nurve injuries

DR. ATIF SHAHZAD PGR ORTHOPEDIC DEPARTMENT

SHL

BIO DATA

Sumera Bibi. 25 yr.Married ,house wife.Right hand dominant. Resident of Mahmoodia Colony Sahiwal.

PRESENTING COMPLAINTS

1. Progressive deformity of Rt. Wrist ---- 2 ½ years

2. Pain and Inability to move Rt. Wrist ---- 1 month

HOPI• Diagnosed as GCT Rt. distal

Radius…………6 years ago.

• Resection and placement of implant

• Resumed her daily activity after 4

m0nths although with decrease

movements of wrist joint.

• Symptoms free for 3 ½ yrs.

• Patient noticed progressively

increasing flexion deformity of her Rt.

Wrist.

CONT……

Pain mild to moderate, continuous, aching.

Aggravated with movement and relieved

with medication.

Limitation of movements of wrist and fingers

CONT……

Difficulty in performing her daily routine

activities and used left hand.

No h/o any associated symptoms

No other systemic complaints.

She came to OPD for consultation regarding

her symptoms.

Past Medical History: Surgery Rt. wrist 6 years back in

private hospital.Family History :

Not significant Personal History :

Married , house wife ,non-addict, non- smoker.

Socioeconomic Status: Poor.

Examination GPE :

A young lady with normal height and built, conscious, well oriented,

Pulse : 98/ minB.P : 110/70mmHgTemp : 98 0 FR/R : 18/min

SYSTEMIC EXAMINATIONRespiratory:

Chest expansion is normalNVB + O

Cardiovascular:S1 + S2 + O

CNS:Intact

GIT: Abdomen is soft, non-tender.B/S audible with normal intensity and frequency.

LOCAL EXAMINATION

LOCAL EXAMINATION Inspection:

1.Flexed posture of Rt. Wrist

2.1 x 10 cm scar mark on dorsal aspect of distal

forearm.

3.Underlying implant visible through 1 x 1 cm

wound.

4.Prominent distal end of ulna.

5.Wasting of muscles of forearm and hands.

6.No erythema, visible pulsations or discharge

from the wound.

CONT….. Palpation:1.Temp is normal with moderate tenderness on

dorsal aspect of distal forearm.

2.Exposed and palpable implant subcutaneously.

3.Scar mark fixed with underlying tissue.

4.Wrist flexion deformity of 550.

5.Forearm circumference of 18 cm on Rt. as

compared to 20 cm on left.

CONT…1. Wasting of thenar and hypothenar

prominences.

2. No swelling or deformity of MCP and IP joints.

3. No palpable axillary lymph nodes.

4. Distal pulses are palpable and comparable

with left forearm.

CONT…Movement:

1. Flexion is 55 to 65 actively and passively

2. Radial and Ulnar deviation not possible.

3. Decreased movements of MCP and IP joints.

4. Distal neurology is intact.

INVESTIGATIONSBaseline Labs:

Hb : 12.2 g/dl TLC : 7800/ul Plt : 123000/ul

Alt : 24 IU/L S/Urea : 23 mg/dl S/ Cr : 0.7 mg/dl Na : 139 mEq/L K : 4.0 mEq/L

CRP : 0.5 ESR : 14 mm

RADIOGRAPH AT PRESENTATION

WHAT TO DO ?

SURGICAL INTERVENTION• Removal of implant and prosthesis.• Centralization of ulna with wrist arthrodesis using 3.5mm DCP and BG

IMMEDIATE POST OPERATIVE RADIOGRAPH

RADIOGRAPHS 6 MONTHS AFTER SURGERY

FOLLOW UP.

THANKS