Luke J. Frost was admitted on 70/21/y-2 and discharged on 07/24/y-2. Diagnosis on admission was fracture of the left femur distal third. Diagnosis on discharge was fracture of the left femur distal third and sciatic neuropraxia.
Surgery closed reduction and percutaneous pinning of the distal femur fracture and application of long-leg cast were done. The 5 year old male patient was admitted on 07/21/y-2 and prepared for surgery on 07/23/y-2. A neurologic examination showed that motor and sensory functions were absent. There was no pain experienced on passive stretch. Cast was bivalved and continuous progress was observed on the patient. Tylenol no.3 Elixir medication was given on discharge. Patient has a history of seizures no known allergies temp. 98.7 pulse 106 and respiration 24.
MR-2 part 1 07/27/Y-2 through 08/06/y-2
Your City Childrens Hospitals (YCCH) initial diagnosis indicated ischemic left leg left distal femur fracture post pinning and cast saw cuts. The patient complained of having purple left toes. The father recalls that the patients toes turned blue after surgery. The cast was split to allow the leg to swell due to the urgency to return to the states. They discussed the alternative methods of immobilizations as well as those appropriate for open physic. The report indicated that there was potential growth of distal femoral physic that is commonly fixed through internal intra-medullar Roding. Afterwards the parents with the help of the doctors determined the optimal course to perform with closed reduction and percutaneous pinning to prevent any swelling that might occur during the flight. On examination the patient was anxious. He was administered with pain medication and fentanyl. Cast split did not reach the knee. He also had a split in the cast behind the heel calf and thigh. The patient is to undergo an angiogram. The left knee is to be disarticulated on 07/29/y-2. The patient is taken through rehabilitation course with PT OT and TR.
MR-2 part 2 07/27/Y-2 through 08/06/y-2
The patient was briefly attended to at St Elias. Here further bivalving of the cast was done before he was transferred to YCCH. Initial diagnosis was ischemic foot with obvious discoloration. There was no pulse with apparent lacerations caused by cast bivalving. An angiogram revealed that there was no circulation at the level of the popliteal artery distally. Planned amputation was commenced after discussion with the family and orthopeadic and plastic surgery service was done. The family agreed and gave a written consent. The patient was attended to by rehab medicine and plastic surgery on 07/28/y-2. After surgery the patient was extubated and moved to the pediatric intensive care unit in stable condition. The patient will continue on IV cefazolin monitoring of CPKs. In addition he will maintain his drain for a few days. He will also need x-rays.
MR-2 part 3 07/27/Y-2 through 08/06/y-2
The patient made positive developments during his short in-patient rehabilitation exercise. The patient showed safe ambulation with FWW and CGA to changeover to toilet. He showed safe standing pivot transfer to BSC and showed LB dressing in bed. The parents were also taken through the rehab course and verbally exhibited understanding of all strategies. Upon discharge the patient was able to carry out simple tasks. Thus no out patient services were recommended. The patient is subjected to a mental evaluation due to the patients father concerns. Notably the patient and the family understand and are coping with this challenge. This is through emotional support from their community.
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