Welcome To Case Presentation

Dr. Mohammed Arif Hossain

Resident (MS, Phase-A)
Ortho Unit -iv
 Particulars of the patient
Name : Mrs. Y
Age : 70 years
Sex : Female
Address : Mirpur,Dhaka
Date of admission : 16/01/2022
Ward : 206
Bed : 18
Reg. no. : 753/27
 Chief complaints

• Pain in right groin due fall on slippery ground 8 days

back.

• Inability to walk on her right lower limb since trauma.

 History of present illness

According to the statement of the patient, She had history

fall on the slippery ground 8 days back. Then she
developed pain in her right groin. Initially pain was severe
in intensity, constant in nature, localised, aggravated by
any sorts of movements & partially reduced after taking
analgesics & rest. She also complaints of inability to walk
on her right lower limb since trauma.
With the above complaints she got admitted in DMCH
for better management. Her bowel and bladder habit
was normal. She is non diabetic, non asthmatic and
non-hypertensive.
• History of past illness : Nothing contributory.
• Treatment history : Nothing contributory
• Drug history : No Significant drug history
• Allergic history : No known drug or food
allergy.
• Immunization history : Immunized as per EPI schedule
but could not vaccinated against COVID 19.

• Personal history : Nothing contributory .

• Socio-economic condition : She has come from middle

class family
• Menstrual history : post menopausal state for 12 years.
 General Examination
• Appearance : ill looking
• Body built : average
• Decubitus : lying on bed
• Anaemia : absent
• Jaundice : absent
• Dehydration : absent
• Pulse : 78 beats/min
• Blood Pressure : 130/70 mm of hg
• Temperature : 98⁰F
• Respiratory Rate : 18 breaths/min
 Systemic examination
• Cardiovascular system : No abnormality
• Respiratory system : No abnormality
• Alimentary system : No abnormality
• Genitourinary system : No abnormality
• Nervous System : No abnormality
 Loco-regional examination
Look:

• Patient is in supine position with surface traction

with 5 kg weight . After removal of traction ,I have
found-

• right lower limb is abducted & externally rotated.

• Overlying skin condition normal.

• No visible muscle wasting.

Feel:
• Temperature: Normal
• Tenderness: present 1.25 cm below the mid inguinal
point just lateral to the femoral arterial pulsation.
• LLD: 1cm
• Vascular status (ADP): intact
• Neurological status : intact
Move :
• Movements of the right hip & knee joint could
not be elicited due to pain.
• Movements of right ankle joint are within
normal range
 Salient feature
Mrs. Y, 70 years old female hailing from Mirpur got admitted in
this hospital with the complains of pain in the right groin due to
fall on slippery ground 8 days back. Initially pain was severe in
intensity, constant in nature, localised, aggravated by any sorts
of movements & partially reduced after taking analgesics & rest.
She also complaints of inability to walk on her the right lower
limb since trauma. Her bowel and bladder habit was normal.
She is non diabetic , non asthmatic and non-hypertensive.
On general examination, the patient is ill looking, body

built average, non anemic, non icteric, not dehydrated, all

other parameters of general examinations are within

normal limit.

On loco-regional examination, the patient in supine

position with surface traction on the right side with 5 kg

weight. After removal of the traction , I have found- right

lower limb is abducted and externally rotated, overlying
skin condition is normal. Temperature normal,
tenderness present 1.25 cm below the mid inguinal
point just lateral to the femoral arterial pulsation,
LLD:1cm, distal neurovascular status intact. Movements
of the right hip & knee could not be elicited due to pain .
movements of right ankle are normal.
 Provisional Diagnosis
A case of 8 days old closed fracture neck of right
femur in a 70 years old female.
 Differential diagnosis

• Right sided trochanteric fracture .

X-ray pelvis A/P view on 16/01/22
X-ray right hip A/P view on 16/01/22
X-ray right knee joint A/P and lateral view
X-ray right hip A/P view on 22/01/22 with
traction
 Routine investigations
• Hb % : 12.5 gm/dl
• Blood group : B(+ve)
• RBS : 6.9 mmol/L
• Serum creatinine : 0.85 mg/dl
• Serum sodium : 142 mmol/L
• Serum potassium : 3.9 mmol/L
• Serum chloride : 103 mmol/L
 Routine investigations

• ECG : normal
• Echocardiography : EF-64%
• Chest x-ray : normal
• HBsAg : negative
• Anti-HCV : negative
• HIV- I & II : negative
• RT-PCR for COVID -19: negative
 Clinical diagnosis

A case of 8 days old closed fracture neck of right femur

(Garden type-IV) in a 70 years old female.
 UNIT PLAN
Replacement hemiarthroplasty of right femoral
component by cemented bi-polar prosthesis
• Bipolar prosthesis Hammer
• Corkscrew (judet) • Head measuring gauze
 • Rasp/Broach with tommy
• Box chisel
bar
Murphy skid Head impactor
Intramedullary reamers
THANK YOU