Case 1: A female patient presented with left thumb pain after being hit by a metal bar. X-rays showed a suspicious thumb fracture but the patient could not be contacted. The exam lacked details to properly identify any fractures or dislocations. Case 2: A male patient was in a motor vehicle accident and presented with pain in his left shoulder, right wrist, and left ankle. X-rays revealed suspicious fractures that were not properly documented by the medical officer. Communication between orthopedics and medical staff needs improvement. Case 3: A male adolescent presented with left hip pain after a motor vehicle accident. X-rays showed

1. RADIOLOGY CONFERENCE ETD
HOSPITAL SULTANAH NORA ISMAIL
19/58/2022

2. Case 1
• Mdm RAR
• 52/M/Female
• Presented to ETD on 21/08/2022
• Alleged hit by metal bar 2 weeks ago while working
• Her left thumb hit directly to the metal, complained
pain over left thumb
• o/e: tender over left thumb, ROM full, no neurological
deficit
• Imaging studies: left hand
• Patient was discharged from ETD on 21/8/22.
• Xray reporting noted suspicious fracture, however
patient unable to be contact.

3. Discussion
• Due to details examination of physical findings
is not being justified and properly
documented, therefore missed fracture/
dislocation over carpal bone was unable to
identify.

4. Case 2
• Mr MS
• 29y/o/ M/ Male
• Presented to ETD on 05/08/2022
• Alleged MVA (MVA) MB skidded. He tried to overtake
another MB, brake suddenly and he was thrown forward and
landed on his left shoulder.
• C/o pain over left shoulder, right wrist and left ankle
• o/e: GCS 15,
• loss of left clavicle prominence, tender, ROM of left shoulder
limited
• Right wrist: ROM limited, CRT< 2sec, good PV
• Left ankle: swollen, deformed, limited ROM, DPA/ PTA
palpable

5. • Imaging studies: Left shoulder, right wrist, left ankle,
left foot
• Pt was refused for below elbow backslab i/v/o
transportation issues, AOR discharge from ETD on
5/8/2022.
• Xray reporting suspicious fracture
• Able to contact his mother next morning for
treatment, the mother will inform pt to return for
treatment and continue his old TCA on 5/9/2022 at
KP2.

6. Discussion
• To improve communication between
Orthoman and Medical officer/ House officer
regarding pt’s fracture and best of care for
patient
• X-ray findings identified by Orthoman,
however no proper documentation by
Medical officer regarding 2nd opinion by
Orthoman.

11. Case 3
• MR MHG
• 14y/o/M/Male
• Presented to ETD on 07/08/2022
• Alleged MVA (MB skidded) , fall over left side
• c/o pain over left hip, still able to stand up post fall.
• o/e: limited ROM over left hip, able to weight bear with
pain
• Imaging studies: Pelvic xray, left hip
• Patient was discharged from ETD on 07/8/2022.
• Xray reporting noted avulsion fracture
• Patient was called back and he returned to ETD for further
management.

12. Discussion
• Missed fracture by medical officer

16. Case 4
• Mr MAP
• 85y/o/M/M
• Presented to ETD on 21/7/2022
• NKMI, ADL semi dependent, vaccinated x3.
• c/o
• generalised body weakness x 2/7
• poor oral intake
• urinary incontinence
• o/e: E2V1M5, tachypenic, RR 26
• Lung: creptitations bilateral

17. Discussion
• Patient was admitted from 21/7/22- 7/8/22
• COVID19 Stage 5A -> post covid syndrome
• TRO pleural disease
• Cover for superimposed bacterial
• As family members opted DNR and AOR discharge, no
further investigations done TRO pleural disease

18. Case 5
• 69y/M/Female
• u/l DM, HPT, IHD, CCF
• Came to ETD at 27/4/2022
• c/o
• shortness of breath x2/7
• fever x2/7
• presyncopal attack x 1/7
• cough x4/7

19. • o/e: E4V5M6, tachypneic
• Lungs: bibasal crepitations
• CVS: DRNM
• PA: soft, non tender
• No pedal edema
• ECG: SVT, HR 221 —> Given IV Adenosine
• Repeated ECG: Atrial flutter

20. • patient was admitted from 27/4/22- 12/5/22 for
• NSTEMI with recurrent SVT
• Pneumonia
• TRO Lung/ mediastinal mass
• done CTPA & HRCT thorax on 10/5/2022
• Pt was discharged well with early TCA MOPC
for lung function test and early TCA cardio HSA