Pedia Ortho SGD

July 8, 2009

Pedia Ortho Case

M.V.B. 11 / M Single Pampanga for prosthesis training

History of Present Illness at birth (1998) – born by a G1P0 mother via NVSD at a hospital,

assisted by a doctor. No FMC; At 1.5 months old – patient’s left leg was observed always in

flexion, prompting consult at a local physician, diagnosed as CPT and managed with serial casting, with no improvement

At 3 months-4 years old – underwent 8 operations for application of Ilizarov fixators, but all were unsuccessful. Family decided to discontinue the Ilizarov since the patient is already schooling, and settled for crutches instead.

At 10 yrs (2008) – Px was seen at a medical mission held at Pampanga. Leg length discrepancy was observed and left leg amputation was suggested to make the limb functional, which they heeded

-confined at Ward 8 of PGH and transtibial amputation was done was done with no complication.

At 11 yrs old (April 2009) – Referred to rehab for fabrication of prosthesis, admitted for 2 weeks for correction of flexion contracture. Px now readmitted for gait training with prosthesis.

Review of Systems

(+) fever (+) prod cough(-) abd’l pain

(-) weight loss (-) colds (-) BM changes

(-) anorexia (-) dyspnea (-) GU changes

(-) headache (-) orthopnea (-) dysuria

(-) nausea (-) chest pain

(-) vomiting (-) easy fatigability

(-) BOV (-) easy bruisability

Past Medical History:

(-) BA, PTB, DM, HD No history of trauma

Family Medical History

(+) BA – mother (+) HPN – maternal lola (+) thyroid CA – maternal lola (-) DM/PTB/HD No similar case in the family

Personal/Social History

Grade 5 Engages in sports like soccer and table

tennis Mother- teacher Father – guidance counselor Has a younger sister

Living conditions

Lives in a concrete 2-storey house one step up the road

Room on the 2nd floor, with 14-step stairs going up.

FIMS

Presently improved by 5 pts (standing, ambulation, stair climbing, transfer activities, bathing)

Physical Examination

E/N Systemic Findings Extremities: left leg partially sagging bulbous

9.5 cm stump, 10° flexion contracture, valgus deformity

MMT: B upper and R lower ext: 5/5 L lower ext: iliopsoas, adductor magnus,

quads and hamstrings – 4/5

ROM: full range of motion B upper and R lower extremities L hip flexion – 110 L hip extension – 0-30 L hip abduction – 0-45 L knee flexion – 10-120 L knee extension – 120-10

DTRs normoreflexive Neurologic Exam: E/N

Present Working Impression:

Congenital Pseudoarthrosis of the Tibia, Ls/p Transtibial Amputation, L (1/9/09, PGH)

s/p Ilizarov