Welcome to Morning

session

Presented by-
Dr. Shaker Ahmed
MS Resident (Phase-B)
Unit - II
Department Of Orthopaedic Surgery
DMCH
 Particulars of the patient

Name : Mr Rohmot Ali

Age : 22 years
Sex : Male
Address :Uttara, Dhaka
Date of admission : 26.12.2022
Date of examination : 15.01.2023
Ward : 101
Bed : 11
Reg no. : 26405/25
History sheet
History sheet
 Chief complaints

• Pain and swelling in the left upper thigh for 22 days following fall
from height.

• Inability to stand and bear weight on left lower limb for the same
duration.
 History of present illness

According to the statement of the patient, he was well 22 days back. Then
he sustained trauma following fall from height and developed pain &
swelling in the left upper thigh. Initially, pain was severe, localized,
constant, non-radiating, aggravated by any sorts of movements and
partially relieved by taking some analgesics and rest.
 History of present illness

He also complained of inability to stand and bear weight on left lower

limb since trauma. Patient also give history of pain and swelling in the
different sites of face following trauma. With these complaints, he
attended to the DMCH orthopedic emergency department and got
admitted to Orthopaedic unit- II for further management. His bowel and
bladder habits are normal. He is normotensive, non-diabetic and non-
asthmatic.
Past history : Nothing contributory.

Treatment history : Nothing contributory.

Drug history : Nothing contributory.

Allergic history : No known drug or food allergy.

Personal history : Nothing Contributory.

Immunization history : Immunized according to EPI schedule

and vaccinated against COVID 19.

Socioeconomic status : Belongs to poor socioeconomic status.

 General examination

Appearance : Anxious

Body build : Average

Decubitus : Supine

Anemia : Present

Jaundice : Absent
 General Examination

Dehydration : Absent

Pulse : 88 beats/min

Blood pressure : 110/70 mm of Hg

Temperature : 98.6° F

Respiratory rate : 18 breaths/min

 Systemic examination

Cardiovascular systems : No abnormalities

Respiratory system : No abnormalities
Gastrointestinal system : No abnormalities
Genitourinary system : No abnormalities
Nervous System : No abnormalities
 Loco regional examination

Patient is supine on bed and left lower limb immobilized by upper tibial
skeletal traction with 7. 5kg weight. After removal of weight-
Look:
• Left lower limb is externally rotated.
• Apparent shortening of the left lower limb in comparison to the right.
• Mild diffuse swelling present over the left upper thigh and different sites of
face(middle part of nose, left side of the mandible).
• Overlying skin condition of left lower limb is normal & multiple healed
abrasion marks present on face.
 Cont..
Feel:
Temperature : Normal
• Tenderness : Present over proximal part of left thigh and different sites
of face( middle part of nose, left side of the mandible).
• Limb length discrepancy : 1.50 cm shortening of the left lower limb in
comparison to the right which is femoral component and infra-
trochanteric.
Distal neuro-vascular status : Intact
 Cont.

Move:

• Movements of left hip and knee joints could not be elicited due to
pain.

• Left ankle and right lower limb have full range of movements(ROM).
 Salient features

22 years old male, hailing from Uttara, Dhaka presented to us with

complaints of pain and swelling over the left upper thigh for 22 days
following fall from height. Initially, pain was severe, localized, constant,
non-radiating, aggravated by any sorts of movement and partially relieved
by taking some analgesics and rest.
 Cont…

He also complained of inability to stand and bear weight on left lower

limb for the since trauma. His bowel or bladder habits are normal. He is
normotensive, non-diabetic and non-asthmatic.

On general examination, patient is non-icteric but mildly anaemic and

all of the vital parameters are within normal limit.

Systemic examinations reveal no abnormality.

 Cont…
On loco-regional examination, the left lower limb is externally rotated.
Mild diffuse swelling present over the left upper thigh and different sites
of face. Left lower limb is apparently shorter than right. Overlying skin
condition is normal. Local temperature is not raised. Tenderness is
present over proximal part of left thigh and different sites of face. There is
1.50 cm shortening of left lower limb in comparison to right, which is
femoral component and infra-trochanteric. Distal neurovascular status is
intact. Movements of the left hip and knee joints could not be elicited
due to pain. All other joints of both lower limbs have full ROM.
 Provisional diagnosis

A case of 22 days old closed fracture shaft of proximal femur (left)

with facial injury in a 22 years old male.
X-rays on 26.12.2022
X-rays 26.12.22
X – rays on 04.01.23
x-rays on 13.01.2023 with traction
X-rays left knee and lumbosacral spine
CT scan of facial bone with 3D reconstruction view
 Laboratory Investigations

Hb % : 10.90gm/dl
RBS : 5.90 mmol/L
S. Creatinine : 1.12 mg/dl
S. Electrolyte : Within normal limit
• HIV 1 & 2 : Negative
 Laboratory Investigations

• HBsAg : Negative
• Anti-HCV : Negative
• CXR : Normal
• ECG : Normal
 Clinical Diagnosis

A case of 22 days old closed subtrochanteric fracture, left with

ipsilateral greater trochanter fracture with facial bone fracture in a 22
years old male.

Subtrochanteric fracture : Seinsheimer type – IIB

Russell-Taylor type – IIA

 Unit plan

Closed reduction and internal fixation (CRIF) by proximal

femoral nail(PFN)
PFN
Instruments
Instruments
Instruments
Instruments
Instruments
Screws
Nail- PFN
Position of the patient

‘C’ Position on fracture table:

Affected limb 10-15 degree adducted &

neutral position, Non-affected hip flexed
and abducted, Knee flexed.
Anatomy
Anatomy
Thank you