Orthopedic case

Orthopedic case Chief Complaints Inabilty ti use left lower limb for 1 day. History 18 year old female Patient was apparently doin fine till 1 day prior hospital admission after she developed inability to use her left lower limb which occured suddenly after being involved in MTA after being knocked by motorcycle while crossinv the road, and thrown on the road pavements and sustaine an injury on the middle part of the leg being characterized by tenderness, swelling, and abnormal movements with no obvius skin laceration or bleeding. No loss of consoussness no convulsion. No asaociated injury. ROS PAST MEDICAL FAMILY SOCIAL all uneventful Vitals Bp 125/75mmhg Pr 92 beat/min rr 18 breath/min Spo2 98% Temp 37C Physical Examination Patient was alert GCS 15 not pale Not jaundice Not cyanosed Left lower limb immobiled on backslab Local EXAMINATION swelling middle part of the leg on its anterior aspect tender on touch Limited active movements at knwe and ankle joints Distal neurovascular status intact Investigations X ray taken showed communuted fracture of the mid shaft of tibia fibula with angular displacements of distal segment medial Fbc done HB 12 Plat 250 B+ Normal createnine and Urea Diagnosis Communuted mid shaft tibia and fibula Management Managements doctors




Reduction and Pop below knee vast 6wks

Hartman procedure is good Opening of anal region in abdomen After 6 month other operation

Coffee bean sign is classic diagnostic feature of sigmoid volvulus Emergency surgery for acute sigmoid volvulus is associated with high morbidity and mortality, it can be reserved in case of it is absolutely necessary to perform surgery, example when there is gangrene bowel, perforation of bowel, peritonitis Nonoperative detorsion is advocated as the primary treatment choice in uncomplicated acute sigmoid volvulus. A flexible sigmoidoscopy/ colonoscopy is now the preferred nonoperative procedure. After complete reduction of sigmoid volvulus, once patient is hemodynamically settled, then elective surgery for resection of redundant sigmoid colon can be performed in a stable, elective, well prepared environment with complete bowel preparation

Volvulus Can be managed conservatively Manage iv fluids Inj ondestron Inj pantaprazole Inj diclofenac Inj Ceftriaxozone Stabilize vitals glycerine enema to relieve impacted stools If not relieved BAenema can be tried