Pediatric Orthopedic Conditions

Block 5AJanuary 6, 2010

Identifying data

MA6 years old, FemaleFilipino, Roman CatholicRight handedFrom Isabelac/c gross deformity of R leg

History of Present Illness

DOI: Dec 2006TOI: 10 AMPOI: House, IsabelaMOI: Fall

History of Present Illness

4 years PTA (Dec 2006)◦Patient was then 2 years old, can already maintain

balance in running and walking◦Patient was running in their house when she slipped

and fell on a one step approximately half a foot high in a kneeling position

◦Patient was then brought to a hospital in Isabela◦X-ray of the R foot showed fracture of the Distal third

of the Tibia◦Casting was then done from ankle to above the knee

and was maintained for 6 months◦No traction done◦Patient was not allowed to walk by parents at this time◦Cast was then remove with a note of small mass at

the site of the fracture

2 years PTA (May 2008) Patient underwent Intramedullary nailing of the

fracture

In the Interim patient was able to walk, still with R leg shorter

than L Patient’s foot was progressively bending at the site

of the fracture with noticeably increased leg length discrepancy

No consults were done due to financial constraints

Review of systems

(-) DOB(-) chest pain(-) palpitation(+) occasional aspiration(-) cough, colds(-) fever, malaise, anorexia, (-) edema(-) abdominal pain(-) urinary changes(-) bowel changes

Past Medical History

Chicken Pox (sept 2009)“combulsion” at 1 year old described as

very high fever, which required hospital admission and was subsequently given unrecalled IV antibiotics

(-) bronchial asthma, recurrent fever, coughs colds

(-) food and drug allergy(-) PTB

Family Medical History

(-) congenital anomaly(+) BA- Father(+) Pulmonary TB- grandfather, completed

6 months of medicationAllergy to chicken- younger brother(-) HPN, DM, Ca, Kidney, liver diseases

Personal Social History

Grade 1Eldest of 2Hobbies include playing with siblings and

female playmates

Birth and Maternal History

Born FT to a then24 year old mother G1P0 via Ceasarian Delivery secondary to

fetopelvic disproportion, pelvimetry was inadequate

Regular prenatal check –up c/o OB with no known comorbidities

Denies smoking, alcohol intake, drug usePatient was already noticed with leg

length discrepancy with no other gross deformities and congenital anomalies

(-) FMC

Immunization

Completed EPI given at the local health center

Developmental HistoryAt par with age

Physical Examination

Awake, alert, cooperative, ambulatory NICRD, comfortably sitted in bed with obvious gross deformity of the Distal third of the R leg

BP 90/60 HR 96RR 24Temp afebrile

PHYSICAL EXAMINATIONHEENT: no gross deformities, structural

congenital anomalies on the head, face and neck, anicteric sclerae, pink palpabral conjunctivae, (-) tonsilopharyngeal congestion (-) cervical lymphadenopathies

CHEST & LUNGS: (-) gross deformities, symmetric chest expansion, clear breath sounds (-) wheezes (-) crackles (-) rhonchi

PHYSICAL EXAMINATIONCVS: adynamic precordium (-) heaves (-)

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

Abdomen: flat abdomen, normoactive bowel sounds, soft to palpation (-) organomegaly (-) tenderness on deep and light palpation

EXAMINATION OF THE EXTREMITIES

Lower extremity, right:◦Full and equal popliteal, anterior and posterior

dorsalis pedis pulses◦No sensory deficits◦Pink nail beds on all digits ,(-) clubbing,

cyanosis◦(+) scar 5 inches x 1 cm at the site of the

operation◦Attitude of the foot: Distal third of leg is

angulated approximately 45 degrees posteriorly

Gross Picture

Radiographs

EXAMINATION OF THE EXTREMITIES

LEG LENGTH MEASUREMENTRIGHT LEFT

TLL

ALL

Assessment