Bed Site Teaching

M. Fakhri Hamas
Preceptor: dr. Rizal Daulay, SpOT, MARS
Identification

Name: Charles Manurung

Age: 41 years old
Gender: male
Religion: moslem
Chief Complain

Lump on the right leg

Clinical History

3 years ago, he accidentally crushed his foot on the wall, then had a
lump on the right leg.
Size 1 cm, the color same as the skin.
because there is no complaints, the patient ignored the lump.
3 years, a lump enlarged so the foot is difficult to moved and
painful.
He was brought to the hospital, and X-Ray examination was
performed.
After the X-ray, the doctor suggest the patient to perform biopsy.
General State

General condition: good

Sensory: Compos Mentis
Vital sign:
Blood pressure: 120/70 mmHg
Pulse rate: 90x/minute
Resporatory rate: 21x/minute
Temperature: 36.5 C
Local State

Right leg region:

Look :
surgical scar (-), wound (+)
bleeding (-), skin loss (-)
bone expose (-), deformity (+)
lump (+), muscle atrophy (-)
discolouration (-), venectasia (+)
 Feel :
crepitation (-)
temperature warmer than the left side
Nervus (sensibility is good)
arterial pulse (+), capillary refill time < 2s)
muscle atrophy (-)
Move :
Active movement: limited
Passive movement: limited
Clinical photos
X-ray
 Alignment: in one line
Bone: discontinuity, periosteal reaction
Cartilage: dislocation (-)
Soft tissue: swelling (+)
 There's a nodule metastases of cancer
Laboratory

Hemoglobin: 13.6
Leukocyte: 10.200
Erythrocyte sedimentation rate: 42 (<10mm/hour)
Diffcount: 1/0/0/71/18/9 (1-2/0-1/3-5/53-62/25-33/3-7)
Clotting time: 7
Bleeding time: 2
HBS Ag: negative
Alkali Phospate: 102 (70-300)
BSS: 126
Anatomic pathology

The fibrocolagen change mixoid and chondroid and solid mass tumor was
found. Abnormal mitotic
Soft tissue tumor, malignancy progress cant be eliminated.
Assesment

Suspect Osteosarcoma
Planning

Symptomatic feature
Chemotherapy and radiotherapy
Palliative
Thank you