DR.

ATIF SHAHZAD
PGR ORTHOPEDIC DEPARTMENT
SHL

BIO DATA
Sumera Bibi.
25 yr.
Married ,house wife.
Right hand dominant.
Resident of Mahmoodia Colony Sahiwal.

PRESENTING
COMPLAINTS
Progressive deformity of Rt. Wrist ---- 2
years
2. Pain and Inability to move Rt. Wrist ---- 1
month
1.

HOPI
Diagnosed as GCT Rt. distal

Radius6 years ago.

Resection and placement of implant
Resumed her daily activity after 4

m0nths although with decrease

movements of wrist joint.
Symptoms free for 3 yrs.
Patient noticed progressively increasing

flexion deformity of her Rt. Wrist.

CONT
Pain mild to moderate, continuous, aching.
Aggravated with movement and relieved with

medication.
Limitation of movements of wrist and fingers

CONT
Difficulty in performing her daily routine

activities and used left hand.

No h/o any associated symptoms
No other systemic complaints.
She came to OPD for consultation regarding

her symptoms.

Past Medical History:

Surgery Rt. wrist 6 years back in

private
hospital.
Family History :
Not significant
Personal History :
Married , house wife ,non-addict,
nonsmoker.
Socioeconomic Status:
Poor.

Examination
GPE :

A young lady with normal height and built,

conscious, well oriented,
Pulse : 98/ min
B.P :
110/70mmHg
Temp : 98 0 F
R/R : 18/min

SYSTEMIC EXAMINATION
Respiratory:
Chest expansion is normal
NVB + O

Cardiovascular:
S1 + S2 + O

CNS:
Intact

GIT:
Abdomen is soft, non-tender.
B/S audible with normal intensity and frequency.

LOCAL EXAMINATION

LOCAL
EXAMINATION
Inspection:
1.Flexed posture of Rt. Wrist
2.1 x 10 cm scar mark on dorsal aspect of distal

forearm.
3.Underlying implant visible through 1 x 1 cm

wound.
4.Prominent distal end of ulna.
5.Wasting of muscles of forearm and hands.

CONT..

Palpation:

1.Temp is normal with moderate tenderness on

dorsal aspect of distal forearm.

2.Exposed and palpable implant subcutaneously.
3.Scar mark fixed with underlying tissue.
4.Wrist flexion deformity of 550.
5.Forearm circumference of 18 cm on Rt. as

compared to 20 cm on left.

CONT
1.

Wasting of thenar and hypothenar

prominences.

2.

No swelling or deformity of MCP and IP joints.

3.

No palpable axillary lymph nodes.

4.

Distal pulses are palpable and comparable with

left forearm.

CONT
Movement:
1.

Flexion is 55 to 65 actively and passively

2.

Radial and Ulnar deviation not possible.

3.

Decreased movements of MCP and IP joints.

4.

Distal neurology is intact.

INVESTIGATIONS
Baseline Labs:

Hb : 12.2 g/dl
TLC : 7800/ul
Plt :
123000/ul

Alt : 24 IU/L
S/Urea : 23 mg/dl
S/ Cr : 0.7 mg/dl
Na : 139 mEq/L
K:
4.0 mEq/L

CRP : 0.5
ESR : 14 mm

RADIOGRAPH AT
PRESENTATION

WHAT TO
DO ?

SURGICAL INTERVENTION
Removal of implant and prosthesis.
Centralization of ulna with wrist arthrodesis using 3.5mm DCP and BG

IMMEDIATE POST
OPERATIVE RADIOGRAPH

RADIOGRAPHS 6
MONTHS AFTER SURGERY

FOLLOW UP.

THANKS