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REHABILITATION MEDICINE PEDIA-ORTHO. Cecilia Lim Hipolito Neil Illescas CASE OF CHRONIC HIP DISLOCATION . PATIENT PROFILE. Patient is K. R 8 years old male Right handed male Roman Catholic Grade 2 109 Luta Sur, Malvar, Batangas CC: Right hip deformity/ limping .

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rehabilitation medicine pedia ortho

REHABILITATION MEDICINE PEDIA-ORTHO

Cecilia Lim Hipolito

Neil Illescas

CASE OF CHRONIC HIP DISLOCATION

patient profile
PATIENT PROFILE
  • Patient is K. R
  • 8 years old male
  • Right handed male
  • Roman Catholic
  • Grade 2
  • 109 Luta Sur, Malvar, Batangas
  • CC: Right hip deformity/ limping
history of present illness
HISTORY OF PRESENT ILLNESS

Patient has no known co-morbids and with full and in good functioning capacity until...

  • DOI: Oct, 2009 (3rd week)
  • TOI: 2 pm
  • POI: School in Batangas
slide4

MOI: While the grade 6 students were playing volleyball, patient tried to get to the ball. Unfortunately, a 40 kg player, also trying to get the ball, collided into him, hitting him at the right side while on all fours; accidentally toppling him. There was noted to have deformity after the accident accompanied by limp and leg shortening. (-) LOC, (-) nausea, vomiting. (-) bleeding. (+) pain ~4/10, nonradiating, dull (pain on movement).

slide5

Patient was then carried home where he was brought to a local albularyo, with no relief of symptoms. There were no medications taken, and no consult at a medical institution.

  • Patient’s pain gradually dissappeared (2-3 weeks). During this time, patient was able to walk in a limp,able to do all his ADLs without assistance.
slide6

1 ½ months PTA, a free medical mission conducted by a private clinic was conducted at their hometown. Xray showed: hip dislocation of the R. No other lab tests done, no medications taken. He was then refered to PGH for further management.

  • 1 month PTA, patient consulted at the ER, and was subsequently admitted.
review of systems
REVIEW OF SYSTEMS
  • (-) Headache
  • (-) nausea, vomiting
  • (-) fever
  • (-) weakness, malaise
  • (-) chest pain
  • (-) abdominal pain
  • (-) change in bowel and urinary habits
  • (+) mild hip pain of R while in traction.
past medical history
PAST MEDICAL HISTORY
  • No known illnesses
  • No known allergy to food and medications
  • No previous surgeries and hospitalizations
family medical history
FAMILY MEDICAL HISTORY
  • (+) DM – grandfather
  • (+) goiter – grandmother
  • (-) HTN, PTB, Asthma, Cancer
personal social history
PERSONAL/SOCIAL HISTORY
  • Patient is born FT to a then G2P1(0100) mother via SVD in a house c/o midwife. No fetomaternal complications.
  • Patient’s development is at par with age.
  • Patient started schooling at age 6, and is currently in grade 2 at age 8.
  • Patient is an active child, with hobbies including playing and watching TV.
slide11

Patient lives in a 1 storey, ~ 40 sqm house in Batangas with his parents and 2 siblings (3 and 1 yr old). The restroom is located around 2 m away from the bedroom; transportation arpund 5 m away from the house; and school around ___m away from house.

  • Patients mother is a housewife, and his father is a bus driver.Family income is about 500-3000/month.
  • Currently, patient’s medical bills were paid from money borrowed from relatives.
immunization
Immunization
  • Complete EPI from the local health center.
nutrition
Nutrition
  • Patient likes to eat fruits, meat, and junkfood.
slide17

GENERAL SURVEY

Patient was received awake, conversant and speaking in sentences, Not in cardio-respiratory distress, oriented to 3 spheres, GCS 15

VITAL SIGNS

  • BP:100/80
  • HR: 98
  • RR: 20
  • T: Afebrile to touch
slide18

HEENT

Anicteric sclerae, pale palpebral conjunctivae, (-) nasal or aural discharges, pale buccal mucosa and tongue, pale lips, (-) tonsillopharyngeal congestion (-) anterior neck mass (-) neck vein engorgement.

CHEST /LUNGS

(-) gross deformities symmetric chest expansion, clear breath sounds (-) crackles (-) wheezes (-) ronchi

slide19

CVS

(-) heaves, (-) thrills, distinct heart sounds, normal rate, regular rhythm

ABDOMEN

Flabby abdomen, normactive bowel sounds, soft to palpation, (-) masses (-) tenderness (-) organomegaly

slide20

SKIN and EXTREMITIES

Full and equal pulses, pale nail beds, good capillary refill (-) edema (-) cyanosis (-) clubbing.

PE on admission:

  • R lower extermity attitude
    • internal rotation;
    • shortened ~ 4 cm,
    • no sensory deficits
    • Limitation motion of the R hip due to pain (minimal)
  • Palpable bony deformity of R hip
  • Galleazi sign
slide21

Currently

Patient’s R leg on Pin traction, L leg on foam traction. Leg length of L, ___, of R ____.

slide22

NEUROLOGIC EXAMINATION

Patient is awake, coherent, oriented to three spheres, and follows commands.

CN I: intact smell

II: pupils 3-3mm EBRTL, (+) visual threat; (-) visual field cuts

III, IV, VI: full intact EOMs

V: brisk corneals, V1 V2 and V3 sensation intact on both sides. Good masseter tone and temporalis.

VII: (-) facial asymmetry

VIII: intact gross hearing

IX, X: Good gag reflex.

XI: good shoulder shrug

XII: tongue midline

Cerebellars: No nystagmus, dysmetria and dysdiadochokinesia;

Meningeal Examination: (-) Brudzinski’s, (-) kernig’s

xray results
XRAY RESULTS
  • Superiorly and posteriorly dislocated, R hips. No acetabular change.
assessment
ASSESSMENT
  • Chronic Hip Dislocation, R secondary to trauma
plan of ortho department
PLAN OF ORTHO DEPARTMENT
  • Skeletal traction, increase in weight for 2 weeks. If failed after maximum weight ~10 kg, would consider OR, possible fixation hip spica?