Tibia Fibula Case 02 Final.pptx ftvuhuhihi huhuhubu
- 1. CASE STUDY OF TIBIA – FIBULA SEGMENTED FRACTURE PRESENTED BY – VEDIKA S. WANKHADE & SARVESH R. BEHETWAR
- 2. Definition: A type of fracture where the broken bone pierces through the skin, creating an open wound. It is also called as compound fracture. • OPEN FRACTURE • Bone is visible through the wound or protruding. • High risk of infection. • Usually caused by severe trauma. (e.g., accident, falls) Treatment: Immediate wound cleaning, antibiotic, surgical fixation. • SEGMENTED FRACTURE Definition : a type of fracture where the same bone is broken in two or more separate places, creating at least one segment of bone between the breaks. Causes : usually due to high-impact trauma ( e.g., road accidents, falls from height). Treatment: Surgical fixation using plates, rods, or external fixators.
- 3. STRUCTURE OF TIBIA AND FIBULA BONE
- 4. • ETIOLOGY 1)High Energy Trauma Include Motor Vehicle Accident Crash Injury 2) Direct Blunt Trauma Sudden blow of Force on Tibia or Fibula Like Sports Injury, Assaults and Bullets 3) Pathophysiology Conditions Rare But can occur include Osteoporosis and Bone Tumour 4) Repetitive Stress( Rare Cases ) Seen in Military Recruit and Athletes
- 5. • SUBJECTIVE DATA • NAME – XYZ • AGE – 55 years • Sex – Male • D.O.A. – 01/07/2025 • REG. NO. – 19783 • WARD NO. – 15 • BED NO. – 4 PAST MEDICAL & MEDICATION HISTORY: NO SOCIAL HISTORY: i) ALCOHOL – NO ii) SMOKING – NO iii) TOBACCO – NO iv) ALLERGY – NOT KNOWN H/O : Fall from bullock cart. Leg Crash C/O : Pain & Inflammation in leg with bleeding was seen. L/E : Leg moment – Negative ROM - Negative Swelling – Positive Wound – Positive
- 6. • OBJECTIVE DATA TEST RESULT REFRENCE FLAG Total bilirubin 0.74 mg/dl 0.10 - 1.20 Normal Direct bilirubin 0.27 mg/dl 0.00 - 0.30 Normal Indirect bilirubin 0.47 mg/dl 0.20 – 1.00 Normal SGOT 91.33 U/L 0.00 – 45.00 High SGPT 29 29 U/L 0.00 – 45.00 Normal Alkaline phosphatase 71.45 U/L 39.00 – 137.00 Normal Total protein 6.90 g/dl 6.00 – 8.30 Normal • Liver Function Test • ECG Report : Normal • HIV Report : Negative • City Scan : No obvious trauma related intracranial abnormality detected. No obvious fracture of the skull vault.
- 7. • Renal Function Test Test Result Reference Flag Albumin 4.44 g/dl 3.20-4.00 Normal Globulin 2.46 g/dl 0.20-1.00 High Urea 24.36 mg/dl 13.00-45.00 Normal Creatinine 096 mg/dl 0.60-1.40 Normal Uric Acid 7.05 mg/dl 2.50-7.20 Normal • Investigation HB :- 11.5 g/dl BT :- 2 min 20 sec CT :- 4 min 40 sec Blood Group :- B +ve Bl. Sugar :- 105.41 mg/dl Bl. Urea :- 24.38 mg/dl Sr. Creatinine :- 0.96 mg/dl HBS AG :- -ve B20 :- -ve ( low ) Normal range :- 13.8 – 17.2 g/dl
- 8. • GLYCOCYLATED HAEMOGLOBIN ( HBA1C) – 5.3% Bio. Ref. Interval Non Diabetic : Below 5.7% Pre Diabetic : 5.7% Diabetic : >= 6.5% Unsatisfactory : 8.0 – 10% Poor Control : >10% • ASSESSMENT • Provisional Diagnosis :- Fracture in Right – tibia midshaft region X – ray recommended. • Final Diagnosis :- Tibia – Fibula fracture, segmented fracture. Surgery / Procedure – External fixation and Tibia Nailing.
- 9. Pre Operative And Post operative X RAYs
- 10. • CLINICAL NOTES • DAY 1 (01 – 07 – 25) S/B Ortho RTA RT Crash injury Laceration over Lt eye brow O/E GC – mod Temp – 100/60 mm Hg PR – 86 bpm SPO2 – 97% S/E CVS – S1 & S2 +ve CNS – Unconscious RS – AP2 BP2 PA - Soft Rx Inj. T.T. 0 – 1 Inj. Diclo. Inj. Tramadol in 100 ml NS Inj. Taxim 1gm IV BD Inj. PAN 40 mg OD Inj. Ondem IV BD IVF. NS (2 units) RL (2 units) DNS (2 units) Thiamine (300 mg) - (100 ml NS) 1 – 0 - 0 Advise – X - ray
- 11. • DAY 09 (09 – 07 – 25) S/B Ortho O/E GC – mod Temp – Afeb PR – 78 bpm BP – 110/70 mm Hg SPO2 – 99 % S/E CVS CNS } NAD RS PA Rx Same Continued Medication Inj. Metro
- 12. • DAY 15 (15 – 07 – 25) S/B Ortho O/E GC – mod Temp – Afeb BP – 110/70 mm PR – 80 bpm SpO2 – 98% S/E CNS CVS } NAD RS PA Rx : - Same Continued Medication Inj. Metro
- 13. • DAY 26 (26 – 07 – 25) S/B Ortho O/E GC – mod Temp - Afeb Rx Same Continued Medication Inj. Piptaz (omit) Start Tab Linozoied. 600 mg BD
- 14. • DAY 29 ( 29 - 07 – 25) S/B Ortho O/E GC – mod Temp – Afeb BP – 110/70 mm/Hg PR – 92 bpm SpO2 – 98% S/E CVS CNS } NAD RS PA Rx Same Continued Medication Tab Cipro.
- 15. • Drugs Prescribed 1. Inj. Tramadol in 100 ml NS 2. Inj. TAXIM 1 gm IV 3. Inj. Diclo IV 4. Inj. Pan 40 mg IV 5. Inj. Ondem 4 mg IV 6. Tab. Calcium 7. Inj. Piptaz 4.5 gm 8. Inj. Amikacin
- 16. • Drug Info Name MOA Effect Inj. Tramadol Binds to MU- Opiod Receptor Inhibit the epinephrine uptake. Narcotic Analgesic used to given in severe pain Post Operative and In Trauma Pain. Inj. TAXIM Inhibits the cell wall synthesis by binds to (PBPs) Casuse Cell wall lysis and cell death. Inj. Diclo Inhibits (COX1 And COX2)Enzymes Analgesic , Anti- inflammantry and Anti-pyretic effects Inj. Pan 40 mg Proton pump inhibitor irreversibly inhibits k+/H ATPase PPI Prescribed for acidity induced due to medication. Active ingredient Pantoprazole. Inj. Ondem 4 mg Blocks Serotonin 5HP3 Receptor. Prevent nausea, Vomiting, Which is caused by Medication. Inj. Paptaz Inhibits the cell wall synthesis by binds to (PBPs) Cause Cell wall lysis and Cell Death. Inj. Amikacin Binds irreversibly to 30S Ribosomal Subunit of Which initiates mRNA Translation. No RNA Translation lead Affected Protein Synthesis lead to cell death. In Gram –Ve bacteria.
- 17. Name MOA Info & Effect Inj Merto (Metronidazole) In Anaerobic bacteria in which it gives reduced and Cause DNA Break. Inhibits the Nucleic acid Synthesis lead to cell Death. Tab Cipro 500 mg (Ciprofloxacin) Inhibit Topoisomerase Enzyme( Used to unwind DNA Strand) .Inhibit the DNA Replication and Transcription.
- 18. • Drug Interaction • Tramadol + Ondansetron– ondansetron is responsible for for reducing tramadol pain relieving ability. • Diclofenac + TAXIM – Can cause the nephron Toxicity. • TAXIM + Pantoprazole– Pantoprazole may decrease the absorption of Cefotaxime. • Amikacin+Taxim– Amikacin can sometimes cause kidney damage when used with Cephalosporin Antibiotic. • Piperacillin + Amikacin—Piperacillin may reduce the effect of Amikacin if mixed in same IV Fluid. • Amikacin+ Diclofenac—Amikacin can cause the kidney damage when used with Diclofenac
- 19. Pharmacist Intervention • Avoid giving Amikacin and Piperacillin into same IV Fluid. • Monitor the Nephron toxic Drug interaction. • As Patient is not alcoholic ,Smoker,Tobacco Chewer And Allergic to any Drugs so other Alteration in Prescription is needed.
- 20. THANK YOU Reference : • Case study taken from District general hospital, Amravati. • Drug Bank • Drug.com