Conversation: The conversation between human and AI assistant.
[|Human|] Respected Sir, With due respect, i would be obliged if you would be kind enough to spare a few minutes of your valuable time and to help us in finding a solution to the problem of my niece. Patient Details : Patient : Miss. Drishty Padhy Age : 10 Years and studying in Standard IV. Gender : Female currently lives in Orissa Case Histroy : My niece Miss. Drishty Padhi, Age -10 years, fell down lying in the back side while playing with friends. She had kept two small stones in her back pocket of the trouser. The stones got smashed after she felt. The right back was swollen after the injury. There are no fever after that incidence till now. This happened on 2nd July 2011. The injury was in the right hip/thigh. There are absolutely no issues in left hip ,thigh and leg.Then we consulted in our company hospital and consulted Ortho pedics specialists in V SS Medical College,Burla. X-Ray and Digital x-rays on Hip, backbone and pelvis did not show any abnormalities. Doctor advised some medicines and to put the Skin Traction for few days. After taking medicine for about a month, putting skin traction for 4/5 hours in a day , situation did not improve. Problem was she was not able to walk, not able to lift the right leg for a inch , pain during travel in car/bike with slow zerking also, pain in right thigh and hip. Then we went to SCB Medical college, Cuttack. Dr. N C Mahapatra, Asst. Professor in Orthopedics dept, seen the patient and advised to a MRI in Spine, both Hips, Pelvis etc. We did two MRIs in August 3rd August 2011. One in Hip, Pelvis etc and other one in Spine. The results of MRIs are given below : 1. MRI - LUMBO--SACRAL SPINE : MRI L.S.SPINE SUGGESTIVE OF :- APPARANTLY NORMAL MRI STUDY OF L-S SPINE & NO SPINAL CANAL STENOSIS 2. MRI- BOTH HIPS & PELVIS : MRI BOTH HIPS SUGGESTIVE OF :- RIGHT INF. LABRAL TEAR WITH GREATER TROCHANTERIC BURSITIS. After the above result of MRI scan, Dr. NCM advised for further rest with some medicines and advised to consult a doctor with Orthopaedic - Paediatrics specialization. We could find that Dr. Debabrata Padhy of Apollo Hospital,Bhubaneswar is a specialist in Orthopadics-Padiatrics. Immediately we consulted him and took my daughter to Dr.Padhy. Dr. Padhy scrutinized all the X-ray , Digital X-ray and MRI Scan reports very carefully. He physically checked the patient too. Then he advised complete skin traction for 24 hours for 15 days with some medicines. Then we put the patient in 24 hour skin traction for 15 days/20 days. After the skin traction was opened we could see a dramatic improvement in her leg. She could able to walk with a smooth chapel comfortably just like normal walk. Without the chappel she was facing problem in lifting the legs. Still the pain in the righ thigh and hip persisted though she is able to walk with the smooth chappel. The pain persists during any travels in bike , car or train with little zerking. Again we took her to Appoplo Bhubaneswar and consulted Dr. Padhy. Dr.Padhy then suggested some blood tests, eg.Vit D3, Calcium-Serun Phosphorous, inorganic-Serum. Alkaline Phosphatase-Serum/Plasma,RA Factor-Quantitaive. All the results of these tests came normal range. Upon seeing the test reports, Dr. Padhy further wanted to ensure for any neurology or rheumatology issues. He then referred to Dr. A Nanda ( Padiatrics-Neurology specialisation) and Dr. P Pradhan( Rheumatology specialist) in Apollo hospital. Both the doctors tested the patient critically and there are no abnormalities in Neurology or rheumatology. There were only some deficiencies of Vit D for which they have given medicines. Again they have prescribe some medicines and advised the patient to take rest. All of them have confirmed that there are no clinical issues. Present Situation : Presently my niece is able to walk with that sponge chapel properly. She is facing the following problems : a) difficulty in lifting the right leg for a inch also. b) Pain in the right thigh and right hip upon touching. c) Not able to walk properly without the chapel. d) Pain in hip, right thigh with little zerking during travel in Bike,Car or train. She is not going to school since last 3 months though she is a brilliant student. One Observation : When she is in asleep, if we touch and press the right thigh, there is no reaction from her. But if we press the right hip then she feels little pain. Request : Since this is already 3 months, and the kid is suffering a lot, my sincere request to you to critically analyze the case and give me a feedback for further action.
[|AI|]  Hi.... I understand your concern these are my suggestions and this is what I feel about your niece case. The inflammation of the hip joint is the reason for the pain which she is experiencing while jerking moment and also while lifting the leg. This means that whenever she tries to do the above activities the bone of the femur head is going and touching the particular Bursa which is inflamed and is causing pain. This is why she is avoiding lifting the leg and the jerking movement is causing the contact of the two surfaces and resulting in pain. The only viable solution for this is absolute bed rest as long as the pain persists along with skin traction, vitamin D supplements and medicine to relieve the pain and when required. Regards -