tenderness •B : Equal chest expansion, trachea in midline, equal breath sound both lungs •C : BP 126/84 mmHg , PR 80 bpm, no external bleeding, no pelvic tenderness or ecchymosis, abdominal soft not tender •D : E4V5M6, pupils 3 mm RTLBE •E : External rotation at left leg , no swelling and ecchymosis PR – normal sphincter tone, yellow feces
- 4. Secondary survey •A : No history of allergy •M : Current medication : ASA(81) 1x1, HCTZ(25)1x1,simvas(40)0.5xhs, enaril(5)1x2 •P : Underlying disease ; HT, DLP •L : Last meal 14.00 •E : As above
- 5. Head to Toe Evaluation •Vital signs : BT36.5 c, PR 80 bpm, RR 14/min, BP 126/84 mmHg •GA : Good consciousness, not pale •HEENT : no pale conjunctivae, anicteric sclerae, no subconjunctival hemorrhage, no evidence of head trauma, no contusion •Lungs : Equal chest expansion, equal breath sound, no accessory muscle use, both lungs clear •CVS : JVP not engorged, pulse full and regular, capillary refill < 2 sec, normal S1S2, no murmur
- 6. Head to Toe Evaluation •Abdomen : No distention, soft, not tender, normoactive bowel sound, no rigidity, no guarding, no rebound •Extremities : External rotation at left leg, anvil and rolling test positive, capillary refill < 2 sec, DPA 2+, PTA 2+ •Neuro : Good consciousness, well cooperated, good orientation to time/place/person •Motor : Grade V all extremities except left leg due to pain •Sensory : Normal sensation to pain, temperature and fine touch
- 8. Investigation : Film Xray •Both hip AP •Left hip AP ,Lateral
- 10. Dx : Closed fracture left femoral neck
- 11. Anvil test Rolling test
- 12. Femoral neck fracture Shenton’s line
- 15. Stage I : incomplete fracture of the neck
- 16. Stage II : complete without displacement
- 17. Stage III : complete with partial displacement
- 18. Stage IV : this is a complete femoral neck fracture with full displacement
- 19. Treatment Goal •Minimize patient discomfort •Restore hip function •Allow rapid mobilization
- 20. Treatment Nondisplaced or garden type 1&2 •Non-operative treatment : bed rest , traction •Internal fixation Displaced or garden type 3&4 •Age < 65 : internal fixation •Age > 65 : arthroplasty