SUBJECTIVE DATA

 NAME : Mr. NATHAMUNI

 AGE : 42 YRS / MALE
 OP NO : 506988

 IP NO : 42304

 DATE OF ADMISSION : 01-07-2011

 OCCUPATION : PLUMBER
SUBJECTIVE DATA

CHIEF COMPLAINTS
PATIENT PRESENTLY COMPLAINS OF PAIN OVER
THE RIGHT KNEE AND DIFFICULTY IN
PERFORMING ACTIVITIES OF DAILY LIVING.

HAND DOMINANCE--- RIGHT HAND DOMINANT

SUBJECTIVE DATA
 PRESENT HISTORY- PATIENT REFERRED TO
PHYSIOTHERAPY POSTOPERATIVELY FOLLOWING OPEN
REDUCTION INTERNAL FIXATION FOR THE RIGHT TIBIA.

 PAST HISTORY- MR. NATHAMUNI GAVE A HISTORY OF

ROAD TRAFFIC ACCIDENT ON 01.07.2011 WHILE
DRIVING BIKE NEAR MARAIMALAI NAGAR. IMEDIATELY
HE WAS BROUGHT TO SRM HOSPITAL CASUALTY. HE
WAS UNDER THE INFLUENCE OF ALCOHOL WHICH WAS
FOUND AFTER HE BROUGHT TO HOSPITAL. CONTD…
SUBJECTIVE DATA
HERE THEY TOOK X-RAY AND DIAGNOSED TO HAVE A
FRACTURE OVER LOWER LEG AND THEY PLANNED FOR REST
INITIALLY (IMMOBILISATION). THEN PLANNED FOR SURGERY
ON 23RD JULY.
* MEDICAL HISTORY- HE IS HBS AG +VE

* SURGICAL HISTORY- 1. OPEN REDUCTION INTERNAL FIXATION

DONE ON 23-07-2011.
2. AUTOGENOUS BONE GRAFTING FROM
RIGHT ILIAC CREST TAKEN. PROCEDURE DONE ON 06-08-
2011

*PERSONAL HISTORY- HE IS A CHRONIC ALCOHOLIC.

PAIN ASSESSMENT
 SITE & SIDE- RIGHT ANTEROLATERAL REGION
 ONSET- SUDDEN
 DURATION- 1 ½ MONTHS
 NATURE- DULL ACHING
 TYPE- INTERMITTENT
 BEHAVIOUR- MECHANICAL/TRAUMATIC
 SEVERITY- 4.9 BY VISUAL ANALOGUE SCALE
 IRRITABILITY- MODERATE
 24 HR PATTERN- NOT SPECIFIC
 AGGRAVATING FACTOR- WIEGHT BEARING ACTIVITIES
 RELIEVING FACTOR- REST AND MEDICATIONS
OBJECTIVE DATA

 ON OBSERVATION
1. MODERATE BUILT

2. DRESSING OVER THE UPPER 1/3RD 0F THE

LEG.
3. SUTURE SITE OVER THE ILIAC CREST REGION
(GRAFT TAKEN)
4. WALKING WITH ASSISSTIVE DEVICE.

5. WASTING OF QUADRICEPS OBSERVED.

OBJECTIVE DATA

 ON PALPATION
1. ADHERENT SCAR – PARTIALLY HEALED.

2. PAIN ON PRESSURE OVER ANTEROLATERAL

KNEE REGION.
OBJECTIVE DATA-- EXAMINATION
RANGES OF MOTION-- AROM
HIP RIGHT LEFT
FLEXION 0-60 0-90 ( WITH KNEE EXTENSION)
FLEXION 0-125 0-135 (WITH KNEE FLEXION)
EXTENSION 0-30 0-40
ABDUCTION 0-40 0-45
ADDUCTION 0-30 0-35

KNEE
FLEXION 10-90 0-135
EXTENSION 90-10 135-0
OBJECTIVE EXAMINATION
ANKLE RIGHT LEFT
DORSIFLEXION 0-20 0-20
PLANTAR FLEXION 0-40-45 0-40-45
UPPER LIMB RANGES SCREENING DONE.
IMPRESSION- FULL AND PAIN FREE RANGES OF MOTION..

MUSCLE POWER
HIP RIGHT LEFT
FLEXORS 3+ 4+
EXTENSORS 3+ 4+
ABDUCTORS 3+ 4+
ADDUCTORS 3+ 4+
OBJECTIVE EXAMINATION
KNEE RIGHT LEFT
FLEXORS 3+ 5
EXTENSORS 3+ 5
ANKLE
DORSIFLEXORS 5 5
PLANTARFLEXORS 5 5

UPPER LIMB MUSCLE POWER SCREENING DONE.

IMPRESSION – ALL MUSCLE GROUPS – GRADE 4+

GAIT EVALUATION- PATIENT WALKS WITH NON WIEGHT

BEARING GAIT WITH WALKER SUPPORT ..
OBJECTIVE DATA– FUNCTIONAL ASSESSMENT
INVESTIGATIONS
INVESTIGATIONS

 X-RAY TAKEN—01-07-2011 RIGHT PROXIMAL

TIBIAL PLATEAU FRACTURE .
 X-RAY TAKEN---23.07.2011  OPEN
REDUCTION INTERNAL FIXATION 6 HOLE WITH
BUTRESS PLATE FIXATION.
DIAGNOSIS

RIGHT SIDE TIBIAL PLATEAU

FRACTURE
FOLLOWED BY
MILD POST TRAUMATIC STIFFNESS
IN RIGHT KNEE JOINT..
PROBLEM LIST

 PAIN NEAR SUTURE SITE.

 REDUCED RIGHT HIP & KNEE RANGES OF
MOTION.
 REDUCED QUADRICEPS MUSCLE POWER.

 ALTERED GAIT PATTERN.

 IMPAIRED ACTIVITIES OF DAILY LIVING.

SHORT TERM GOALS

 TO RELIEVE PAIN
 TO IMPROVE HIP & KNEE RANGES OF MOTION.

 TO IMPROVE LOWER LIMB MUSCLE POWER.

 TO TEACH CORRECT GAIT PATTERN.

 TO IMPROVE ACTIVITIES OF DAILY LIVING.

LONG TERM GOAL

TO MAKE THE PATIENT WALK

INDEPENDENTLY IN THE
COMMUNITY WITHOUT ANY
ASSISSTIVE DEVICES AND GET
BACK TO HIS WORK..
PHYSIOTHERAPY TREATMENT
 1. QUADRICEPS STRENGHTHENING EXERCISES GIVEN.
 2. ANKLE TOE MOVEMENTS.
 3. HIP AND KNEE MOBILITY EXERCISES ENCOURAGED.
 4. HOT PACKS FOR PAIN RELIEF.
 5. PATIENT MADE TO WALK WITH NON-WIEGHT BEARING
GAIT PATTERN.
 6.PATIENT EDUCATION AND EXPLANATION ABOUT THE
IMPORTANCE OF EXERCISES TO THE CARE GIVER DONE.
HOME ADVICES

 HIP AND KNEE SELF MOBILITY EXERCISES IN

HIGH SITTING.
 QUADRICEPS STRENGHTHENING.

 STRAIGHT LEG RAISE EXERCISES.

 DO’S AND DONT’S.