case study- 4 fracture(1)
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CASE STUDY- 3
Presentator – Dr. Ranjith
Abeysinghe
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Personal details
• Patient name !r. A. ". Ariyasena• Age #$yrs•
Se% !ale• Address &el'(a) *alle• Ci+il stat's !arried•
,'ation !ason• Religion /'ddhist
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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
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History of presentcomplaint
• 7ad tra'ma in Aril 8$2#.• Then a1ter that) 1elt se+ere ain and
s(elling in right 1orearm. Pain aggra+ated
(hen mo+ing the arm and at night. 9naddition to that) di:'lt to mo+ed rarmand he got 1e+er a1ter that. Also Slightde1ormity seen in right 1orearm.
• A1ter see6ing 1or medial ad+ies) b't theresent omlaint still e%ists.;b't ain isno( red'ed<.
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Medical history• =irst he admitted to the &agoda hosital
to get (estern mediine.• P,P (as alied.• *ot anti-biotis and ain 6illers.• Pain (as red'ed b't s(elling) de1ormity
and immo+ability still ersists.• Then a1ter 8 (ee6s) he admitted to the
Ay'r+edi hosital to get Ay'r+edatreatments.
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Family history
•
&o 1amily history• 7a+e three hildren
Occupational history
•
7as (or6ed as a mason in a ri+ateb'ilding. 7ad 1o'ght (ith anothermason and then this tra'ma o'rred.
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Dietary habits
• Rie and +egetables 1or all the threemeals
• Eat meat or >sh one a (ee6• 7as eaten lot o1 siy 1oods• 5ess (ater inta6e
Sleeping pattern• less slee 1rom the hildhood. &o( it is
more dereased d'e to this disease.
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Habits • 7ea+y aloholi and igarette smo6er
• Eat betals at least ?-@ times Bowel habits
• 2 times er 8 days. !ild ain o'r and
lasts 1rom 2$-2# min'tes a1terde1eation. 7ard stools.
Urination
• D& B-#2-8 times er day• &o ain or any abnormal disharge
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Constitution
• Physially - atha-itta• !entally - Rajas g'na
Body constitution• 7eight – #B• Feight – BG 6g• /.!.9. – 8$.@@
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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
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E%amination o1 SIra
• Rasa - a+ara• Ra6tha - madya•
!ansa - madya• !edas - a+ara• Asti - a+ara
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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<
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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.
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• 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.
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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
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Dosha and D'shya•
Dosha!ainly atha Pitta"aha
• D'shya Rasa Ra6tha !ansa Asti
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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
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"n#estigations• K-ray o1 R1orearm
A-P ie( 5ateral +ie(
• =/C
Di$erential Diagnosis• "anda /hagna• Sandi /hagna
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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
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Prognosis
• Yaya – /ody onstit'tion – Dietary habits – Time – !ental state
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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
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'reatment (rotocol)*ls+aid u,-O.u/•
ieli'• >aos'• ndysr mOMsldr• (&76aMr mOMsldr• m7dm7
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'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
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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
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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<.
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• 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.
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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.
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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.
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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.
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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.
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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.
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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
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(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.