Orthopedics Case Presentation

Guide- Dr.Akash sir

By- Tejaswini.S.R
A. Particulars of patient.
Name : Mr.XXX
Age : 75yr
Sex : Male
Occupation : Currently not working
Socioeconomic status : Lower middle class
Address : Manvi, Raichur.
Date of admission : 25-07-2020
Date of examination : 27-07-2020
B.Chief complaints.
Pain in right groin since 2 days.
Inability to walk since 2 days.
C.History of present illness.
Patient was apparently normal 2 days ago. Then he
complained of pain in right groin since 2 days. It is
sudden in onset,following fall in bathroom due to
slip.Pain localized to groin region,shooting type of
pain,non radiating which aggravates on movement of
the limb and relieves with rest.There is no history of
loss of consciousness following fall.
Patient also complaints of inability to walk since 2
days. It is sudden in onset following trauma.Patient
unable to move limb, if he attempts to do, there is
increased pain,and a sound patient was able to hear
after fall.
Patient has limitation in daily living activities like not
able to sit cross-legged, squatting not possible.

No history of long term use of steroids,anti epileptic

drug, Alcohol, multiple joint pains, no history of
constitutional symptoms such as loss of
weight,appetite,evening rise of temperature, fever.
D.Past history
No history of similar complaints in past.
Not a known case of diabetic
mellitus,hypertension.
No history of previous accidents, operation on
hip.
No history of tuberculosis, rheumatoid
arthritis, bleeding diathesis.
E.Personal history
Diet - Vegetarian
Sleep - Undisturbed.
Appetite – Good.
Bowel and bladder movements – regular
No history of addiction.
F.Treatment History
Not taken any treatment for present condition.
Not on any medication.
No H/o allergy to food and any drug.

G.Family history
No history of tuberculosis, joint disorders in
family.
 SUMMARY OF CASE

75 year old elderly male came with chief

complaint of pain in right groin and inability
to walk since 2 days, probably fracture
around hip.
 GENERAL PHYSICAL EXAMINATION

Here is an elderly patient heavily built, well nourished,

conscious,cooperative,well oriented to time,place and
person.

Vitals
Pulse Rate: 75bpm, normal rate,rhythm,volume,character,
no radio radial delay, no radio femoral delay.
Blood Pressure: 120/80 mm Hg in right arm.
Respiratory Rate : 18 cpm.
Temperature: 98.5 degree Fahrenheit.
No Pallor
No Icterus
No Clubbing
No Cyanosis
No Edema
No Lymphadenopathy
Height - 155 cm(since patient cannot stand
measured in supine posture)
Weight – 65 kg
BMI – 28.88 kg/m2
 Head to toe examination

Head – Normal.
Hair – Greyish, well distributed.
Forehead – Wrinkles present.
Eyes –Normal.
Ears –Normal.
Nose –Normal.
Face – Normal.
Oral cavity – Teeth –stained. Tongue – Coated, central, pinkish.
Lips and gums – normal, Palate – normal.
Throat – normal.
Neck – Trachea central.
Chest – Normal.
Upper limb – Normal.
Abdomen - flat ,umbilicus central in position
External Genitalia – normal.
 LOCAL EXAMINATION.
Done in supine position exposure from
xiphisternum to midthigh.
Gait : Patient unable to walk.
Attitude: The patient in supine position, with
lumbar lordosis, ASIS at same level, limb in
external rotation with the hip and knee in
flexion, ankle in plantar flexion, outer border
of foot not touching bed.
 INSPECTION:
1)Anteriorly .
ASIS level : Both ASIS at same level.
Level of patella : Right side slightly up.
No fullness in suprapatellar, parapatellar and
infrapatellar fossa.
No wasting in calf muscles.
There is apparent shortening of Right limb.
2)From side.

Exaggerated lumbar lordosis present.

Prominence of trochanter present.
No sacrs or sinuses.

3)From the back.

Spine central.
No wasting of gluteal folds.
 PALPATION.

Superficial Palpation : No local rise of

temperature, No tenderness.
Deep Palpation :
Tenderness present at Scarpas triangle at
midinguinal point.
1)Greater trochanter:
Bony tenderness present.
Supratrochanteric shortening present.
No irregularity, No thickening, No broadening.

2)Head of femur : Normal

Vascular sign of Narath : Bilateral femoral pulse
palpable.

3)Telescopic test : Not able to elicit due to pain

4)Active straight leg raising test : Not possible.

 Movements

Right Left
JOINT MOVT ACTIVE PASSIVE ACTIVE PASSIVE
HIP- Flexion Not done due to 60 120 120
pain
Extension - 5 30 30
Abduction - 20 45 45
Adduction - 10 30 30
Medial/Internal - 5 45 45
rotation
Lateral/External - 30 45 45
rotation

KNEE – Flexion 20 40 135 135

Extension 0 0 0 0
ANKLE- Plantar - - 40 40
flexion

Dorsiflexion - - 10 10

Inversion - - 20 20

Eversion 8 10 10 10
 Deformity Assessment.
No deformity present in coronal,sagittal,axial
plane.
 MEASUREMENTS

• 1)Linear measurement:
Right Left

Apparent 99cm 100cm

length
True length 73cm 74cm
2)Segmental measurement:
Brayants triangle : Shortening of 1cm present in
right side.
Nelaton’s line :Upward displacement of greater
trochanter present.
Schoemaker’s line :Cross midline below
umbilicus.
Morri’s bitrochanteric test : Both side distances
are not equal.
Chiene’s test :Two lines converge.
3)Circumferential measurement:

Right Left
Quadriceps level 55cm 55scm
Calf level 38cm 38cm

There is no quadriceps and calf muscle wasting.

Conclusion: Supratrochanteric shortening.
EXAMINATION OF INGUINAL LYMPH NODES :
Normal.
SYSTEMIC EXAMINATION
Respiratory System: Normal vescicular Breath
Sounds Heard.
Cardiovascular Examination : S1,S2 heard.No
murmur.
Central Nervous system :Conscious,coopertaive.
Per abdomen : Soft,non tender.
Final Diagnosis.

75 year male with Right intracapsular fracture

probably involving neck of femur without any
complications.
Investigations.
X ray of pelvis with both hips AP and lateral
view.
Routine CBC.
Chest X ray.
ECG.
 Treatment.
Hemiarthroplasty or Total hip replacement.