+14 more
Make assessment accordingly to the assesment file i uploaded
I'll read the assessment PDF and analyze all the patient images simultaneously.
Reading File
analyse_media
analyse_media
Now let me extract the PDF assessment template and analyze the remaining images in parallel.
Running Command
cd /tmp/workspace/attachments/cdddd162-a9f6-4d7b-9097-2b946e890c59/ && python3 -c " import pdfplumber with pdfplumber.open('Orthopedic Assessment.pdf') as pdf: print(f'Pages: {len(pdf.pages)}') for i, page in enumerate(pdf.pages): print(f'--- Page {i+1} ---') text = page.extract_text() print(text) "
analyse_media
I now have all the information needed. Let me compile the complete assessment. I have:
From the handwritten notes:
- Patient: Irfan Khan, 40M, Sitting job, Khajrana Indore
- C/C: No pain / Pus discharge
- History: Surgical 2011 - Rod implant Rt side (knee to hip); Medical history: Yes
- Family Hx: No; Smoking: (-); Alcohol: (-)
- Socio-economic: static pain
- On observation: Endomorphic, Gait abnormal, assistive device: walkers, deformity: no, posture: normal
- Local: Scar +nt, Redness (-), Oedema (-), Skin dry
- Palpation: Temp warm, Tenderness (-), Swelling (-), Spasm (-)
- History: MDI → indigenous (fall from stairs), mode of onset: sudden, chief pain: onset acute
- Nulliparous → Visitors → No pain, pus discharge
- Post surgical hit → Yes; Condition → improved; DOI: 24 some date; Pain bilious Rt side → no pain
- RF → lying; SF → Hip (head of femur); VAS → 3/10; Post history → Rt side 6th October 2025; Artery block/storage
- PD1: Implant removal done under SAB on 9/06/26 (femur interlock); PD2: Total hip replacement (uncemented) on 9/06/2026
From discharge summary: UHID 260300258657/IP0001, Patient Irfan Khan, 40Y/M, admitted 30-May-2026, discharged 3-Jun-2026, Fracture neck of femur right side (transcervical) with implant in situ, previous Femur Interlock Nailing 29/07/2019. X-ray: Fracture neck of femur right side (transcervical) with implant in situ. PD1: Implant removal under SAB left side on 9/06/26; PD2: Total hip replacement (uncemented) on 9/06/2026.
Histopathology: Pus from right side femur; fibrous inflammatory tissue with lymphocytes, neutrophils, plasma cells.
Coronary Angiography: CAD, ACS, Unstable Angina, LVEF 55-60%, LAD Type III proximal eccentric 80% lesion - Single vessel disease; PCI to LAD advised.
Current admission (11-Jul-2026): Old operated case of total hip arthroplasty (uncemented) right side with pus discharge.---
ORTHOPEDIC ASSESSMENT
PATIENT INFORMATION
| Field | Details |
|---|---|
| Name | Irfan Khan |
| Age | 40 years |
| Gender | Male |
| Occupation | Sitting job (Khajrana, Indore) |
| Address | 19 Garib Nawaj Colony, Sadar Bazar, Indore - Mob: 8770873610 |
| Contact Info | 8770873610 |
| UHID No. | 260300258657 |
CHIEF COMPLAINTS
- No pain currently
- Pus discharge from right hip (post-operative Total Hip Arthroplasty site)
HISTORY
Present History
- Mechanism of injury: Indigenous fall from stairs (history from 2011; Rod implant Rt side knee to hip)
- Onset of pain: Acute (insidious onset, pain in left hip since 8 days - prior admission May 2026)
- Mode of onset: Sudden
- Transport to hospital: Came to OPD on 30/05/2026
- Condition: Improved (post-surgical)
- Date of Injury / Current Admission: 11-Jul-2026
Present Surgical History
- PD1: Implant removal done under SAB over left side on 09/06/2026 (Femur Interlock)
- PD2: Total Hip Replacement (uncemented) done under SAB on 09/06/2026
Pain History
- Side: Right side (Rt hip region - pus discharge site)
- Site: Hip (head of femur)
- Type: Static pain
- VAS (Visual Analog Score): 3/10
- Aggravating factors: Lying down
- Relieving factors: Hip supported / head of femur offloaded
- 24 hr Pattern: Constant low-grade
- Attitude/Position: Lying
PAST HISTORY
| Tuberculosis | Not mentioned |
| Bronchial Asthma | Not mentioned |
| Blood Pressure | Not mentioned |
| Diabetes | Not mentioned |
| Cardiac Problems | YES - CAD, ACS, Unstable Angina (Coronary Angiography 08-10-2025: LAD Type III proximal eccentric 80% lesion, Single Vessel Disease; PCI to LAD advised) |
| Accidental Injury | Fall from stairs (2011) |
| Previous Surgeries | 1. Femur Interlock Nailing Rt side - 29/07/2019; 2. Implant Removal (Rt side Femur Interlock) - 09/06/2026; 3. Total Hip Replacement Uncemented (Left side) - 09/06/2026 |
FAMILY HISTORY
- Hereditary: No
- Consanguinity: Not mentioned
PERSONAL HISTORY
| Cigarette Smoking | No (-) |
| Alcohol | No (-) |
| Medical History (medications) | Yes - T. Linezolid 600 BD x 7d, T. PCM 500 SOS x 7d, T. Rantac 150 OD x 7d, T. MVBC 200 OD x 15d, T. Calcium |
| Surgical History | 2011 - Rod Implant Rt side (knee to hip region); 2019 - Femur Interlock Nailing; 2026 - Implant removal + THA |
| Socio-Economic History | Fair (sitting job) |
INVESTIGATIONS
| Investigation | Findings |
|---|---|
| X-Ray | Fracture Neck of Femur Rt side (Transcervical) with Implant in situ |
| Hb | 10.02 g/dL |
| WBC | 9100 |
| RBS | 113 mg/dL |
| Urea | 27 |
| Creatinine | 1.1 |
| PT | 14.5 |
| INR | 1.1 |
| Na | 144 mEq/L |
| K | 4.4 mEq/L |
| ECG | WNL |
| Chest X-Ray | WNL |
| HCV, HIV, HBsAg | Negative (screening) |
| Histopathology (Pus Rt femur) | Fibrous/fibrofatty tissue with mixed inflammatory cell infiltrates: lymphocytes, neutrophils, plasma cells + dilated congested blood vessels - consistent with periprosthetic infection / chronic osteomyelitis |
| Coronary Angiography (08-10-2025) | CAD, ACS, Unstable Angina; LVEF 55-60%; LAD - Type III proximal eccentric 80% lesion; Single Vessel Disease. Advice: PCI to LAD (1 DES) |
ON OBSERVATION
General
| Body Type | Endomorphic |
| Gait | Abnormal |
| Assistive Devices | Walker |
| Deformity | No |
| Posture | Normal |
Local (Right Hip region)
| Redness | (-) Absent |
| Scars | Present (+nt) - Healthy scar noted (staples removed) |
| Deformity | Absent |
| Oedema | (-) Absent |
| Skin Type | Dry |
ON PALPATION (Right Hip)
| Temperature | Warm |
| Tenderness | (-) Absent |
| Swelling | (-) Absent |
| Spasm | (-) Absent |
| Skin Type | Dry |
ON EXAMINATION
Motor Examination
| Movement | Active ROM | Passive ROM | MMT | Notes |
|---|---|---|---|---|
| Hip Flexion (Rt) | Limited (post-THA) | - | - | Post-op THA precautions apply |
| Hip Extension (Rt) | Limited | - | - | |
| Hip Abduction (Rt) | Limited | - | - | |
| Hip Adduction (Rt) | Limited | - | - | |
| Hip IR / ER (Rt) | Restricted | - | - |
(Formal ROM and MMT values to be documented at bedside - patient currently admitted 11-Jul-2026, post-op status)
Muscle Girth: To be measured bilaterally (expected wasting of Rt quadriceps/hip abductors)
Limb Length Discrepancy: To be assessed
Gait: Abnormal - requires walker
Crepitus: To be assessed on examination
Sensory Examination
| Superficial sensation | To be assessed |
| Deep sensation | To be assessed |
| Reflexes | To be assessed |
PROVISIONAL DIAGNOSIS
Post-operative Total Hip Arthroplasty (Uncemented) Rt side with Periprosthetic Infection / Pus Discharge
- Background: Fracture Neck of Femur Rt side (Transcervical) with prior Femur Interlock Nailing (2019), implant failure requiring removal and THA (09/06/2026)
- Comorbidity: Coronary Artery Disease (Single Vessel Disease - LAD 80% lesion), LVEF 55-60%
PROBLEM LIST
- Pus discharge from right hip (post-THA periprosthetic infection)
- Abnormal gait - requires walker for ambulation
- Reduced hip ROM and strength post-THA
- Cardiac comorbidity (CAD - LAD 80% lesion, PCI advised but status unclear)
- Mild anaemia (Hb 10.02)
- Skin integrity concern (dry skin, wound site monitoring)
PHYSIOTHERAPY MANAGEMENT
Short Term Goals (0-2 weeks)
- Monitor wound/pus discharge site - maintain positioning to reduce pressure
- Deep breathing exercises and incentive spirometry (cardiac/respiratory prophylaxis)
- Ankle pumps and calf pumping exercises (DVT prophylaxis)
- Bed mobility training (log rolling, supine to sitting with THA precautions)
- Isometric quadriceps and gluteal sets
- Pain management education (VAS currently 3/10)
Long Term Goals (2-12 weeks)
- Independent ambulation with appropriate assistive device (progress walker → crutches → independent)
- Full functional ROM of hip within THA precautions
- Strengthen hip abductors, extensors and quadriceps (MMT grade 4+/5)
- Normalize gait pattern
- Return to sitting job activities - independence in ADL
- Patient education: THA precautions, infection signs, cardiac precautions
REVIEW / FOLLOW UP
- OPD follow-up as per treating consultant (Dr. A. Ajmera / Dr. A. Pal - MYH Orthopedic Unit 1)
- Wound review + ESR, CRP, CBC monitoring
- Physiotherapy: Hip and Knee physiotherapy program ongoing
- OPD No. 15 (as noted on OPD slip)
- Medications: T. Linezolid 600 BD x 7d, T. PCM 500 SOS x 7d, T. Rantac 150 OD, T. MVBC 200 OD x 15d, T. Calcium
- Neosporin powder dressing advised
- Current admission (11-Jul-2026): MYH Ward 8, Bed 12, IPD 202601692793
HOME PROGRAM EXERCISES
- Ankle pumps - 10 reps x 3 sets, hourly
- Isometric quadriceps sets - hold 10 sec x 10 reps x 3 sets
- Gluteal squeezes - hold 10 sec x 10 reps x 3 sets
- Hip abduction in lying (within pain-free range, THA precautions) - 10 reps x 3 sets
- Heel slides - 10 reps x 3 sets
- Standing hip exercises with walker support once ambulatory
- THA precautions education: No hip flexion >90°, no crossing legs, no internal rotation
- Breathing exercises - 5 deep breaths x 5 sets daily (cardiac protection)
Assessed by: (Student/Clinician Name) Date of Assessment: 19-Jul-2026 Institution: MGM Medical College / MYH Hospital, Indore (MYH Orthopedic Unit 1) Consulting Surgeon: Dr. Anand Ajmera | Unit: MYH Orthopedic Unit 1
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