Ortho case
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Transcript of Ortho case
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นพท.คณุสันนัท์ ธนาวฒิุชยานนัท์ วพม.
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Chief complain : ปวดข้อมือซ้าย 2 ชัว่โมง PTA
Present illness :
› 2ชัว่โมง PTA ; ผู้ ป่วยให้ประวตัิวา่ ขบัรถมอเตอร์ไซด์ตกหลมุแอง่น า้ เอามือซ้ายลง ขณะขบัใสห่มวกกนัน๊อคศีรษะไมก่ระแทก ไมส่ลบ จ าเหตกุารณ์ได้ตลอด หลงัเกิดเหตปุวดบริเวณข้อมือซ้าย Pain score 7/10 ข้อมือซ้ายผิดรูป บวม ขยบัข้อมือได้ล าบาก ไมมี่อาการชา จงึสง่มารักษาท่ีรพ.มหาราช
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A- no stridor,can flex,extend,rotation neck
B-equal breath sound ,CCT-negative
C-Pulse 83/min , BP 131/79
D-E4V5M6 ,pupil 3 mm. react to light
E- No back lesion
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• No underlying disease
• No history of drug allergy
• No family history of malignancy , Hypertension, Type 2 DM, Dyslipidemia, Coronary artery disease
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Vital sign : BP 131/79 mmhg PR 83/min
BT 36.8 èC RR 20/min
General appearance : Good conscious ,Alert, Awake
HEENT: no evidence of head trauma, not pale conjunctivae, Anicteric sclerae
Chest: Clear, equal breath sound both lungs
Abdomen: soft, not tender, normoactive bowel sound
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Orthopaedic examination :
left forearm ;
ono swelling, no external wound
o Left forearm and wrist deformity
oLimit ROM of wrist joint
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Can move finger
Paresthsia at left dorsal hand
Capillary refill < 2 seconds
no wrist drop , motor : can’t evaluate
Pulse 2+ all extremities
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Intra-articular fracture
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ORIF c LCP distal radius (VA) c locking
screw
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หลงัผ่าตดัใส่ posterior long arm slab ในท่า supination
2-4 wks
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