Medical Records Summary
MR-1 07/21/y-2 through 07/24/y-2
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 performed, closed reduction and percutaneous pinning of the distal femur fracture and application of long-leg cast. The 5 year old male was admitted on 07/21/y-2 and prepared for surgery on 07/23/y-2. Neurologic examination showed lack of motor and sensory functions. There was no pain experienced on passive stretch. Cast was bivalved and continuous progress was observed on the patient. Tylenol no.3 Elixir medication single teaspoon by mouth every four hours was given on discharge. Patient has 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 children’s hospital, initial diagnosis ischemic left leg, left distal femur fracture post pinning and casting, and cast saw cuts. Patient complained of having purple left toes. The father recalls that the patient’s toes turned blue after surgery. Because of the urgency to return to the states the cast was split to allow the leg to swell. They discussed the alternative methods of immobilizations as well as those appropriate for open physic. The report indicated that there was the significance for potential growth of distal femoral physic 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 for 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, also had a split in the cast behind the heel, calf and thigh. The patient is to undergo an angiogram; left knee is disarticulated/amputated on 07/29/y-2. 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, where further bivalving of cast was done before transfer to YCCH. Initial diagnosis was ischemic foot, with obvious discoloration and no pulse with apparent lacerations caused by cast bivalving. An angiogram revealed 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. 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 and 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. Patient showed safe ambulation with FWW and CGA to changeover to toilet, 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, hence no out patient services were recommended. Due to the patient`s father concerns, the patient is subjected to a mental evaluation. It is observed that the patient and the family understand and are coping with this challenge, through emotional support from their community.
MR-2PART 4 07/27/Y-2 through 08/06/y-2
During the mental assessment follow up before discharge, Luke appeared to be petulant with a tendency to screech. The overall view is that the patient was nervous and wanted the mother to assist him with his deeds. The patient is observed to be more comfortable with support from his siblings. The patient responds positively to options given to him. The mother is exhausted and stressed; both the patient and the mother are optimistic about the discharge. Recommendation are, Luke`s behavior is to be checked progressively and adequately reinforced. The prognosis of attaining goal is good due to a caring and highly supportive family. The patient and family both illustrated knowledge and understanding of the situation and the family`s part in maximizing operational independence.
MR-3 PART 1 11/16/Y-2 through 11/26/y-2
The inpatient progressive note from Sun Valley Hospital for Children taken; shows that Luke progressed well after undergoing a knee ambulatory/disarticulation. The wounds have properly healed. From the x-ray it is not clear whether there is a patella although the family confirms that it was removed during amputation. The patient is to be fitted with prosthesis. The consequences of knee disarticulation have been extensively discussed with the patient and the family; they are comfortable with terminal growth. The patient’s femur is normal and it is projected to grow to its full length. Need of adjustments of socket fitting using socks has been adequately articulated because of the importance in change of the limb’s shape. To reduce the length of socket it is recommended the use of seal-in linear to get the pivot of the knee as close as possible to the residual limb.
MR-3 PART 2 11/16/Y-2 through 11/26/y-2
The therapy progress/ discharge note reveals the patient was given ambulation/ gait training. At first the patient was nervous, but was very cooperative with therapy. Thee patient`s immediate family was also present, they also got active in the therapy which provided a lot of encouragement and support to the patient. Patient complained of prosthesis pinching his thigh, Wess Craver was present and made alterations. The patient was confident and optimistic about therapy. The patient was able to stand dynamic and static with minimal assistance. The patient was able to kick a ball with the prosthetic limb but only did it to minimize the body weight he felt on the prosthetic limb. Once some alterations were made to the prosthesis, the patients gait improved tremendously.
MR-3 PART 3 11/16/Y-2 through 11/26/y-2
According to the Sun Valley hospital for children physical therapy note, the parents claimed that the patient did not flex the prosthetic knee when he climbed up and down the stairs. But he was able to do so when verbally prompted by the mother. It was also noted by the patient’s mother that he developed deviations in the gait caused by fatigue. The mother indicated that the residual limb skin looked alright after doffing. When prompted to make quick strides, the patient was able to flex the prosthetic knee up to 90% and 50% on knee extension. When the patient makes extensions of the hip for heel strike, the distance of stride is balanced and the cadence is improved, a natural gait display is exhibited they the patient.
MR-4 8/28/Y-2 THROUGH 8/27/Y-2
This follow up report from your city children’s hospital indicates that the patient is making a good recovery. The diagnosis is supracondylar femur fracture, left. A physical examination of the patient reveals that the patient`s left lower extremity dressing is still in place. The pin sites are still clear, and there is no active drainage observed. However there is granulation matter observed over the distal incision. There are no areas of flatulence noted. There are no visible symptoms of ischemia or any infection observed.
MR-5 10/06/Y-2 through 10/12/Y-2
Before the follow up operation the patient actually took of the bandages on his own. The small cuts made during the first operation have healed perfectly without any erythema, discharge or edema. The wounds were cleaned with Betadine and alcohol before being dressed. The patient was hypersensitive but unbroken. X-rays taken reveal osteopenia of the distal femur; there are no fresh fractures or dislocations. The patient is to return to the clinic in a week’s time for splint removal. In conclusion, Doctor David Michael performed the process of electronic findings on the left femur. Banal and Logan acknowledged radiography on 12/10/Y-1 at 10:15, 14:19, and 16:49 respectively. The results of the findings are status post ORIF with two large pins fixing the distal femoral shaft fracture and cast application. The parts were at a satisfactory position and well aligned. Noting that his lungs osculated is important. The other body parts acted as prove that Luke had acquired great medical care and that the doctors and any other person who took part in his well-being believed he was going to recuperate soon as abdominal sounds were normal.
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