MANU UKLMUPALVIU & IKAUMA CLINIC Dr. M. N. Manukaran psn Tel : 03-91305200 MD(UKM), MS Ortho(UKM), FICS. 03-91322022 Ext 8307 Consultant Orthopaedic Surgeon Fax : 03-91305100 PANTAI CHERAS MEDICAL CENTRE HIP : 012-3070125 Room 20, 3rd. Floor 1, Jalan 1/96 A, Taman Cheras Makmur, 56100 Kuala Lumpur 4" March 2013 Your Ref 21* Rabiulakhir 1434 Our Ref > MNM/092/13 MANAGER, INSURANCE MANAGEMENT & GROUP FINANCE, TELEKOM MALAYSIA BERHAD, 50762 KUALA LUMPUR, Dear Sirs, ‘SPECIALIST REPORT ON EN. AHMAD KHAIRUL WALIUDDIN BIN AZIMI LLC, NO: 870813-11-5243 on the 31" January 2013, a specialist medical examination was carried out on the abovenamed to assess his disabilities arising from injuries sustained in an alleged motorvehicle accident on the 28" April 2011 En. Ahmad Khairul Waliuddin was a 23 year old telecommunications technical assistant at the time of the said accident. He is Right handed, MEDICAL HISTORY This has been available from the following sources: a) Medical report by Dr. Ahmad Izuddin bin Abdul Manaf of Hospital Kemaman, ‘Terengganu consisting of the following i) Date of accident: 28" April 2011. i) Injuries: Closed fracture Left ulna styloid with DRUJ disruption. b) The client — He gave a history of a motorvehicle accident on the 28" April 2011 He sustained injuries to the Left wrist AQHe was admitted to the Hospital Kemaman, Terengganu. The Left wrist was initially immobilized with a POP cast. The Left wrist was later operated upon with a K-wire and casting. The pin site became infected. Removal of the K-wire and cast immobilization was done. Physiotherapy was also done. PRESENT COMPLAINTS 1) He has pain in the Left wrist on exertion. 2) He has a deformity of the Left wrist. 3) He has stiffness of the Left wrist. 4) He has difficulty to open the door. 5) He is unable to lift heavy weights. PHYSICAL EXAMINATION His general health is satisfactory. The following are significant findings on examination: 1) Scars - Deep abrasion scars of the Left forearm and both the knees. - ‘One pin site scar over the Left ulnar styloid, 2) Deformities (see photographs) - There is ventral titing of the Left wrist joint. ~ There is swelling of the Left wrist. 3) Measurements - Forearm length measured from the lateral epicondyle to the radial styloid Right 25cm Left 25cm i.e. There is no shortening of the Left forearm, 13~ Arm girth measured 10 cm above the elbow joint Right 26.5 om Left. 24.5 om ie. There is 2.0 cm of wasting of the Left arm. ~ Forearm girth measured 8 cm below the elbow joint Right 24.5cm Left. 22.5 om ie, There is 2.0 cm of wasting of the Left forearm. ~ Wrist girth measured at the radial styloid Right 15m Left 16cm i.e. There is 1.0 cm of swelling of the Left wrist. 4) Movements - Wrist movements Right Left Dorsiflexion 0°-90° 0-70 Palmarflexion 0-90? 0° 45° Pronation 0-90" —0°- 70° Supination 0°-90° 0° 30° Ulnar deviation 0-45" 0°. 20° Radial deviation 0-30"? - 15° ie. There is moderate limitation of the Left wrist movements. 5) Functional Assessment ~ The power of grip is weak in the Left hand. X-RAYS Left wrist: The fracture of the ulnar styloid had united. There is evidence of subluxation of the distal radio-uinar joint (DRUJ)._ It had been treated with a K-wire fixation. The wire had been removed. There is ventral tilting of the wrist joint. Total destruction of the distal end of the ulna and radius bones due to infection is noted. Gross narrowing of the wrist joint space is noted, These are features of secondary osteoarthritis of the wrist. olOPINION 1) En. Ahmad Khairul Waliuddin sustained serious injuries to the Left wrist in the motorvehicle accident on the 28" April 2011. 2) The injuries were: ~ Closed fracture of the Left ulnar styloid with DRUJ disruption 3) The injuries had healed with the following disabilities: a) Pain in the Left wrist on exertion, b) Ventral tilting of the Left wrist. ©) Swelling of the Left wrist ¢) Stiffness of the Left wrist. ©) Secondary osteoarthritis of the Left wrist. ) Wasting of the Left arm and forearm. 9) Weak grip in the Left hand. h) Inabilty to lift heavy weights. 4) The fracture of the Left ulnar styloid and the DRUJ disruption had led to severe infection of the distal radius and ulna. This had also resulted in secondary osteoarthritis with ventral tilting of the wrist joint. It is the cause of the pain and deformity of the wrist. These are permanent disabilities. 5) The moderate stiffness of the Left wrist is secondary to the infective destruction of the wrist joint and the osteoarthritis. It is also the cause of the weak grip in the hand. This too, is a permanent disability. 158) The infective destruction of the Left wrist joint had predisposed to secondary osteoarthritis of the wrist. Itis the cause of the pain and stifiness, and the relative Uselessness of the hand. He will require fusion of the wrist joint in the functional Position. The operation will cost about RM 10000/. This will relieve the pain and stabilize the wrist joint 7) The wasting of the Left upper limb is due to prolonged immobilization and disuse of the limb. This will not improve fully with physiotherapy. 8) The scars sustained in the accident and the operation will be permanent. 8) En. Ahmad Khairul Waliuddin bin Azimi has permanent disabilities of the Left wrist His whole person impairment arising from the above injury is assessed at 19%, according to the Australian Government Comeare assessment scale. He will have aifficulties in undertaking jobs and activities those require climbing, scaling, carrying of weights and all those requiring the free use of the hands. Yours faithfully, fim -PANTAI HOSPITAL @Q) Gh, ssn frm 1200376027 wHD4/D990/4n = —| fauna KRATRUL UAL IUODIN 8 AZM sS 120764047 M/2ay 13/08/87 fee NN A a | Koala Lumpur Senn eee eee ‘Note: Please press hard when waiting ‘Admission date (ddimmiyy): 2907 (2012. | Discharge date (dd/mm/yy): | Reason for admission: Septic aceite ole wv Final diagnosis ICD code: (10 bo completed by hospital staff AS alore/ Significant physical and other findings! Significant diagnoses and co-morbidities: Diagnostic procedures performed: 0 Xray 0 Surgery = Kuotic 1 Cprrlaed MRI 2 Others (spncty) 28 Qn GUE c |v Caprolangporrny 3 Tmo LeT-Scan, . ES ‘Therapeutic procedures performex OE ey ‘Significant medications and other treatments: - ee ‘atthe time of discharge: rh 1 Others (spect) Folioyep Instructions apatent clinic follow-up 1 Others (spect): = DR. Raw kk Gat San Aap dele G ——— (Attending Consultant) Name aren Time \_AWAAD _f ua suc COALIUODIN (Patient's | Guardian's Name) UC No: 82%5/3 1 Saux hereby ackno\ ey discharge summary. ‘Signature :__ : Date: —3SUM yo7 au Jo SsaUysNS aya BuIMOYs p pue E SydesBO,0YgAurwoo'rewed@pud :wew-3 2g¢1 2922-09 xe 9890 9622-608 “EL “eIseleW indwn7 ejeNy QOL6S leIUed Wing UeIeT g 2uz4-90-2000340 (c-9s0¢2) Pug UPS ex}UeD JeoIpeW fejUEd “quauinsop peyeseuab Jayndwog, W2VITW 9€F0T ZTOZ/LO/0E 2 Jesn/suTL/eyed yutad : yaewoy ZT0Z/LO/0E pezed 2988TLOZTI“ON TITa 00°SE HSWO i ZOJ peatecez jueudeg butog (oan) Juno Sq Kea uoradraoseq ANYDONEYAL ’ 000b2 Lbopgcoziw ON epostda NWAWNaY ‘Nuve OM NTC wavITw xetyseo “y OLWE'L6ZT WW SEFOT ZL0z/L0/0€ owra/ezed IW2ZV"a NIGGQTTWM ‘TONIWHY GYWHY : aekea €vOTSETOON ON adrecey IWZW"d NIGGATTWM TONIWHY GYWHY + oUeN quUeT3eEq T : ebedg LZ09LE00ZT : ON NUW Lataomt Twrotaso “induiny Bjpay WL1dSOH IVLNWdS = INPATIENT BILL, AKIMAD KHATRUL WALTUDDIN B.AgMT, Page ey 1297, BATU 4, BLL No : Iaz0718862 LW KG. BARU, KEMAMAN 24000 TERENGGAND Employee/Co Guarantor: GL No/PHC Ref Bill Type FINAL (Ri Patient Name : AHMAD KHATRUL. WALIUDDIN B.AgHI 1/¢ No 870813115243, HRN to 1200376027 Ramission No : A120764047 Admitting Dr : DR RANJIT SINGH DESCRIPTION HOSPITAL CHARGES FOUR BEDDED 3DAYSS98.00 ADMINISTRATIVE CHARGE LABORATORY INVESTIGATION MPDICAL 6 SURGICAL SUPPLIES MEDICATION WURSING PROCEDURE, Discount DOCTOR CHARGES CONSULTATION & ASSESSMENT DR_RANJTT SINGH ~ ORTHOPAEDICS, HANDGNICROSURGERY Discount ToraL cuances’ ROUNDING ADJUSTMENT PAYER BILL SIZE, OTHER BILL 3 AMOUNT DUE Print Dato/Time/User: 30/07/2012 10:28 BNORA, Remarks nor Bill Date/Time Prepared By Account credit Term Adm Time/Date Dis Timo/Date Ward/Rm/Ded/Type: wwné /D440/ 48/204 Charge Type AwouNr Gov"? TAX cw a 294.00 17.64 35.00 0.00 423.60 0.00 116.25 0.00 1,615.85 0.00 80.00 0.00 (29,40) 9.00 585.00 0.00 3,061.80 17.66 1 30/07/2012 10:28 £1618 27/07/2012 £08:37 30/07/2012 2 IPD PAYABLE, a) 311.64 38,00 423.60 116.25 1,619.85 80.00 (29,40) 585.00 (58,50) 3,079.44 0.01 45,00 3,044.45 35.00 Payment by cheques only acceptable for corporate accounts. Cheques should he crossed "Account Payee Only" and made payable to "PANTAI MEDICA, CENTRE SDN BHD” E.50.E Computer generated document. Pantai Medical Contre Sdn Bhd (7305650) 8 Jalan But Pant 59100 Kuala Lumpur Malaysia. To 608-2296 0888 Fax: 603-2282 1557 Exmalprll@pant com my