Extern conferenceortho-korat-22-12-60 Ext.ณัฐณิชา

1. Extern conference
EXT ณัฐณิชา ภัทรวิมลพร

2. Patient profile
ผู้ป่วยชายไทย อายุ 52 ปี อาชีพผู้ช่วยผู้ใหญ่บ้าน ภูมิลาเนา จ.นครราชสีมา(อาเภอเมือง)

3. Chief complaint
ตกจากกาแพงสูง 3 เมตร 3 hrPTA(11:30am 15/12/60)

4. Primary survey
A - Can speak clearly, full ROM of neck, not tender along C spine
B - Clear equal Breath sound both lung, Chest crepitation test - neg
C - V/S stable(BP = 126/75, HR = 114, RR = 20/min)
-> NSS IV load 500 ml -> BP = 114/78 HR = 97
D - E4 V5 M6, pupil 3 mm RTLBE

5. Primary survey
E - tender at Rt hip with external rotated position
- tender at Rt ankle and Rt calcaneous

6. Adjunct to primary survey
Chest X ray (AP)

7. Adjunct to primary survey
Film pelvis AP

8. Secondary survey
Allergy - No allergy to drug/food
Medication - No current medication
Past history - Unknown Underlying disease(ไม่ได้ตรวจ)
Last meal - 11:00am 15/12/60

9. Secondary survey
Event
- 3hr PTA ขณะเดินอยู่บนกาแพงสูง 3 เมตร ก้าวพลาด พลัดตกจากกาแพง เอาเท้าลง ส้นเท้าและสะโพกขวากระแทกพื้น ไม่ได้รับ
บาดเจ็บที่ศรีษะ/อก/ท้อง ไม่สลบ จาเหตุการณ์ได้ ไม่คลื่นไส้อาเจียน ปวดที่ส้นเท้าและสะโพกด้านขวา ขยับสะโพกขวาไม่ได้ ไม่มีแผล
เปิดที่เท้าและสะโพกด้านขวา ไม่ปวดหลัง สามารถขยับหลังได้ตามปกติ

10. Secondary survey
V/S BT = 37.0, BP = 124/80, HR 110, RR 20 bpm
GA A Thai man, alert, well oriented to time place person
HEENT No subconjunctival hemorrhage
Heart Normal s1 s2, no murmur
Lung CCT – neg, clear equal BS both lung
Abdomen Soft, not tender

11. Secondary survey
Extremities
 Rt Hip -flexion abduction and external roatate position
- marked tender at Rt hip
- limit both active and passive ROM due to pain
 Rt calcaneous - no open wound/deformity
- Marked tender

12. impression
1. Fall from height
2. Rt Subtrochanteric fracture
3. Rt calcaneus fracture

13. Adjunct to secondary survey
Film TL spine

14. Adjunct to secondary survey
Film TL spine

15. Adjunct to secondary survey
Film LS spine

16. Adjunct to secondary survey
Film LS spine

17. Adjunct to Secondary survey
Filp Rt hip lateral

18. Adjunct to Secondary survey
Rt femur lateral

19. Adjunct to Secondary survey
Rt ankle AP

20. Adjunct to Secondary survey
Rt ankle lateral

21. Adjunct to Secondary survey
Rt ankle mortise

22. Adjunct to Secondary survey
Rt calcaneus axial view

23. Adjunct to Secondary survey
CT Rt calcaneus with 3D reconstruction
>> comminuted intraarticular fracture
of Rt calcaneous

24. Diagnosis
1. Close fracture of Rt Subtrochanter
2. comminuted intraarticular fracture of Rt calcaneous

25. Management(Close fracture of Rt
Subtrochanter)
Set OR for ORIF with long Gamma nail

26. Film pelvis S/P ORIF with long Gamma
nail

27. Management(Close fracture of Rt
calcaneus )
•On Rt posterior long leg slab
•รอ Set OR for primary subtalar arthrodesis (combined with ORIF to restore height)

28. Subtrochanteric fracture

29. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

30. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

31. Subtrochanteric Fx : Anatomy

32. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

33. Subtrochanteric Fx : Mechanism of Inj
> younger patients : a high-energy mechanism
> older patient : a low-energy mechanism

34. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

35. Subtrochanteric Fx : Classification
Russel-Taylor Classification
> Type I : No extension into piriformis fossa

36. Subtrochanteric Fx : Classification
Russel-Taylor Classification
> Type II : Extension into greater trochanter with involvement of piriformis fossa

37. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

38. Subtrochanteric Fx : Treatment
Operative management >> ORIF with Intramedullary nail / fix angle plate

39. Subtrochanteric Fx : Treatment
Operative management >> ORIF with Intramedullary nail / fix angle plate

40. Subtrochanteric Fx : Treatment
Non Operative management >> observation with pain management
> can not tolerate surgery

41. Subtrochanteric fracture
1. Anatomy
2. Mechanism of injuries
3. Classification
4. Treatment
5. Complication

42. Subtrochanteric Fx : Complication
1. Malunion
2. Nonunion