Orthoconference
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A 29-year-old male presented to the emergency department with a gunshot wound to the right hand sustained 3 hours prior. On examination, the patient had a 2cm open wound on the dorsal side of the right hand with swelling and tenderness. X-rays showed a comminuted fracture of the third metacarpal bone with a retained foreign body. The patient was admitted for debridement surgery, removal of the foreign body, and fixation with K-wires under antibiotic treatment.
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Ortho..
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Extern.con.anklefx.chaipat
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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.
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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.
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Orthoconference
- 2. Hx • Case :29 • CC : 3 hr PTA
- 3. Primary survey • A : pass • B : pass • C : pass • D : pass
- 4. Secondary survey • A : • M : • P : no U/D • L : 12.00. , 20.00. • E : 3 hr PTA 1
- 5. Physical examination • V/S : BT37 , BP125/77 , PR 80 , RR16 • GA : good consciousness , well cooperated • HEENT : not pale conjunctivae • Heart : normal s1s2 , no murmur • Lungs : clear both lungs • Abdomen : soft not tender
- 6. Physical examination • Right hand : marked swelling , LW. size 2cm. at dorsal site,no active bleeding, tender , limit ROM of wrist due to pain , neurovascular intact , capillary refill < 2sec.
- 9. Problem list • GSW size 2 cm. right hand with retained foreign body
- 10. Investigation • Film X-ray right hand AP,lat,olique
- 14. Impression • Opened comminuted fracture of right 3rd metacarpal bone of right hand with retained foreign body
- 15. Initial management • ATLS protocol • tetanus toxoid • local wound care : irrigate NSS + dressing wound • adequate pain control • immobilization • refer
- 16. Management • NPO • Admit • Antibiotic : cefazolin + gentamycin (Gustilo lllA) • 5% DN/2 1,000 ml IV rate 80 ml/hr • Set OR for debridement + K-wire fixation + remove FB • Pain control • Post-op : short arm volar slab