Todd Reilly Case Study

HISTORY OF PRESENT ILLNESS: I believe Mary is status post right hip closed reduction percutaneous pinning on the 25th, I believe by Todd Reilly, MD, so she is essentially three weeks out. She presents with ambulance service, although no one from the nursing facility where she is at is with her despite previous instructions. I really have no history on her at all, as she demented and cannot communicate. Apparently, though, she is minimal to no ambulation. She was in a wheel chair when they picked her up so I do not know if she is even walking at all. She does not seem to be in any acute pain or complain of any acute pain.

PHYSICAL EXAM: On exam, she is very confused, demented. She does not answer questions but she does not seem to

respond to any painful stimuli. She does not seem to have pain to the hip when I asked or when motion of the hip is done.

IMAGING: X-rays of the right hip, just an AP show collapse of the subcapital of the femoral neck fracture back to its original displacement.

IMPRESSION: Three weeks out from right femoral neck fracture with loss of reduction.

PLAN: It is difficult to make any determination at this time, as we do not know her medical history and/or pain level and/or ambulation level. If she is just bed to chair, transfers, and wheel chair only, I think he would probably just leave this alone especially if she has any significant medical risks. However, if she is ambulating at all or weightbearing, this could be converted to a hemiarthroplasty. We will try to contact someone from the nursing facility and/or see her back in one to two weeks with her nurse with her so we can make more appropriate determinations. We will get another x-ray of the right hip at that time as well.