Wednesday, November 23, 2011

Case 4

Case of Bilateral AVN

Patient  is a 65 year old male who presented with 
C/o pain in the right hip since 5 years and 
C/o pain in the left hip since 1 month
C/o inability to walk since 1 month

HOPI:
Pt was apparently alright 5 years back when he experienced a fall in his residence, trivial in nature following which he was able to get up and walk though it was painful. Patient took rest at his home and had OTC analgesics. He was alright with in a week  though he experienced pain occasionally on and off with activity. The pain has progressively increased ever since with increasing frequency and severity with disabling intensity since 1 month. Patient experiences pain in the right hip radiating to the right knee. Patient is also experiencing pain in the left hip since 1 month. Patient is unable to sit cross-legged and squat since one month. 
No history of fever
No h/o weight loss
No h/o decreased appetite

O/e: 
Past history:
History of hip surgery in child hood with no any intra/post op complication.
No history of any chronic illness/long term medications.
No history of any allerdies to drugs.
No significant past/personal history and general examination findings.
HIP EXAMINATION:
Inspection:
Patient is examined in supine decubitus
Rightlower limb in 45 degrees flexed position.
Apparently shortened limb.
Right ASIS is at higher level.
Scarpas triangle is free.
Gluteal,thigh muscle wasting present.
no sinuses,swellings,dilated veins or pulsations.
Palpation:
No local rise of temperature,ASIS at higher level at Rt side.
Joint tenderness ant and post.Greater trochanter nontender, relatively lessprominent,poximally migrated,irregular,broadened.
Femur shaft nontender and normal.
Movement:
FFD: 20 DEGREES.
ADDUCTION DEFORMITY:10 DEGREES
EXTERNAL ROTATION:5 DEGREES
INTERNAL ROTATION:5 DEGREES
Measurements:
Apparent shortening 5cms.true shortening 2cms.
2cms wasting of thigh muscles.
2cms supratrochanteric shortening,confirmed by byrants triangle base.
specific tests:
Narath sign: negative.
Nelton’s line trochanter is above the line.
Shoemaker’s linecoinciding on Left of midline below the level of umblicus.

Plain Xray of Pelvis with both hips shows the dense sclerotic and deformed head of Rt femur with changes in acetabulum left hip is apparently normal on X ray

MR Findings







Click on image below to view image n scroll through the series of images in actual size



















































1 comment:

  1. There is some disparity in measurements!

    ReplyDelete