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13-Year-Old Male

The patient jumped vertically during a basketball game, landing on the right leg. They heard a loud snap, and obvious deformity was noted.

Resulted in Right Tib Fib #

Previous Left Ankle Injury

NKDA

Otherwise Healthy

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Grade 8. Active basketball player.

Lives with Mom, Dad and Younger Sister

Dad is a teacher with a previous job as a care aid. Mom travels for work.

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Arrival at Emergency Room: 7/10

Pre Reduction: 6-7/10

Post Reduction: reported "no pain"

Pre Surgery: 3-4/10

Post Surgery: 4-5/10

While mobilizing: 7/10

Analgesic

Morphine IV or PO 2.5mg-5mg

Advil 400mg PO q4-6h

Tylenol 1000mg PO q6h

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Arrival at Emergency Room BP156/78 P55 O2 100% RA T37.1

Pre Reduction BP148/81 P69 O2 99% 4LO2 via NP

Post Reduction BP135/64 P51 O2 100% RA

Post Surgery BP 138/63 P52 O2 98% RA

Post Mobilization (Pain 7/10) BP 161/68 P82

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Alert and Orientated to Person Place Date/Time and Situation

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Heart Rate regular

Bilat Pedal pulses present

Cap Refill <3 seconds to all extremities

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Lungs clear bilaterally

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Indepentently using urinals

No concerns

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No abdominal discomfort. Voiding regularly and independently with urinal.

Eating small amounts of food.

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Surgical incision to right leg, covered with 4 aquacel and wrapped with tensor

IV to Left ACF, Saline Locked, removed in the afternoon

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Pre Surgery

Initial reports of decreased sensation

Colour Warmth and Some movement are present.

Post Surgery

CWMS intact, decreased movement, possibly due to increased edema

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Xray: Comminuted transverse fractures through the distal 1/3 of the right tibia and fibula is noted with moderate lateral and mild anterior displacement of the distal fracture fragments is noted with some impaction as well.

Post Surgical Xray: Status post IM nailing of the distal tibial shaft fracture, with near anatomic osseous alignment.  The hardware is satisfactory.

The fracture of the distal fibular shaft is in improved alignment, with mild lateral displacement of the distal portion compared with the proximal component

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Intramedullary Nailing of Right Tibia

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Patient has 4 steps into their home and a full flight of stairs up to bedroom.

Crutch and 2 wheeled walker education provided

Patient demonstrated good understanding on use and safety

Also able to use stairs effectively with crutches.

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All blood work within normal values

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The patient lives in Coquitlam with their Mom, Dad and younger sister.

Hs in grade 8, actively plays basketball

Mom travels for work.

Dad is a School Teacher (Previous Care Aid)

Currently patient has just started Spring break, Dad is able to be home with the patient for 2 weeks

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Patient is upset that he has a broken leg before summer, as well as the challenges this may pose when getting back into basketball.

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Patient has a strong network of friends as per mom, and a strong family support system.

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Adolescent

Piaget - Formal Operations

Erikson - Identity VS Role Confusion

Physical Growth

Puberty/Hormonal Changes, sexual maturation, dramatic growth

Motor Development (fine and gross)

Reaching Maturity

Language

Nothing Significant

Social/Cognition

Abstract Thinking

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This patient from conversation with him and family, shows that he is hard working and resillient, as he wants to get back to playing basketball.

He shows independence by trying to get up first on his own before asking for help, and cooperates with his care.

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Patients dad is a teacher, and off during spring break so able to be at home with him in the initial stages of recovery

Mom is attentive to patients needs, food water, repositiong

Sister is able to help when needed, and provides social stimulation

Patient has a large friend network and stayes in touch via his iPad.