ORTHO CASE

PRESENTATION
DR NAVEEN KULKARNI
BMCRI

24-04-2023 1
PATIENT PARTICULARS

Mr Bhima

54 year old, Male

Farmer by occupation

Hailing from Bangalore

Date of examination 7/11/21

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CHIEF COMPLAINTS

Pain in lower part Discharging wound

of right thigh since over right thigh
5 months since 4 months

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HOPI

Patients was apparently normal 2 years back, when he met with a road
traffic accident injuring his right thigh bone for which, he visited the
district hospital where the diagnosis of fracture was made and patient
was treated by external fixators for a period of one year.

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HOPI (Cont.)

• Patient started developing pain in lower part is right thigh 5 months

ago, insidious in onset, throbbing in nature, non radiating.

• The episode of pain was associated with fever, continuous type, high
grade fever with chills and rigors. pain aggravated on waking and pain
and fever were partially relieved by medications.

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HOPI (Cont.)

• Patient developed similar episode one month later. patient had associated
discharging wound that developed over right thigh, the episode of
discharge was following an episode of pain and fever. Discharge was
purulent in nature, mixed with blood and was scanty in amount.

• Discharge partially relieved on taking medications given by local doctor.

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HOPI (Cont.)

• Patient also complains of small bone piece coming out of the wound.

• Patient uses crutches to move around.

• Patient had similar episode 1 week back.

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HOPI (Cont.)

• No h/o evening rise of temperature, weight loss.

• No h/o knee joint swelling.

• No h/o right lower limb stiffness.

• No h/o dental caries, ear pain.

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PAST HISTORY

• Not a known case of diabetes, hypertension.

• Not a known case of tuberculosis.

• No history of previous medical or surgical history other than ones

already mentioned.

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FAMILY HISTORY
• Nothing significant.

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PERSONAL HISTORY

• Diet : mixed.

• Appetite : adequate.

• Sleep: adequate.

• Bowl and bladder habits : normal and regular.

• Chronic alcoholic and chronic smoking history present.

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GPE

• Middle aged gentleman moderately built and nourished is conscious

cooperative and well oriented to time place and person.

• Patient was examined in supine position in broad day light with

adequate exposure.

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GPE (Cont.)

• There was no pallor, icterus cyanosis clubbing , generalised

lymphadenopathy and edema.

Vitals

• Pulse : 88/min

• Bp : 124/78 mm Hg

• Patient was afebrile at the time of examination.

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SYSTEMIC EXAMINATION

• CVS : S1, S2 heard normally, no murmurs.

• CNS : No neurological deficits noted.

• RS : Bilateral NVBS heard.

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GAIT
Patient had an antalgic gait when asked to walk without crutches.

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LOCAL EXAMINATION OF RIGHT LOWER LIMB

Inspection

• Attitude of limb : limb is extended at the knee joint.

• Hip is in neutral position.

• Ankle is in neutral position.

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Cont.
• Large sinus Seen over the anterior aspect of lower part of right thigh,
10 cm above the knee joint line.

• A pink fleshy growth was seen in the sinus covered with blood stained
discharge.

• Sinus appear to be off 1cm in diameter with punched out margins.

• Surrounding skin hyperpigmentation seen.

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Cont.
• There is surgical scar healed by primary intention above the patella.

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PALPATION

• No local rise in temperature.

• Deep tenderness present over the wound.

• Inspectory findings confirmed.

• The sinus is fixed to underlying bone.

• Skin around sinus indurated.

• Underlying bone had irregular surface.

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Cont.
Knee Joint Right Left

Passive Slight flexion No restriction

restriction.
Fixed in extension.

Active Slight flexion

restriction
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Cont.
Hip joint Right Left
Flexion
Extension
Abduction
No restriction No restriction
Adduction
Internal rotation
External rotation
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Cont.
Measurements Right Left

Apparent length 100 100

True length 90 90

Upper segment 47 47

Lower segment 43 43

Girth of thigh 50 50

Girth of leg 30 30

*Right
24-04-2023 inguinal lymph node is palpable, tender and discrete 22
DIAGNOSIS

“CHRONIC OSTEOMYELITIS OF LOWER 1/3rd OF RIGHT FEMUR WITH

ACUTE EXACERBATION.”

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 THANK YOU
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