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DR. ATIF SHAHZAD PGR ORTHOPEDIC DEPARTMENT SHL

DR. ATIF SHAHZAD PGR ORTHOPEDIC DEPARTMENT SHL

BIO DATA

Sumera Bibi. 25 yr. Married ,house wife. Right hand dominant. Resident of Mahmoodia Colony Sahiwal.

PRESENTING

COMPLAINTS

  • 1. Progressive deformity of Rt. Wrist years

---- 2 ½

  • 2. Pain and Inability to move Rt. Wrist ---- 1 month

HOPI

Diagnosed as GCT Rt. distal Radius…………6 years ago.

Resection and placement of implant

Resumed her daily activity after 4 m0nths although with decrease movements of wrist joint.

Symptoms free for 3 ½ yrs. Patient noticed progressively increasing flexion deformity of her Rt. Wrist.

HOPI • Diagnosed as GCT Rt. distal Radius…………6 years ago. • Resection and placement of implant

CONT……

Pain mild to moderate, continuous, aching. Aggravated with movement and relieved with medication. Limitation of movements of wrist and fingers

CONT……

Difficulty in performing her daily routine activities and used left hand.

No h/o any associated symptoms No other systemic complaints.

She came to OPD for consultation regarding her symptoms.

Past Medical History:

private

Surgery Rt. wrist 6 years back in hospital.

Family History :

Not significant Personal History :

non-

Married , house wife ,non-addict, smoker.

Socioeconomic Status:

Poor.

Examination

GPE :

A young lady with normal height and built, conscious, well oriented,

Pulse :

B.P :

98/ min

110/70mmHg

Temp : 98 0 F

R/R :

18/min

SYSTEMIC EXAMINATION

Respiratory:

Chest expansion is normal NVB + O

Cardiovascular:

S1 + S2 + O

CNS:

Intact

GIT:

Abdomen is soft, non-tender. B/S audible with normal intensity and frequency.

LOCAL EXAMINATION

LOCAL EXAMINATION
LOCAL EXAMINATION

LOCAL EXAMINATION

Inspection:

1.Flexed posture of Rt. Wrist

2.1 x 10 cm scar mark on dorsal aspect of distal forearm.

3.Underlying implant visible through 1 x 1 cm wound.

4.Prominent distal end of ulna. 5.Wasting of muscles of forearm and hands.

CONT… ..

Palpation:

1.Temp is normal with moderate tenderness on dorsal aspect of distal forearm. 2.Exposed and palpable implant subcutaneously. 3.Scar mark fixed with underlying tissue. 4.Wrist flexion deformity of 55 0 .

5.Forearm circumference of 18 cm on Rt. as compared to 20 cm on left.

CONT…

  • 1. Wasting of thenar and hypothenar prominences.

  • 2. No swelling or deformity of MCP and IP joints.

  • 3. No palpable axillary lymph nodes.

  • 4. Distal pulses are palpable and comparable with left forearm.

CONT…

Movement:

  • 1. Flexion is 55 to 65 actively and passively

  • 2. Radial and Ulnar deviation not possible.

  • 3. Decreased movements of MCP and IP joints.

  • 4. Distal neurology is intact.

INVESTIGATIONS

Baseline Labs:

Hb :

12.2 g/dl

TLC :

7800/ul

Plt :

123000/ul

Alt :

24 IU/L

S/Urea : 23 mg/dl

S/ Cr : 0.7 mg/dl

Na :

139 mEq/L

K :

4.0 mEq/L

CRP : 0.5

ESR : 14

mm

RADIOGRAPH AT PRESENTATION

WHAT TO DO ?

SURGICAL INTERVENTION

Removal of implant and prosthesis.

Centralization of ulna with

wrist arthrodesis using 3.5mm DCP and BG

SURGICAL INTERVENTION • Removal of implant and prosthesis. • Centralization of ulna with wrist arthrodesis using
SURGICAL INTERVENTION • Removal of implant and prosthesis. • Centralization of ulna with wrist arthrodesis using

IMMEDIATE POST OPERATIVE RADIOGRAPH

RADIOGRAPHS 6 MONTHS AFTER SURGERY

RADIOGRAPHS 6 MONTHS AFTER SURGERY
RADIOGRAPHS 6 MONTHS AFTER SURGERY

FOLLOW UP.

THANKS