51yr male with swelling & pain of




































 51yr male Tractor driver by occupation was apparently alright 3months back

One day while he was returning back from field with a Water pump generator on bike(he was under the influence of alcohol),lost his control,fell on the ground.He got sustained injuries to right lowerlimb ,taken to private hospital in nalgonda,surgery(ORIF + Distal Tibia,fibula plating)was done.After 15days he started walking with walker,There after 1week he walked with a stick,After that 20day’s he started walking without support.patient is having pus discharge from surgical site after 1month,he was diagnosed to be having high sugars(so his injury is not healing-as said by local doctors),he was having surgical site dressing for every 5days.Started taking Glimepiride(2mg)+Metformin(500mg) daily OD till 7day’s,Later started taking xBD

From 1month pt had insidious onset of dragging type of pain  initially in  right hip region later on to left hip region till knee.After 1week of pain over B/L lower limbs,Pt developed swelling of the limbs till knee.Pt was getting pain killers(IM injection) to gluteal region initially one injection for 2day’s,after 1week he started taking one injection daily for 15days

Not a k/c/o HTN,Asthma,TB,Epilepsy,CVA,CAD

O/E

Pt is c/c/c

Bp-120/80mmhg

Pr-84/min regular

Cvs-S1 S2 +

Rs-B/LAE+

P/A-Soft





Xray on 2-3-2021(After 4day’s of pain in the hip region)


      

    



Day 2
 



 

 


 

    

Diagnosis:- ?Avascular Necrosis of Right femoral head,Right Lower limb ORIF+Distal Tibia fibula plating(3months back),K/c/o DM-2(1month back),Hypoalbuminemia 

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