Hasil Bacaan Rontgen

Temuan Rontgen

• Sendi bahu (proksimal): Posisi kepala humerus terlihat sejajar, tidak tampak dislokasi
• Batang humerus (diafisis): Korteks tulang tampak kontinu dan utuh, tidak ada garis fraktur yang jelas, tidak ada angulasi atau deformitas
• Siku (distal): Artikulasi antara humerus distal, ulna (olecranon), dan kepala radius terlihat intak. Tidak ada dislokasi nyata
• Densitas tulang: Normal, tidak ada lesi litik atau blastik yang mencurigakan
• Jaringan lunak: Tidak tampak pembengkakan atau benda asing

Catatan Penting

⚠️ Ini hanya satu proyeksi (lateral). Dalam radiologi berlaku prinsip "satu view bukan bukti cukup."

1. Foto AP (Anteroposterior) humerus kanan untuk melengkapi
2. Korelasi dengan gejala klinis (nyeri, bengkak, keterbatasan gerak)
3. Laporan resmi dari dokter radiologi

X-Ray Reading Summary

Findings

• Shoulder joint (proximal): Humeral head is aligned, no obvious dislocation
• Humeral shaft (diaphysis): Cortical margins appear continuous and intact - no visible fracture line, no angulation or bony deformity
• Elbow joint (distal): The articulation between the distal humerus, olecranon (ulna), and radial head looks intact. No obvious dislocation or subluxation
• Bone density: Normal, no lytic or blastic lesions seen
• Soft tissues: No gross swelling or foreign bodies

Important Notes

⚠️ This is only ONE view (lateral). In radiology, the principle is "one view is no view."

1. AP (Anteroposterior) view of the right humerus to complement this
2. Correlation with clinical symptoms (pain, swelling, limited range of motion)
3. Official report from a radiologist

Assessment - Swollen & Painful Lips

Most Likely: Cheilitis (Lip Inflammation)

• Dry, cracked lips with prominent vertical fissuring
• Mild redness/inflammation along the vermilion border
• No blisters or ulcers visible

Possible Causes

What to Do

1. Moisturise - apply petroleum jelly (Vaseline) or lip balm without fragrances
2. Avoid licking lips - makes it worse
3. Stay hydrated - drink more water
4. Avoid spicy/acidic food until healed

⚠️ This is a general visual assessment only, not a clinical diagnosis. Please consult a doctor or dermatologist for proper evaluation and treatment.

1. How long have the lips been swollen and painful?
2. Any recent new lip products, toothpaste, or food you ate before this started?
3. Any blisters or sores that appeared before the swelling?
4. Fever or other symptoms alongside?

Revised Assessment - 2 Weeks Duration

Top Possibilities

Less Likely Now

• Herpes labialis (usually resolves in 7-10 days on its own)
• Simple dehydration

Key Questions to Narrow It Down

• Any new lip product, food, or medication started around the same time?
• Is it worse after eating certain foods?
• Are you outdoors a lot (sun exposure)?
• Any white patches inside the mouth?

What Should Be Done

1. See a doctor or dermatologist - 2 weeks warrants proper examination
2. They may prescribe a mild topical steroid (e.g. hydrocortisone cream) if allergic
3. Or antifungal if angular cheilitis with fungal component
4. A patch test may be done to identify allergens

⚠️ Do not self-medicate with strong steroids on lips without medical advice. Please get it checked - 2 weeks is long enough to warrant a proper consultation.

✅ Hydrocortisone 1% Cream

• Brand examples: Dermacort, Hydrocortisone cream (generic), HC45
• Lowest potency steroid - safest for face/lips
• Apply thinly, 1-2x daily, max 5-7 days only

⚠️ Important Warnings for Lips

• Do NOT use betamethasone, mometasone, or clobetasol on lips - too strong, will thin the skin
• Do NOT apply inside the mouth
• Do NOT use long term - steroid dependency and skin atrophy
• If no improvement in 5-7 days - stop and see a doctor

Also Use Alongside:

• Vaseline / plain petroleum jelly - protect and moisturise the lip barrier
• Avoid lipstick, flavoured lip balm, SLS toothpaste in the meantime

🔴 Honest caveat: Since this has been going on 2 weeks, a steroid cream alone may not be enough. If the cause is fungal (angular cheilitis), you actually need antifungal cream (clotrimazole), not steroid. Using steroid on a fungal infection can make it worse.

A proper diagnosis first would give you the right treatment. A pharmacist visit (even without a full doctor consult) can help point you in the right direction.

Angular Cheilitis Treatment

🥇 First Line - OTC Antifungal

Miconazole (Daktarin) is often preferred - works on both fungus AND bacteria

🥈 If Also Inflamed/Red - Combination Cream

• Miconazole + Hydrocortisone (e.g. Daktacort)
• Treats fungus + reduces inflammation at the same time
• Use for max 7 days

🏠 Home Care Alongside

• Vaseline on the corners - keeps moisture out, prevents cracking
• Vitamin B2 (Riboflavin) & B12 supplements - deficiency is a common underlying cause
• Iron & zinc supplements if diet is poor
• Avoid licking the corners of your mouth
• Keep the area dry - saliva pooling makes it worse

❌ What NOT to Do

• Do not use steroid cream alone without antifungal - fungus will get worse
• Do not share utensils/towels during treatment

When to See a Doctor

• No improvement after 2 weeks of antifungal
• Spreading beyond the corners
• Recurrent episodes - may need to check for diabetes, anaemia, or denture fit

Most cases resolve in 1-2 weeks with proper antifungal treatment + good lip hygiene.

🔴 YES - This Needs Stitches. Go to Clinic/Hospital Now.

Why It Needs Sutures

⚠️ Most Important Concern

• The extensor tendon (yang control jari untuk lurus) could be damaged
• Joint capsule might be breached
• A doctor MUST check tendon function before closing

Do This Right Now

1. Press firmly with a clean cloth to stop bleeding
2. Do NOT flex/bend the finger
3. Go to emergency / clinic immediately - wound this fresh is best stitched within 6 hours
4. Tell them how it happened (clean cut? rusty object? glass?)

Also Ask About

• Tetanus jab - if not done in last 5 years
• Tendon check - ask them to check if tendon is intact

Bottom line: Kena pergi hospital sekarang. Luka macam ni kat sendi jari, tak boleh tunggu. Kalau tendon kena, lambat rawat boleh affect movement jari permanently.

No Antibiotic Needed - For Now

Current Status: ✅ No Signs of Infection

• Small (~2-3mm), superficial wound
• Just dried blood/crust - early healing
• No pus, no spreading redness, no swelling
• No throbbing or warmth visible

What to Do

1. Clean it - gentle wash with soap and warm water
2. Apply Vaseline or antiseptic cream (Betadine/Povidone Iodine)
3. Cover with a plaster - keep it clean and protected
4. Don't pick at the crust - let it heal naturally

Watch for These Infection Signs - Then You'd Need Antibiotics

Bottom line: Clean minor wound, no antibiotic needed right now. Just keep it clean, covered, and dry. Should heal within 5-7 days. If it gets worse or shows any signs above - see a doctor.

Post I&D Axillary Abscess - Dressing Solutions

🥇 Best Options for Wound Packing/Dressing Solution

What the Evidence Actually Says

"Some prefer plain gauze, some use gauze soaked in saline or povidone-iodine, and some use gauze impregnated with iodine (iodoform). No single method is universally superior."

• Keep the incision open so it heals from inside out
• Prevent premature surface closure
• Allow continued drainage - NOT to absorb all drainage (that's the outer dressing's job)

⚠️ Important Notes for Axillary Abscess Specifically

• Axilla is a high-moisture, high-friction area - change dressing daily or every 1-2 days
• Pack loosely - tight packing causes tissue necrosis
• Leave a small tail of gauze protruding from wound for easy removal
• Do NOT use full-strength hydrogen peroxide - destroys healthy granulation tissue

Dressing Change Routine

1. Remove old packing gently
2. Irrigate cavity with normal saline (syringe flush)
3. Repack loosely with saline or iodoform gauze
4. Apply bulky outer dressing to absorb drainage
5. Change every 1-2 days or when soaked through

When to Stop Packing

• When cavity is visibly smaller and shallower
• Drainage has significantly reduced
• Healthy granulation tissue forming
• Usually 5-10 days post I&D

Bottom line: Normal saline-soaked gauze OR iodoform gauze are both good choices. Saline is gentler and equally effective. Iodoform has the added antiseptic benefit which is useful in the axilla given the high bacterial load in that area. Change dressing daily. - Textbook of Family Medicine 9e; Roberts & Hedges' Clinical Procedures in Emergency Medicine

Povidone-Iodine for Post I&D Dressing - Yes, But With Conditions

✅ YES - Acceptable, but use it correctly

The Key Rule: Dilute It

Paradox: Full-strength Betadine is actually cytotoxic - it kills the new healthy cells trying to heal the wound. Diluted is MORE effective for wound healing.

How to Dilute

• 1:10 = 1 part Betadine + 9 parts normal saline
• Should look like weak tea colour - light brown, not dark brown
• If it's still dark - dilute more

Practical Approach for Axillary I&D

1. Irrigate cavity with normal saline first (flush out debris)
2. Pack with gauze lightly soaked in diluted povidone-iodine
3. Cover with dry outer dressing
4. Change daily
5. After 3-5 days when infection is controlled - switch to plain saline to promote healing

When to Stop Povidone-Iodine

• Once wound looks clean with no pus
• Healthy pink/red granulation tissue forming
• At that point, saline only - povidone can slow healing if used too long

Summary: Povidone-iodine is fine for post I&D dressing, especially in the first few days when infection risk is highest. Always dilute it. Once wound is clean and healing - switch to saline. Never use full-strength on an open wound.