Wednesday, November 3, 2010

Day 2 (second part)

Later I went to clinic & follow Mr Shuk Clinic

One of the case was:-
An early 30th gentleman, overweight, walked into the room using stick (both sides)

Mr Shuk: hah, liyana, examined this patient leg. Tell me what you see
Me: I go~

There is multiple scars at the left leg
3 vertical scars
1st: medial side estimating about 25cm
2nd: anteriorly but slightly lateral measuring around 30cm
3rd:lateral side estimating 25cm
all of the scars are well healed
There is also multiple puncture scars extending from the distal third of leg up to the lateral thigh - due to external fixator crossing the joint
One irregular healed scar at the middle third of tibia measuring about 10cmx5cm)
Otherwise the leg is not swelling, no deformity & not wasting

The scars are non tender,
no edema of the leg
no bony discontinuity felt (try to find bone gap - in case of nonunion)
No bony tenderness (try to locate the fracture site if it is still tender)
pulses equal & CRT <2secs

fracture site is not mobile
ask patient to move the leg & the joint actively

In conclusion (explanation based on scars)
This patient had closed fracture of upper third of tibia
complicated with compartment syndrome - fasciotomy done (scar at medial&lateral side)
fracture was stabilised with external fixator (external fixator scar)
after wound closed by SSG (the irregular scar), pt undergo plating (the anterior slightly medial scar)

Initially dah tertipu ingatkan open fracture due to EF. memandangkan ada fasciotomy trus tuka it is closed fracture. EF was put after fasciotomy done

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