Interesting Case Orthopedics

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Extern Thiwaporn P.Interesting CaseOrthopedics

Patient profile 50 Chief complaint : 4

2

Present illness4 .

3

Primary surveyA : Can speak, full ROM of neckB : Equal breath sound , CCT negativeC : BP 130/70 mmHg, P 88/minD : E4V5M6 pupil 3 mm RTLBEE : Lt.knee Cut wound length 5 cm. wide 1 cm. expose patella with +/- stepping

Secondary surveyAllergy Medication Past history Last meal 05.00 PMEvent

Physical examinationVital sign T 36.8 c, BP 130/70 mmHg, P 88/min, RR 18/min, O2sat 98%General appearance : A Thai girl, cryingHEENT : not pale conjunctiva, anicteric scleraHeart : no active precordium, no heaving, no thrill, normal S1S2, no murmurLung : clear both lungAbdomen : soft, not tender, no guardingExtremities : cut wound deep to bone at anterior left knee , limit ROM due to pain

Differential diagnosis & Investigation

Diagnosis Open fracture Left patella

Fracture of Patella

Investigation Film Knee AP and LateralFilm Knee Merchants view

Classification Modified Weissman

TreatmentNon-operative managementknee immobilized in extension (brace or cylinder cast) and full weight bearing 6-8 weekindicationsintact extensor mechanism (patient able to perform straight leg raise)Non-displaced or minimally displaced fractures (displace or step off < 3 mm.)

Operative managementORIF with tension band constructindicationspreserve patella whenever possibleextensor mechanism failure (unable to perform straight leg raise)open fracturesfracture articular displacement >2mmdisplaced patella fracture >3mmpatella sleeve fractures in childrenpartial patellectomyindicationscomminuted superior or inferior pole fracture measuring