Case proforma:

Preoperative:
Name: Age: Sex: IP no:
Date of admission:
Time of injury to admission:
Mode of injury:

diagnosis:
Associated injuries:
Co-morbidities:
X ray findings:
CT findings:
Classification:
Distal neurovascular status:
INTRAOPERATIVE
Time from injury to surgery:
Position:
Anaesthesia:
Approach:
Procedure done:
Plate placement:
Plates used:
Blood loss:
Duration of surgery:
Postop immobilisation:
POSTOPERATIVE
Drain collection:
Day of drain removal:
Postoperative x ray:
Wound status at the time of discharge:
Suture removal:
IV antibiotics:
Oral antibiotics:
Details of associated injury treatment:
Distal neurovascular status:

FOLLOWUP
Date: Visit number:
Postoperative month:
Wound status:
X ray:
Weight bearing:
KNEE SOCIETY SCORE :
1. Pain:

2. Range of motion:

3. Stability: Anteroposterior

Mediolateral

4. DEDUCTIONS :

Flexion contracture

Extension lag

Alignment

Medial proximal tibial angle:

Articular step off: