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 .
Cecilia Lim Hipolito
CASE OF CHRONIC HIP DISLOCATION
Patient has no known co-morbids and with full and in good functioning capacity until...
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).
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.
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.
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.
Patient was received awake, conversant and speaking in sentences, Not in cardio-respiratory distress, oriented to 3 spheres, GCS 15
Anicteric sclerae, pale palpebral conjunctivae, (-) nasal or aural discharges, pale buccal mucosa and tongue, pale lips, (-) tonsillopharyngeal congestion (-) anterior neck mass (-) neck vein engorgement.
(-) gross deformities symmetric chest expansion, clear breath sounds (-) crackles (-) wheezes (-) ronchi
(-) heaves, (-) thrills, distinct heart sounds, normal rate, regular rhythm
Flabby abdomen, normactive bowel sounds, soft to palpation, (-) masses (-) tenderness (-) organomegaly
Full and equal pulses, pale nail beds, good capillary refill (-) edema (-) cyanosis (-) clubbing.
PE on admission:
Patient’s R leg on Pin traction, L leg on foam traction. Leg length of L, ___, of R ____.
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