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Pedia Ortho SGD

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;

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Pedia Ortho SGD

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  1. Pedia Ortho SGD July 8, 2009

  2. Pedia Ortho Case • M.V.B. • 11 / M • Single • Pampanga • for prosthesis training

  3. 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

  4. -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.

  5. 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

  6. Past Medical History: • (-) BA, PTB, DM, HD • No history of trauma

  7. Family Medical History • (+) BA – mother • (+) HPN – maternal lola • (+) thyroid CA – maternal lola • (-) DM/PTB/HD • No similar case in the family

  8. Personal/Social History • Grade 5 • Engages in sports like soccer and table tennis • Mother- teacher • Father – guidance counselor • Has a younger sister

  9. 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.

  10. FIMS • Presently improved by 5 pts (standing, ambulation, stair climbing, transfer activities, bathing)

  11. 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

  12. 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

  13. DTRs normoreflexive • Neurologic Exam: E/N

  14. Present Working Impression: • Congenital Pseudoarthrosis of the Tibia, L s/p Transtibial Amputation, L (1/9/09, PGH) s/p Ilizarov

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