INTER-DEPARTMENTAL MEET

DEPARTMENT OF ORTHOPAEDICS
&RADIOLOGY
CASE
 A 23 year male patient came to our OPD with complaints
of pain and discharging sinus over left hip along with
difficulty in walking for past 3-4 months.
 Patient was apparently normal 4 years back after which he
sustained a trivial trauma while playing and sustained
injury, whereby he went to Apollo hospitals, and he was
diagnosed to have left intertrochanteric fracture with
osteopetrosis, for which CC screw fixation(1st procedure)
was done over the left hip. He was apparently normal for
the next 3 months.
cont
 3 months after the surgery the patient noticed swelling and
discharging pus at the operated site, he went to Apollo
hospital again, for which he was treated with Incision and
Drainage with betadine wash over the screw site (2nd
procedure)
 Patient didn’t recover with the treatment, whereby he
continued to walk with pain and he was limping for next 7
months.
cont
 After 7 months patient went to another doctor for the same
complaints of pain and limping, whereby he was
diagnosed with necrosis of bone, for which Screw
removal along with removal of necrosed head of femur
procedure was done (Girdlestone Arthroplasty)
 After the procedure the patient used to walk with crutches
for the next 3 months
cont
 3 months after the 3rd procedure, the patient again noticed
swelling and discharging pus which was continuous with
occasional serous discharge at the same operated site, for
which he did self dressing with betadine and gauze pad.
 The patient now came to our hospital with complaints of
pain, discharging pus over left hip along with limp
walking.
cont
 The pain was at anterolateral aspect of left hip which was
insidious in onset, gradually progressive,dull aching type
of pain,not radiating, pain aggravated on walking,
prolonged standing and during activity, reduced on taking
rest.
 Rest pain is present
 Night pain is present
 No h/o night cries
cont
 H/o shortening of left leg after the 3rd procedure which
was non progressive and aided with crutch support.
 No h/o fever, loss of weight and loss of appetite
 No h/o morning stiffness , small joint pain and other joint
involvement
 Not a k/c/o DM , HTN ,TB ,BA ,CAD, Epilepsy , drug
allergy, blood dyscariasis.
no h/o childhood limping
Local Examination
Examination of left hip-
• Gross shortening of left lower limb on standing
• Surgical scar over left hip present
• Swelling present over side of left hip of size 10*10 cm with
discharging pus. Skin over the swelling is stretched and
oedematous.
• Left thigh , leg segments and sides are atrophied with muscle
wasting.
• Left gluteus muscle is atrophied to right
• Gluteal fold asymmetry present
• Warmth and tenderness present laterally
Local Examination (cont)
• Left greater trochanter is superior when compared to right
• Left medial malleoli is superior when compared to right.
• Left foot equinus is present
• Sensation intact
• ROM- restricted and painful
• ATM +
• No visible pulsations
• No fullness in scarpas triangle
• No FFD in hip and knee
MOVEMENTS RIGHT LEFT

FLEXION 0-120° 0-60°– ACTIVE

70°- PASSIVE beyond
painful
EXTENSION 0-10° 0-10° - PAINFUL

ABDUCTION 0-40° 0-30°- ACTIVE

0-40°-PASSIVE,PAINFUL

ADDUCTION 0-20° 0-10° PASSIVE,PAINFUL

INTERNAL ROTATION IN FLEXION-0-35° PAINFUL AND

IN EXTENSION- 0-30° AGITATED

EXTERNAL ROTATION IN FLEXION- 0-45° PAINFUL AND

IN EXTENSION-0-40° AGITATED
 APPARENT LENGTH 112CM 106CM

TRUE 88CM 77CM

FEMUR - 44CM FEMUR-28CM
TIBIA- 39CM TIBIA-39CM

MEASUREMENTS RIGHT LEFT

THIGH 47CM 43CM

LEG 35CM 30CM

 BRYANTS TRIANGLE – left side – Inversion noted.
 NELATON’S LINE – ASIS