Welcome to Morning Session

Dr Md Abdul Halim Nazmul

MS Resident(Phase-B)
Orthopaedic Surgery ,DMCH
Unit - 1
 Particulars Of The Patient

Name :Mr Mamunur Rashid

Age :55 years
Sex :Male
Address :Dhaka
Date of Admission :13/04/2024
Reg No :7739/109
Cabin :55
 Chief Complaints

• Pain ,swelling and deformity of left forearm for 7 days

following RTA
• Pain and mild swelling just above the right shoulder for
same duration.
 History of present illness

• According to the statement of the patient wife he was

reasonably well 7 days back. Then he sustained trauma
due to RTA.Then he developed pain,swelling and
deformity in middle part of left forearm. Initially pain was
continuous, localized, severe in nature and aggravated
by any sorts of movement & partially relieved by
analgesics & rest.He also complaint of pain and mild
swelling just above the right shoulder.
 History of present illness

He could not recall the accident and the event

afterwards.But he can remember event before
accident.With these complaint he got admitted into
DMCH for further management.

He is normotensive,non asthmatic and non diabetic.His

bowel bladder habit is normal.He does not give any
history of fever,cough,haemoptysis or haematomesis.
• History of past illness: Nothing Contributory
• Treatment History:Application of LABS at DMCH
following trauma
• Personal History: Nothing Contributory
• Socio-economic History: Belongs to middle class
family
• Immunization History: Immunized according to EPI
schedule & vaccinated against COVID-19
• Drug History: took some analgesic for pain
• Allergic history : no known drugs or food allergy
 General Examination

• Appearance : Anxious
• Body build : average
• Decubitus : Supine
• Anaemia : absent
• Jaundice : absent
• Dehydration : absent
• Pulse : 74 beats/min
• BP : 130/80 mm of Hg
• Temperature : 98o F
• RR : 16 breaths/min
 Systemic examination
• Cardiovascular system : Nothing contributory
• Respiratory system : Nothing contributory
• GIT system : Nothing contributory
 Loco regional Examination:

Look :
.After careful removal of the long arm back slab,I examined the
patient.

Left upper limb

•Mild swelling&deformity present in middle of right forearm.

•Skin condition is normal.
•No scar marks.
•No apparent shortening & muscle wasting
• Right upper limb

Bruise present just above the right shoulder joint.

Mild swelling present.
Feel:
LEFT UPPER LIMB
•Temperature-Normal
•Tenderness- mild tenderness is present at the mid shaft of
radius & ulna.
•No shortening & muscle wasting
•Distal neurovascular status is intact.
 RIGHT UPPER LIMB
•Temperature-Normal
•Tenderness-Mild tenderness present just above the right
shoulder.
•No shortening & muscle wasting
•Distal neurovascular status is intact.
 Cont.
Move:
LEFT UPPER LIMB
• Movement of elbow joint, supination and pronation and
wrist joint could not be elicited due to pain

• RIGHT UPPER LIMB

• Elbow and wrist joint movement are within normal range
of motion.
 Salient features

Mr Mamunur Rashid 55 years old male hailing from

Narayangonj sustained trauma due to RTA developed
pain in his middle part of left forearm. Initially pain was
continuous, localized, severe in nature and aggravated
by any sorts of movement & partially relieved by
analgesics & rest.He also complaint of pain,swelling just
above the right shoulder joint.
 Salient features
. He also complains inability to use left forearm following
trauma. On general examination and systemic examination
reveals no abnormality. On loco-regional examination mild
swelling&deformity present in middle of left forearm,Skin
condition is normal,
no apparent shortening & muscle wasting
 Salient features
Temperature normal ,mild tenderness is present at the mid
shaft of radius & ulna,
No shortening & muscle wasting, distal neurovascular
status is intact. Movement of elbow joint,wrist joint,
supination and pronation could not be elicited due to
pain.There is mild swelling and bruise present just above
the right shoulder joint.Mild tenderness present
 Provisional Diagnosis

• 7 days old closed fracture shaft of radius-ulna (left) with

fracture around the right shoulder with anterograde
amnesia in a 55 years old male.
X-ray right forearm(13.4.2024)
X-ray right forearm(13.4.2024)
 Lab findings

• Hb% : 11.0gm/dl
• RBS : 5.4mg/dl
• S.Creatinine : .80mg/dl
• HbsAg: Negative
• Anti HCV : Negative
• S. Electrolyts:
• Na+:146 mmol/l,K+: 6.4 mmol/l,Cl-:107 mmol/l
• Blood grouping: O(+ve)
Echocardiography: LVEF 56%
 Clinical diagnosis
• 7 days old closed fracture shaft of radius-ulna (Left) with
clavicle fracture (right) with anterograde amnesia.
• AO classification: 2R2A2, 2U2A2
Neer classification: Type A 1
 Unit Plan:

Open reduction & internal fixation of radius & ulna by small

dynamic compression plate(DCP) and screws .
Thank you