Case 1

12

- bone osteolytic lesion head of femur(7/6/60)

ddx. infection or Malignancy

Or stress shielding wolfs law ( outline

cortex

- (2 ) , DM(?), 68
- DM ()
< 100, HbA1C <6.5
- arthrocenthesis
Ddx. 1. Septic arthritis
2. crystal induce arthritis
*
Dx. Post operation septic arthritis
-

prosthetic hip
- intertrochanteric fracture
 osteomyelitits +- septic arthritis osteolytic lesion CT
lesion involve joint
Tx.
adequate debridement + adequate ATB
improve implantation

1) ARB
2) Arthropasty
3) Resection arthropasty
- Dx , complication invest
complication ( CBC, , ESR, CRP ,
procalcitonin)
-
1. X-ray
2. U/S guide
3. CBC ESR CRP
4. Biopsy
- PCR
- C/S
- Tissue Patho
Case 2

-U/D : DM, RA (10 ) ,HT ( RA )

-RA involve C-spine hyperextension

spinal cord tube

- gluteus medius abduct

- subchondral bone free nerve ending involve nerve

cartilage nerve

- ()

2. ( joint space
)

lodcarf

r/o infection trauma

** limit of ROM congruency joint

- stiffness joint contracture

tendon muscle
- :
Dx. Primary hip

- Past history : trauma

- Ddx. Cause of arthritis AVN, OA
- RA OA hip
- : deformity
()
- PE
1. Power
0 , 1 tone, 2 horizontal, 3 gravity , 4 partial resistance, 5 full
2. Thomas test
3.
4. Flexion contracture
( flexor extensor f
stroke flexor lesion )
-


- Rt. Abdut 60 Lt 40

 lateral thigh

*** 1 (fracture femur) femur (
4 , 10
- morning stiffness
-
- RA medial malleolus