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MIDSHAFT OF FEMUR
INTRODUCTION
A # may be a complete break in the continuity
of a bone or it may be an incomplete break or
crack.
CLASSIFICATION
1. Open / compound #.
when there is a wound of the skin surface
leading down to the site of #.
PATTERNS OF FRACTURE
DR MANAGEMENT
1. Conservative management
Close manipulative reduction (CMR)
followed by POP
b) Traction
skin traction
skeletal traction
2. Surgical management
) Dynamic hip screw (DHS)
) K-Nail/intramedullary nail (IMN)
) Interlocking nail (ILN)
) Screw & plate
a)
PT MANAGEMENT
a)
b)
c)
d)
e)
f)
g)
a)
b)
c)
d)
CASE STUDY
PATIENTS PARTICULAR :
Unit : Orthopedic
Name : Ms. N
Age : 14 years old
Sex : Female
No R/N : D.O.Admitted : 13th Mac 2015
D.O.Ass : 18th Mac 2015
Diagnosis : Closed # Rt. midshaft femur.
Doc. Management :
Post K-nail done on 17/3/15 for Rt femur.
SUBJECTIVE ASSESSMENT
pt c/o :
pain over anterior aspect of Rt thigh.
Pain VAS : 6/10 (rest)
Pain nature : deep aching
Pain area : anterior aspect
of Rt. Thigh
(refer to body chart)
Present Hx:
admitted in ward on 13/3/15 due to alleged
MVA (MB vs Car) at 6.00pm on 13/3/15.
Past Hx:
Nil
PMHx/PSHx :
Nil
Medication :
Nil
Family history :
NIL
Social Hx :
Form 2 students.
non smoker & non alcoholic
stay with parents.
single storey house.
toilet : sitting
Ix/MRI/x-ray :
x-ray : on 13/3/15 :
closed # midshaft Rt. Femur
On 17/3/15 :
Post K-nail Rt. femur
OBJECTIVE ASSESSMENT
General observation :
pt on POD 1
Malay woman, middle body size, 16 yrs old
pt lying on his bed
pt alert & co-operative
abrasion wound at lat. aspect of Lt arm.
Local observation :
no muscle wasting
swelling at Rt. thigh & calf muscle.
Redness at operation site of Rt. thigh
Palpation :
slightly in local temperature at operation
site.
tenderness around the operation site.
Measurement ROM :
generally both UL : AFROM
generally Lt. LL : AFROM
for Rt. LL ( in supine lying position)
Hip flex w kn. bending
Hip abduction
Hip adduction
Knee flexion
Knee extension
Ankle plantarflexion
Ankle dorsiflexion
Active
Passive
-
unable to
do d/t pain
FROM
FROM
5/5
Right
unable
to do
d/t pain
3/5
Left
46.5
50.5
55.5
Right
50.5
54.5
60.0
Diff
3.5
4.0
4.5
Left
39.5
Right
40.0
Diff
0.5
Rt > Lt swelling
From head of fibula
Calf muscle (10cm)
Rt > Lt swelling
Right
Diff
93
92
100
99
- Umbilicus to med.
malleolus
Normal
ANALYSIS
Problem listing :
pain due to # & operation.
swelling LL due to inflammation.
limited ROM of hip & knee joint due to pain.
muscle weakness due to pain.
Short term goals :
to maintain clear airway.
to reduce swelling.
to increase ROM at affected side ( hip &
knee joint)
PLAN OF TREATMENT
Deep breathing exercise.
Active free exercise.
Stretching exercise.
Strengthening exercise.
Circulatory exercise
Ambulate pt.
Intervention :
1) Deep breathing exercise.
- pt in lying position.
- do 5x/hrly/day
2) Incentive spirometer
-sit up in bed
-10x/hourly
3) Active free exercise for both UL & Lt. LL.
- pt. in lying position.
- for UL sh.flex through elevation, sh.abd.
& add., elb.flex & ext, hand grip.
- for Lt LL hip & knee flex, SLR, hip abd &
add.
- do 5x/hrly/day
Evaluation :
Review :
PROGRESSION NOTE :
19/03/2015
S
O
same as initial assessment
A
P
Intervention : Cont. the same treatment
1) Deep breathing exercise.
- do 5x/hrly/day.
2) Incentive spirometer
- do 10x/hourly
3) Active free exercise for both UL & Lt. LL.
- do 5x/hrly/day.