Arab American university

Faculty of allied medical scienc

Physiotherapy department

Clinical field (1)

(Femoral fracture )

Prepared by:

Shima Yosef alrete

ID:201620084

Supervisor name: Dr. Mosab Amoudy

Specialization: physiotherapy

Department of health sciences

Faculty of allied medical sciences

Arab American university – Jenin

Summer 2018/2019

ORTHOPAEDICS ASSESSMENT

For clinical field work

Physiotherapy Department
I. SUBJECTIVE ASSESSMENT

Name: Sohaib Soliman Mustafa Alan Date of Birth:04.09.

Gender: Male Address: Nablus

Occupation: work Marital Status: Single

Referred by: Orthopaedic doctor Date of Assessment: 10.7.2018

Diagnosis: femoral fracture (left side)

Main Complaints:

The patient inability to do daily or functional activity also he feel a sever pain and
constricted of movement .

CASE HISTORY:

Present History:

His injury occurred on the date of 5.7.2018 due to RTA(Road traffic accident).

After an hour he lost consciousness and the paramedics moved him through the
ambulance and gave him first aid, then took him to the radiology department and
the doctors found that there was a broken thigh, At the same time he entered the
operations department to conduct the operation and they put in his thigh plate and
screw. The beginning of the pain was gradually and he feel continuous sever pain,
also when he lying on the affected side or walking he feel the pain is increasing ,
unlike that he doesn't feel pain at rest or sitting also he take a medication to relieve
pain such Norphin and Optalgin.

Past History:

Free

Social History:

Sohaib 23 years old ,Male , He is smoker ,live in a hight place and this is difficult to
get down and up also that led to be depressing

Medical History:

Free
RADIOLOGICAL TESTS

He had X-Ray, it's show that there is a femoral fracture on left side.

II. OBJECTIVE EXAMINATION

General Observation:

1.He doesn't have any deformities (varus or valgus)

2.The Q angle is normal.
3.limitation in Range of motion
4.Fatigue when he do the movements or exercises
5. Anxiety

Local Inspection:

1.Swelling
2.Redness
3. Scar due to surgery

Palpation:

1. tenderness: with palpation the patient feel pain at the site of surgery.

2. swelling you can compare with the other side.

3. Skin is dry .

Posture Analysis:

Anterior:

Face: normal

Shoulder: normal

Nipples : normal

Umbilicus : normal

Anterior superior iliac spine: abnormal

Knee: normal

Ankle: normal

Lateral:
-Spinal column(in siggital plane)- he doesn't have any kyphosis or
sciliosis or lordosis

- shoulder is normal

- pelvis is normal

Posterior:

Scapula – normal

Vertebral column is normal

PSIS -abnormal

PHYSICAL EXAMINATION:

Pain:

1.Onset: gradually

2.location of pain: in the left side of the femur.

3.duration of pain: at all the day increase with movement (continues pain).

4.type of pain: Aching pain on the femur .

5. pain scale: 7\10

 2: Range of Motion:

Date Joint Pt. Active Passive Notes

Position
01.07.2018 Hip prone 0-5 0-10 With pain
03.07.2018 joint(extension) 0-5 0-10
05.07.2018 0-10 0-15
19.07.2018 0-10 0-15
21.07.2018 0-15 0-20

3.End feel:

The end feel of the hip extension is firm but he can't do full extension.

4: Muscles Power:

Date Joint Pt.position Muscles RT side LT side

01.07.2018 Hip joint Short sitting Psoas major 4 5

flexion Iliacus

05.07.2018 .extension prone Gluteus 4 2

maximum and
hamstring

abduction Side lying Gluteus medius 4 5

19.07.2018
Gluteus
minimus

adduction Side lying Adductor 4 5

magnus, brevis,
longus ,
pectineus ,
gracilis

Knee joint prone Hamstring 5 3

muscle
flexion
 extension Short sitting Quadriceps 5 5
femoris

5: Muscles Bulk:
Pt.position Muscles Measurement Notes
Date
RT. LT.
Long sitting Gluteus 49 45 The muscles is
01.07.2018 maximum strengthen
& Hamstring 49 46
05.07.2018. muscles
19.07.2018 49 47

Balance:
Static: normal

Dynamic: abnormal because he use crutches

6: Sensory Assessment

A-Superficial sensation: Normal without any sign

B- Deep sensation: Normal without any sign

7: Reflexes: NORMAL REFLEXES

Reflex Left Right

Superficial Abdominal

Babinski

Deep Biceps

Brachioradialis

Triceps

Knee Jerk

Ankle Jerk

8: Gait Analysis: abnormal Gait

 Type of gait : antalgic gait he put more weight bearing on the non affected
side, leg is in neutral position and he use crutches when she transfer from
place to another.

Additional Notes:

Addition to injury the patient suffer from scratch on head and leg.

Effects of Daily Living Activities (ADL):

Sitting: no pain

Standing: Some pain

Walking bending: Some pain

Lying: pain on the affected side.

Cough\ Sneeze: no pain

Rest: no pain

Stress: with pain

Warmth: no pain

Work: with pain

Associated Symptoms:
The patient suffer from pain on femur and Dizziness and fatigue.

Special Tests:
No special test we do the strengthing exercises.

Summary of Main Problems:

He had a femoral fracture on the left side and he did a surgery and put plate and
screw, also the patient complain of pain during extension , limited ROM and
weakness on the left side due to pain.

Final Diagnosis:

Goals:

 Short Term;
1. To relive pain and Swelling
2. To prevent contracture o
3. To Increase ROM
4. To Increase muscle power
 Long Term;
1. Restore movements
2. Mobility of the affected joint
3. Strength the affected muscles
4. Restore daily\ functional activities to its back to normal
5. Improve gait
Methods of treatment:-

1.Hot pack (10-15) to relieve pain and relaxation of muscle .

2.TENS (Transcutaneous electrical nerve stimulation) to stimulate the nerve to

produce motor contraction to reduce acute and chronic pain.

3. Exercises

- isometric and isotonic exercise for knee and hip joint

-ankle exercise to increase circulation

-strengthining exercise to improve muscle power

-weight bearing exercise

Home program:

To do the exercise at home specially strengthing exercises such flexion , extension of

hip and knee ankle and increase the intensity of exercise in the second and third
weaks .

Recommendation:

 Don't walking for long time.

 Do to exercises
 Sleep on the back.
 Don't tired yourself.

he should go back to the doctors if he develop any new or worsening symptoms

Re-evaluation:-

The patient his situation is improvement , the swelling and pain is reduced and he
know can to do partial Range of motion also his muscles is strengthened and therefore
his muscles mass is returned proximately to it's normal mass.