Extern orthopedics conference

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  1. 1. Extern Orthopedics Conference Presented by Ext. Chawisa Panaphorn Phramongkutklao College of Medicine
  2. 2. History Case 58 Chief compliant : 7
  3. 3. History Present illness : 7 . : 90
  4. 4. Physical Examination Primary Survey: A. Can talk fluently, no stridor, spontaneous movement of neck, no C-spine tenderness B. Equal breath sound on both lungs, trachea in midline, Chest compression test positive on Rt. side C. BP 135/88 mmHg, PR 90 bpm, no external bleeding D. E4V5M6, pupil 3 mm RTLBE E. no seen external wound
  5. 5. Physical Examination Head to toe examination: vital sign : BT 37.2 C, BP 135/88 mmHg, PR 90 bpm, RR 20/min General appearance : good consciousness, talkative, not pale, no jaundice HEENT : not pale conjunctivae, anicteric sclerae Heart : normalS1S2, no murmur Lung : no bruising seen, no external wound, normal chest expansion, clear on both lungs Abdomen : no abdominal distension, hyperactive bowel sound, soft, not tender, no guarding, no rebound tenderness
  6. 6. Physical Examination Head to toe examination: Extremities : Rt. Wrist swelling and tender, Dinner fork deformity, capillary refill < 2 secs, radial and ulnar pulse can be palpated (as figure) Neuro : no wrist drop or finger drop, limit active ROM due to pain, sensory intact all, DTR 2+ all
  7. 7. Physical Examination
  8. 8. Physical Examination Secondary Survey A. No food and drug allergy M. Current medication : Amlodipine (5) 1x2 oral pc Atenolol (100) 1x1 oral pc P. U/D of HT, no history of surgery, no history of trauma in this area before, no history of drinking and smoking, no family history of hematologic disease L. NPO time 8.00 am. E.
  9. 9. Investigation ? Film Rt. Wrist AP, lateral view
  10. 10. Problem list Close fracture of Rt. Distal radius (extra-articular) with dorsal displacement and volar angulation in old aged Thai male (Colles fracture on Rt. wrist) Underlying disease of hypertension
  11. 11. Management Successful outcomes correlate with accuracy of articular reduction restoration of anatomic relationships early efforts to regain motion of wrist and fingers Non-operative management closed reduction and cast immobilization indications extra-articular - Radial inclination change 5mm radial shortening - comminuted and displaced extra-articular fxs (Smith's fx) - Barton fracture
  12. 31. Colles fracture
  13. 32. Colles fracture Complications - malunion/nonunion - stiffness and decreased grip strength - pin complications (infections, fracture through pin site) Others - Pain control - elevation (holding their arm up above their heart) - keep cast dry - early mobilize to prevent stiffness resume Light activities 1 to 2 months after the cast is removed or within 1 to 2 months after surgery. resume Vigorous activities 3 and 6 months after the injury
  14. 33. Referrence http://www.orthobullets.com/trauma/1027/distal-radius- fractures http://orthoinfo.aaos.org/topic.cfm?topic=a00412
  15. 34. Thank you