case study- 4 fracture(1)

7/24/2019 Case Study- 4 Fracture(1)

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CASE STUDY- 3

Presentator – Dr. Ranjith

Abeysinghe



Personal details

• Patient name !r. A. ". Ariyasena• Age #$yrs•

Se% !ale• Address &el'(a) *alle• Ci+il stat's !arried•

,'ation !ason• Religion /'ddhist



Present omlain 0 d'ration

• Main complain

Pain and s(elling in the right 1orearm1or 2 month• Other complaints

Red'e normal mo+ements o1 r1orearm1or 2 month

Slight de1ormity and sti4ness in right1orearm sine 2 month

5oss o1 aetite sine 3 (ee6s



History of presentcomplaint

• 7ad tra'ma in Aril 8$2#.• Then a1ter that) 1elt se+ere ain and

s(elling in right 1orearm. Pain aggra+ated

(hen mo+ing the arm and at night. 9naddition to that) di:'lt to mo+ed rarmand he got 1e+er a1ter that. Also Slightde1ormity seen in right 1orearm.

• A1ter see6ing 1or medial ad+ies) b't theresent omlaint still e%ists.;b't ain isno( red'ed<.



Medical history• =irst he admitted to the &agoda hosital

to get (estern mediine.• P,P (as alied.• *ot anti-biotis and ain 6illers.• Pain (as red'ed b't s(elling) de1ormity

and immo+ability still ersists.• Then a1ter 8 (ee6s) he admitted to the

Ay'r+edi hosital to get Ay'r+edatreatments.



Family history

•

&o 1amily history• 7a+e three hildren

Occupational history

•

7as (or6ed as a mason in a ri+ateb'ilding. 7ad 1o'ght (ith anothermason and then this tra'ma o'rred.



Dietary habits

• Rie and +egetables 1or all the threemeals

• Eat meat or >sh one a (ee6• 7as eaten lot o1 siy 1oods• 5ess (ater inta6e

Sleeping pattern• less slee 1rom the hildhood. &o( it is

more dereased d'e to this disease.



Habits • 7ea+y aloholi and igarette smo6er

• Eat betals at least ?-@ times Bowel habits

• 2 times er 8 days. !ild ain o'r and

lasts 1rom 2$-2# min'tes a1terde1eation. 7ard stools.

Urination

• D& B-#2-8 times er day• &o ain or any abnormal disharge



Constitution

• Physially - atha-itta• !entally - Rajas g'na

Body constitution• 7eight – #B• Feight – BG 6g• /.!.9. – 8$.@@



E%amination o1 Srothas

• Anna (aha srotas- – Agni Abya+arana sa6ti – A(ara

Harana sa6ti - A(ara

• Rasa +aha srotas - a(ara• Ra6ta +aha srotas – madya

• !ansa +aha srotas – madya• Asti +aha srotas – a(ara



E%amination o1 SIra

• Rasa - a+ara• Ra6tha - madya•

!ansa - madya• !edas - a+ara• Asti - a+ara



Local !amination Tri+ida ari6sha on a4eted site

• Darshana ari6sha• De1ormity in 23 o1 right 1ore arm• S(elling in that area• Red'ed the mo+ements o1 r1orearm

• Sarshana ari6sha• !oderate ain (hen to'hing the a4eted arm• Di4erent mo+ements'nable to er1orm orret

mo+ements (hen to'hing• 7eard so'nds (hen to'hing;Jhimi Jhimi<

;reit's<

• Prashna ari6sha•

Pain resent (hen e%amination;tenderness<



Aording to &idana anha6a

• Ca'ses ;&idana< – 7as eaten lot o1 siy 1oods be1ore getting

this tra'ma –

5o( ons'mtion o1 (ater – For6ed hard and had less time ha+e a rest – Alohol) igarette inta6e – 5ess slee) onstiation – ata ra6riti) rajas g'na These 1ators may hel to aggra+ate the

disease and red'e the healing o1 1rat're.



• R'a – !oderate ain in a4eted area – S(elling and sti4ness in r1orearm – Di:'lt to do normal mo+ements

• Samrati – D'e to tra'ma) and the 1rat're o1 the

bone) mainly ata and also Pitta 0

"aha doshas get +itiated 0 a4et onrasa) ra6tha) mansa and asti dath'sand rod'ed the de1ormity) ain)s(elling and loss o1 normal mo+ements.



Pathogenesis

Aganth'ja &idana;tra'ma<

=rat're o1 the right 1orearm

itiated ata) Pitta 0 "aha dosas

A4ets on rasa) ra6tha) mansa) asti dath's

A'm'lated in right 1orearm

Pain) s(elling) de1ormities in right 1orearm

Unable to er1orm normal mo+ements o1 r1orearm



Dosha and D'shya•

Dosha!ainly atha Pitta"aha

• D'shya Rasa Ra6tha !ansa Asti



Roga marga) Srothas and Srothod'sti

• Roga margaya;site o1 disease< – e%ternal;/ahira<

• Srothas – Asti (aha srothas – Rasa) ra6tha) mansa (aha srothas

• Srotho d'sti- Sanga



"n#estigations• K-ray o1 R1orearm

A-P ie( 5ateral +ie(

• =/C

Di$erential Diagnosis• "anda /hagna• Sandi /hagna



Diagnosis

• %anda bhagna – Pain) s(elling in 23 o1 r1orearm – Sti4ness – 7eard so'nds (hen mo+ing the arm – Unable to er1orm normal mo+ements o1

r1orearm



Prognosis

• Yaya – /ody onstit'tion – Dietary habits – Time – !ental state



Ci&ithsa sutra2 (&sLd1M yD1Ma i6aN iajd% hdMs mOlDMs% m6Q

LDM os.a1oa6 m16 19aghsMajd hd N m1gdamr lYd6a oMajd hdjoa n6a, 'd1rMa

8 FMams9a*' 9a)s9ag% i6aN% 4jo7d6 Lg1haMa

MMQ YMd6 mrs1Yal% mO1oayd%Yajdr1haMa

3 &.a6 'd1oV mrsWdh lDMs% mOlDMs% 61haMa MMQ YMdXn6d is%1Ma mM m%Za6 jd MMQ

iYOeM i%ysMdj



'reatment (rotocol)*ls+aid u,-O.u/•

ieli'• >aos'• ndysr mOMsldr• (&76aMr mOMsldr• m7dm7



'reatment

• 0byanthara)"nternal1

- Seially atha shama6a dr'gs- Dasham'la 6asaya [ babila m'l[s'd'l'n'

- 5a6shadi g'gg'l' 2 b.d. (ith (arm (ater

- Thalisadi h'rna 2 tea soon (ith (arm (ater b.d.

• Bhahira)!ternal1- Aliation o1 &ilyadi oil and orret the osition o1

bones- Alied "ata6ala aste and bandaged (ith sti6s

• Sathwawa2aya Ci&ithsa



Pathya aathya• Pattya

– 5ight diet is ad+ised. – Ta6e lenty o1 Z'ids and (ater – Red'ed the mo+ements o1 rarm 'ntil

omlete 're – !editations and yoga to red'e stress and

an%iety

• Aathya – Siy and 1ermented 1ood – Alohol) igarette inta6e –

S(imming in old (ater



0natomy of the forearm

• The radi's and 'lna ha+e an imortant role in

ositioning the hand. The 'lna has a stabilising role)(hile the radi's is arti'lated in a (ay (hih allo(sit to roll o+er the 'lna) mo+ing the hand 1roms'ination ;e%ternal rotation< to ronation ;internalrotation<.

• The t(o bones o1 the 1orearm are the radi's)laterally) and the 'lna) medially. ,ther omonentso1 the 1orearm inl'de s6in) blood +essels) and so1ttiss'e.

• At its 'er end) the radi's arti'lates (ith theait'l'm o1 the h'mer's at the elbo() and (ith the'lna ;s'erior radio 'lnar joint<. At its lo(er end itarti'lates (ith the sahoid and l'nate bones and

also (ith the 'lna ;in1erior radio 'lnar joint<.



• At its 'er end) the 'lna arti'lates(ith the trohlea o1 the h'mer's) and

(ith the head o1 the radi's ;s'eriorradio 'lnar joint<. At its lo(er end itarti'lates (ith the radi's ;in1erior radio

'lnar joint<.

• The oleranon roess at the 'er end

o1 the 'lna 1orms the rominene o1 theelbo(. The styloid roesses o1 theradi's and the 'lna 1orm rominenesat the (rist.



Forearm fractures• =orearm 1rat'res ao'nt 1or most limb

1rat'res. Frist 1rat'res are the mostommon 1orearm 1rat're.• =rat're ris6 1ators inl'de osteoorosis

;more ommon in (omen than in men<

and malignany ;athologial 1rat'res<.• =rat'res o1 the radi's and 'lna may

o'r in isolation - 's'ally d'e to a diret

blo( - b't these are 's'ally assoiated(ith 1rat're or dislaement o1 theother bone in that 1orearm.



Classi3cation• =orearm 1rat'res an be lassi>ed as

either ro%imal) middle or distal.• They an a4et one or both 1orearm

bones.

• They are either oen or losed.• Pro%imal 1orearm 1rat'res may

in+ol+e the elbo( joint.• Distal 1orearm 1rat'res may in+ol+e

the (rist.



Mechanism of in2ury

's'ally a signi>ant 1ore inj'ry. These

most ommonly o'r in motor +ehileaidents) and also o'r 1rom a diretblo() a 1all 1rom a height or d'ring sort.

(resentation

ain and s(elling at the site (ith ob+io's

de1ormity.



0ssessmentmay be ner+e in+ol+ement (ith

araesthesiae) aresis or loss o1 1'ntion.Do not eliit reit's) as this may a'se1'rther so1t tiss'e inj'ry. Do not robe

oen 1rat'res as this may a'se deeerontamination.

"n#estigation

K-ray the entire length o1 the 1orearm)(rist and elbo() (ith AP and lateral+ie(s. Consider omartment syndrome.



Management• dislaed 1rat'res are the 's'al

sit'ation in ad'lts.• ,erati+e treatment (ith internal

>%ation or intramed'llary nailing (ill

be needed in nearly all ases) so re1er'rgently.• Closed red'tion may be attemted

;(ith s':ient sedationanalgesia ]m'sle rela%ants< i1 there is a'tene'ro+as'lar omromise.



Complications of forearm fractures• &on-'nion and mal'nion ;'nommon<.

• Comromise o1 the brahialradialartery blood s'ly.

• !edian) 'lnar or radial ner+e inj'ry.

• 9n1etion ;more li6ely i1 the 1rat're isseondary to a r'sh inj'ry<.

• Comartment syndrome ;more ommon

in both-bone 1orearm 1rat'res<.• Radio 'lnar 1'sion ;synostosis<.• Re-1rat're

(re#ention of forearm fractures



(re#ention of forearm fractures

•

Pre+ention o1 osteoorosis.• Ade'ate treatment o1 e%isting

osteoorosis.•

The 'se o1 (rist and elbo( g'ards(hilst ta6ing art in ertain sortingati+ities) s'h as mo'ntain bi6ing ands6ating.



'han& 4ou

case study- 4 fracture(1)

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