Approach To Patient

APPR OAC H TO
ORTH OPA EDI C

PATI ENT
Dr. Ashish Gohiya

Assistant Professor
Department of Orthopaedics &
Traumatology
• The Doctor or hospital is not doing
a favor by seeing the patient, the
patient is doing a favor in the
making of a doctor or towards the
growth of the hospital
www.esnips.com/web/gohiya
Fir st vi sit wit h the
patie nt
• Acceptance by the patient &
relatives
• Our approach
Bio dat a of patie nt
• Name
• Age
• Sex
• Address
• Religion
• Occupation
Hist ory
•HIS – STORY
•His Own language
Pr ese ntin g Complain ts
• Chief complaints
• Chronological order
1. Pain
2. Swelling
3. Deformity
4. Difficulty in movement
5. Wound / sinus
6. Constitutional symptoms
H/O Pre se nt Illn ess
• Patient was apparently alright
-------- back.
• Elaborate incidence of trauma in
detail
• Elaborate all presenting complaint
in chronological order
• Don’t add new complaint.
Pain
1. Site
2. Duration
3. Onset
4. Progression
5. Character
6. Severity
7. Diurnal variation
8. Radiation
9. Relieving factor
10. Aggravating factor
11. Associated symptoms
Swellin g
1. Site
2. Onset
3. Progression
4. Painful / Painless
5. Similar swelling elsewhere
6. Associated symptoms
Defo rm it y
1. Site
2. Onset
3. Progressing / static / regressing
4. Attempts for correction
5. Disability due to deformity
Difficult y in mov eme nt
1. Onset
2. Progression
In detail
Si nu s
1. No.
2. Site
3. Relation with deeper structure
4. Relation with skin
5. Margin
6. Discharge
• Color
• Nature
• Odour
• Bony spicules
Pa st Histo ry
• Earlier injury
• Earlier infection
• Tuberculosis
• Syphilis
• Leprosy
• No significant past history
Tr eat me nt Hist or y
• All sorts of treatment
Pe rso nal Histo ry
• Occupation
• Addiction
• Allergy
• Marital status
• Children
Fam ily Hist ory
• Similar illness in the family
• H/O tuberculosis
• H/O arthritis
•Summarize
History
Examination
Exami natio n
• General Examination
• Systemic Examination
• Local / Regional examination
Ge neral Ex amin at io n
1. Built
2. Nutrition
3. Pallor
4. Cyanosis
5. Edema
6. Lymph nodes
Sy ste mi c E xam in ati on
• CNS – Pt conscious, cooperative,
oriented to time, place & person.
• R/S – chest expansion normal, B/L
vesicular breathing, no added
sounds.
• CVS – S1, S2 heard no murmur
• A/S – soft, non tender, no
organomegaly
Local Exam in ati on
• Look
• Feel
• Move
• Measure
• Special test
• Distal neurovascular status
• Adjacent joint status
Look
• Gait / Attitude
• Look from different sides
• Look for
– Bones
– Soft tissue
– Skin
• Color
• Scar mark
• Discharging sinus
• Dilated veins
Feel
• Temperature
• Tenderness (Bone, joint, soft
tissue)
– Touch
– Pressure
– Thrust
• Palpate all tissues for any

abnormality
Mo ve ment
• Zero position , axis of movement
• Active movement
• Passive movement
• Restriction of movement
• Range of movement
• Fixed flexion deformity
• Fixed in flexion
Me asure me nt
• Circumferential
• Linear
• Apparent
• True
• Segmental measurement
Sp ecial test
• Depending on the site and
pathology
Ex am in at io n in co mple te
•Distal neurovascular
status
•Status of adjacent
joints
Et io lo gi cal c la ssifi cati on
1. Congenital
2. Developmental
3. Traumatic
4. Infective / Inflammatory
5. Neoplastic
6. Metabolic
7. Degenerative
8. Idiopathic
Pr ob ab le D iag nosis
• Causative pathology -Tuberculosis
• Anatomical site - Rt Hip
• Duration - 6 months
• Stage - stage of
arthritis
• Complication - fixed
flexion
deformity
300
• Treatment - untreated
Inve stig at io n
• Routine
investigation
• X - Ray of the
part
De fin it ive Diag nosis
Treatment
Rehabilitation
THAN K
YOU
• When life in danger – u r God
• When danger passes off – u r equal to God
• When pain goes off – u r normal huma
being
• When bill is given – u r Devil


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APPR OAC H TO

ORTH OPA EDI C

Dr. Ashish Gohiya

• Local / Regional examination

• Palpate all tissues for any

• When danger passes off – u r equal to God

• When pain goes off – u r normal huma

• When bill is given – u r Devil

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