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: terkebil-kebil...ok..here I go~

Look:
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

Feel:
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

Move:
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)


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