Case2

Brief History:

25 years old male, asymptomatic 5 months back, sustained injury in RTA about 5 months back, insignificant impaction as pt returned to job immediately.

History of massage therapy for initial one month.

Pain around left hip. Restricted hip movements. Pain more in night, night cries present.

Unable to squat, sit crossed leg, almost bed ridden since 1 month.

No history of swelling, discharge.

Weight loss +,decrease appetite +.

Brief positive finding:

On general examination:

cachexic,malnourished anemic patient,uncomfortable due to pain.

Unable to bare weight on left lower limb(antalgic gait)

HIP EXAMINATION:

Inspection:

left lower limb in 45 degrees flexed position.

Apparently shortened limb.

Left ASIS at higher level.

Scarpas triangle is free.

Loss of prominence over greater trochanter region.

Gluteal,thigh muscle wasting present.

No scars ,sinuses,swellings,dilated veins or pulsations.

Palpation:

No local rise of temperature,

ASIS at higher level at left side.

Joint tenderness ant and post.

Greater trochanter tender, relatively less prominent,poximally migrated,irregular,broadened.

Femur shaft nontender and normal.

Movement:

FFD: 45 DEGREES.

ADDUCTION DEFORMITY:10 DEGREES

EXTERNAL ROTATION:5 DEGREES

INTERNAL ROTATION:5 DEGREES

Measurements:

Apparent shortening 4 cms.

true shortening 2 cms.

2cms wasting of thigh muscles.

2 cms supratrochanteric shortening,confirmed by byrants triangle base.

specific tests:

Narath sign: negative.

Nelton’s line coinciding on rt side below level of umblicus.

Shoemaker’s line : trochanter is out side of the line.

X RAYS FINDING:

HEMI PELVIS ,LEFT HIP A/P AND FROG LEG VIEW.

SHENTONS LINE WELL MAINTAINED.

LOSS OF GREATER TROCHANTER COUNTOR,EROSION OF GREATER TROCHANTER.

MULTIPLE CALCIFIED LEISON AROUND THE HIP JOINT IRREGULAR AND VARIATING IN SIZE.

EROSION OF SUPERIOR,WEIGHT BEARING SURFACE OF HEAD OF FEMUR AND ROOF OF ACETABULUM.

D.D OF –RAY FINDING:

1.MYOSITIS OSSIFICANS.    3.CHRONIC IFECTIVE PATHOLOGY AROUND HIP.? Tuberculosis.

2.NEOPLASM OF GREATER TROCHANTER.

Whats ur Dx?