Displaced fracture of posterior wall of left acetabulum initial encounter for closed fracture Opioid abuse uncomplicated Apnea not elsewhere classified Poisoning by other opioids accidental (unintentional) initial encounter Unspecified place in hospital as the place of occurrence of the external cause Attention-deficit hyperactivity disorder unspecified type Bipolar disorder unspecified Pain in unspecified joint Dorsalgia unspecified Nicotine dependence cigarettes uncomplicated Personal history of other infectious and parasitic diseases
 
Name:  ___                   Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   M
 
Service: ORTHOPAEDICS
 
Allergies: 
No Known Allergies / Adverse Drug Reactions
 
Attending: ___.
 
Chief Complaint:
Left posterior wall acetabular fracture status post MVC
 
Major Surgical or Invasive Procedure:
No surgeries performed

 
History of Present Illness:
REASON FOR CONSULT: Status post MVC with left posterior wall
acetabular fracture

HPI: ___ male w/ hx hepatitis C, substance abuse, ADHD, 
depression
presents status post MVC in which he was the restrained front
seat passenger.  He was brought to an outside hospital where
imaging showed a left acetabular fracture and he was transferred
here.  He does note predominantly left hip pain as well as some
bumps and bruises elsewhere.  Pain is predominantly on the left
side of his body.  He notes left leg pain but no numbness or
tingling.  Denies any chest pain, trouble breathing. 
 
Past Medical History:
ARTHRALGIA                                                      
BACK PAIN                                                       
BIPOLAR DISORDER                                                
EXUDATIVE TONSILLITIS                                           
HEPATITIS C                                                     
HEROIN ABUSE     
 
Social History:
1 pack/day smoker
Endorses some alcohol use though he is vague, 1 sixpacks per 
week
Has a history of heroin use as well as cocaine use.  Notes he
relapsed with cocaine a week ago.  He is on Suboxone with his
clinic at ___ in ___.    
 
Physical Exam:
General: Well-appearing male in no acute distress.

Right upper extremity:
Skin intact, no deformity, soft, nontender forearm and wrist.  
He
has full painless range of motion at the shoulder, elbow, wrist,
digits.  Motor intact to EPL/FPL/IO 
SILT axillary/radial/median/ulnar nerve distributions
2+ radial pulse, WWP

Left upper extremity:
Skin intact. No deformity 
Some scattered abrasions with one over the clavicle.  He does
note tenderness to palpation at the distal radius though he has
good range of motion there. Soft, non-tender arm. Fires
EPL/FPL/DIO. SILT axillary/radial/median/ulnar nerve
distributions. 2+ radial pulse, WWP

Right lower extremity:
- Skin intact
- No deformity, edema, ecchymosis, erythema, induration
- Soft, non-tender thigh and leg
- Full, painless ROM at hip, knee, and ankle
- Fires ___
- SILT S/S/SP/DP/T distributions
- 1+ ___ pulses, WWP

Right lower extremity:
- Skin intact
- No deformity, edema, ecchymosis, erythema, induration
- Soft, tenderness to palpation at tibia and ankle
- Fires ___.  Able to flex and extend at the knee.
- SILT S/S/SP/DP/T distributions
- 1+ ___ pulses, WWP
 
Brief Hospital Course:
The patient presented to the emergency department and was 
evaluated by the orthopedic surgery team. The patient was found 
to have a left posterior wall acetabular fracture and was 
admitted to the orthopedic surgery service. The patient was 
treated nonoperatively and worked with physical therapy who 
determined that discharge to home with home ___ was appropriate. 
The patient was given anticoagulation per routine, and the 
patient's home medications were continued throughout this 
hospitalization. 

On the night of ___ patient was found apneic, satting in 
the 80%s, and unarousable. A CODE BLUE was called and  multiple 
doses of Narcan were given.  The patient was transferred to the 
TSICU. Utox upon arrival was floridly positive for multiple 
substances. Found to have drugs in rectum per TSICU staff that 
were believed to have been brought in by his friends.  He was 
placed on a Narcan drip.  He stayed in the TSICU until ___ largely for monitoring purposes.  He was weaned from his 
Narcan drip and seen by addiction psych and chronic pain.  
Chronic pain suggested the patient go back onto his home regimen 
of Suboxone and Klonopin.  Addiction psych provided final 
recommendations which included:

Mr. ___ is a ___ year old male with opiate use disorder, on 
buprenorphine maintenance for 10 months. Recent relapse on 
opiates, which he attributes to
"hanging with the wrong ___  He was inducted back on 
buprenorphine while hospitalized.  He is ready to ___ home today. 
 
1.Attempted to reach ___, psych NP at ___. 

She confirmed he is a patient there and missed his last
appointment with her. 
2.Plan to use remaining buprenorphine he has at home, to get to
his next appt on ___.
3.Encouraged to attend his weekly therapy session and add
recovery meetings that have helped him stabilize in the past.
4.He is not interested in IOP or PHP at this time.

At the time of discharge the patient's pain was well controlled 
without additional narcotic pain medications other than his home 
burprenorphine. The patient was voiding/moving bowels 
spontaneously. The patient is touchdown weightbearing in the 
left lower extremity, and will be discharged on Lovenox for DVT 
prophylaxis. The patient will follow up with Dr. ___ 
routine. A thorough discussion was had with the patient 
regarding the diagnosis and expected post-discharge course 
including reasons to call the office or return to the hospital, 
and all questions were answered. The patient was also given 
written instructions concerning precautionary instructions and 
the appropriate follow-up care. The patient expressed readiness 
for discharge.
 
Medications on Admission:
Amphetamine-Dextroamphetamine 
Buprenorphine 
BuPROPion (Sustained Release) 
Citalopram
ClonazePAM
CloNIDine
LamoTRIgine
TraZODone
 
Discharge Medications:
1.  Acetaminophen 650 mg PO Q6H  
2.  Enoxaparin Sodium 40 mg SC QHS 
Start: Today - ___, First Dose: Next Routine Administration 
Time 
RX *enoxaparin 40 mg/0.4 mL 40 mg subcutaneously Nightly Disp 
#*30 Syringe Refills:*0 
3.  Lidocaine 5% Patch 1 PTCH TD QAM 
RX *lidocaine 5 % Apple one patch to area of pain Once daily PRN 
Disp #*25 Patch Refills:*0 
4.  Nicotine Patch 14 mg/day TD DAILY  
5.  Albuterol Inhaler 1 PUFF IH Q6H:PRN wheezing   
6.  Amphetamine-Dextroamphetamine 30 mg PO BID  
7.  Buprenorphine 8 mg SL DAILY  
8.  BuPROPion (Sustained Release) 200 mg PO BID  
9.  Citalopram 40 mg PO DAILY  
10.  ClonazePAM 1 mg PO BID  
11.  CloNIDine 0.1 mg PO BID  
12.  LamoTRIgine 200 mg PO BID  
13.  TraZODone 50 mg PO QHS:PRN insomnia  
 
Discharge Disposition:
Home With Service
 
Facility:
___
 
Discharge Diagnosis:
Left posterior wall acetabular fracture

 
Discharge Condition:
AVSS
NAD, A&Ox3
LLE:
No pain with log roll or gentle hip ROM
Fires ___
SILT throughout 
WWP

 
Discharge Instructions:
INSTRUCTIONS AFTER ORTHOPAEDIC SURGERY:

- You were in the hospital for orthopedic surgery. It is normal 
to feel tired or "washed out" after surgery, and this feeling 
should improve over the first few days to week. 
- Resume your regular activities as tolerated, but please follow 
your weight bearing precautions strictly at all times.

ACTIVITY AND WEIGHT BEARING:
- TDWB LLE

MEDICATIONS:
  1)  Take Tylenol ___ every 6 hours around the clock. This is 
an over the counter medication.
  2)  You should continue to take your Suboxone and other 
medications as prescribed by Column Health. Please follow-up 
with them for ongoing prescriptions.
      
ANTICOAGULATION:
- Please take Lovenox daily for 4 weeks
Physical Therapy:
TDWB LLE
Treatments Frequency:
No wounds or specific wound care instructions
 
Followup Instructions:
___

{'Left posterior wall acetabular fracture': ['Displaced fracture of posterior wall of left acetabulum'], 'MVC': ['initial encounter for closed fracture'], 'Substance abuse': ['Opioid abuse', 'uncomplicated'], 'Apnea': ['Apnea', 'not elsewhere classified'], 'Poisoning by other opioids': ['Poisoning by other opioids', 'accidental (unintentional)', 'initial encounter'], 'Unspecified place in hospital': ['Unspecified place in hospital as the place of occurrence of the external cause'], 'ADHD': ['Attention-deficit hyperactivity disorder', 'unspecified type'], 'Bipolar disorder': ['Bipolar disorder', 'unspecified'], 'Joint pain': ['Pain in unspecified joint', 'Dorsalgia', 'unspecified'], 'Nicotine dependence': ['Nicotine dependence', 'cigarettes', 'uncomplicated'], 'Personal history of infectious and parasitic diseases': ['Personal history of other infectious and parasitic diseases']}