case presentation for upper &lower limb fracture

1. CASE PRESENTATION
On upper limb Fracture And lower
limb Fracture

2. CASE OF FEMUR FRACTURE
PATIENT DETAILS:
• A 74 year old female.
• History taken from patient and her son
PRESENTING COMPLAINTS:
• Alleged h/o self fall in bathroom due to slip followed by which patient
had difficulty in walking and pain ,redness,swelling in the left hip
area.

3. H/O PRESENT ILLNESS:
• Apparently alright one day back ,h/o fall and developed pain ,swelling
and inability to move left hip
• No h/o giddiness/syncope/seizure/sweating/headache before falling
• No h/o head/chest/abdomen injury
• No h/o loss of consciousness/vomiting/ENT bleed.
• Patient was able to do her daily routine activity on her own before
the fall
• No h/o recent chest infection / covid 19 infection

4. PAST HISTORY:
• Hypertention since 8 years
• No other comorbid illness like DM/IHD/COPD/EPILEPSY etc.
• No h/o drug allergy
• h/o tubal ligation at 35 years of age under spinal anaesthesia and
recovery was uneventful

5. TREATMENT H/O:
• On tab . Amlodipine 5mg BD
• No h/o blood transfusion
PERSONAL H/O:
• Normal bowel and bladder habit
• Normal sleep pattern
• Mixed diet
• Married since 55 year
• Post menopause
FAMILY HISTORY:
• No relevant family history

6. GENERAL EXAMINATION:
• Moderatly built and nourished
• Approximate weight 45- 50 kg and height 153cm ,BMI 23kg/m2
• Conscious and oriented to time ,place,person
• No pallor/icterus/clubbing/cyanosis/generalized LN pathy/pedal
oedema
• Hair /skin/nail- normal .No bed sores
• Jvp not raised
• Venous access- present and adequate

7. VITAL EXAMINATION:
• TEMP-afebrile
• PULSE-right upper limb 78 beats /min,regular,normal volume,no
radio-radial or radio-femoral delay ,no pulse deficit,All peripheral
pulses palpable
• BP-138/80mm of Hg in left upper limb ,supine position
• RR-16breaths /min abdominothoracic,normal indepth
• SPO2- 98% at room air

8. AIRWAY ASSESSMENT:
• No obvious facial deformity
• Edentulous with removable artificial denture
• Mouth opening >3 finger
• MPC – 2
• Thyromental distance >6.5cm
• Hollow cheeks,neck movements not restricted

9. LOCOMOTOR SYSTEM:
• patient in supine postion arms by side
• Traction with sand bag on left lower limb
• Redness,swelling over left hip joint
• No open wounds or bleeding
• Tenderness,local rise of temperature and inability to move left hip
joint
• Patient was able to move joints of all other three limbs

10. SYSTEMIC EXAMINATION:
CVS-
• S1 S2 heard normal , no murmur,
RS-
• Trachea centrally placed.
• AEBE clear with no added sounds.
ABDOMEN-
• Umbilicus centrally place,
• Abdomen soft non-tender, not distended,
• No organo-megally on palpation
CNS-
• Higher mental functions were normal, no sensory or motor deficits,
• All the deep and superficial reflexes were normal,
SPINE EXAMINATION
• NORMAL dorso-lumbar curvature

11. • 74year old female ,k/c/o hypertention on tab amlodipine 5mg bd with
s/p tubal ligation,with left hip trauma posted for total hip
replacement .
SUMMARY:

12. CASE OF UPPER LIMB FRACTURE:
Presenting complaints-
-A31 yr old male ,resident of lower parel came with chief complaints of
left forearm pain and swelling since 4days

13. History Of Present Illness
• Patient was apparently alright 4 days back .
• A/H/O fall on left upper limb in the house on wet floor 4 days back
and sustained injury to left forearm.
• No history of giddiness,loss of consciousness , vomiting , seizure,ENT
bleed.
• no history of head or chest or abdominal trauma .

14. Past medical history
No history of
• DM, HTN, IHD, COPD , Asthma,Diabetes,Epilepsy,stroke,TB,bleeding
disorder
• Patient was not on any medication
• There is no history of allergy.

15. Surgical history
• No surgical or anesthetic history .
Drug history
He was not on any medication.

16. Family history
• No significant family history
Personal history
• mixed diet
• normal sleep,bowel and bladder habits
• No history of alcohol or drug abuse .
• No history of smoking.
• Married since 3 years

17. General examination
• moderately built and nourished
• Approximate weight 60kg and height 164cm,BMI 22KG/m2
• Conscious oriented to time place and person and comfortable
• No pallor, cyanosis, clubbing, icterus , edema, or lymphadenopathy
VITAL SIGNS:
• Pulse- right upper limb 84beats /minute regular, normal volume , no radio-radial delay
or radio-femoral delay,no pulse deficit.All peripheral pulses felt.
• BP- 124/68 mmHg.in right upper limb , supine position
• Temp-afebrile.
• RR- 16 breaths per minute regular abdominothoracic ,normal indepth
• Spo2-98% at room air

18. Local examination
• Swelling over the dorsal aspect left forearm
• Multiple small abrasions +,No change in skin colour ,
• No Deformity seen
• able to move fingers,painful and restricted thumb movements
Palpation-
• tenderness+
• Crepitations +
• Sensation +
• Pulse- palpable
• ROM-Painful and ,restricted thumb abduction and opposition
• Capillary refiling time < 3 sec suggestive of no vascular compromise.

19. Airway examination
• No obvious facial deformity
• Mouth opening > 3 fingers
• Mallampati grade- 2
• Thyro-mental distance more than 6.5 cm
• Adequate movement of neck
• Slux +1
• Teeth -normal

20. Systemic examination
CVS-
• S1 S2 heard normal , no murmur,
RS-
• Trachea centrally placed.
• AEBE clear with no added sounds.
ABDOMEN-
• Umbilicus centrally place,
• Abdomen soft non-tender, not distended,
• No organo-megally on palpation
CNS-
• Higher mental functions were normal, no sensory or motor deficits,
• All the deep and superficial reflexes were normal,
SPINE EXAMINATION
• NORMAL dorso-lumbar curvature

21. Provisional Diagnosis-
• 31 year male without any co morbid illness,with trauma to left
forearm without any neurovascular compromise
• X-ray left forearm s/o radius fracture
• posted for open reduction and internal fixation with plating .