HPI - 25 year old who was run over, followed by loss of consciousness, brought to local hospital and while there, was diagnosed with fat embolism & treated with IV fluids. Now his vitals are stable - BP 100|70 mmHg, pulse 96/min, respirations 22\min
Which orthopaedic injury would you want to treat first?
HPI - fixed since 6 months with IMN humerus
How would you have treated this fracture initially?
HPI - Sustained open fracture of distal radius and ulna after he was injured by a heavy gate of a truck.
Underwent Irrigation/debridement and application of external fixator - distal radius and orif of distal ulna.
Patient is 2 weeks post op.
How would you have treated this open fracture on initial presentation?
HPI - Two years ago, she had a car accident in another country. Was kept in a long leg cast for tibial plateau fracture during 45 days.
Now complains of pain and difficulties in daily activities (walking, prolonged standing position, stairs)
What would be your preferred treatment for this 28 years old active woman with posteromedial tibial plateau mal-union?
HPI - 2 days ago .. falling on both outstretched hands with pain at right wrist joint and left elbow joint .
How would you manage the scaphoid fracture?
HPI - Undergone surgery for #shaft of humerus ,4weeks ago
Post op X-ray 4 weeks show dislocation shoulder
When to go for dislocation reduction?
HPI - This gentleman had a FOOSH from 5 feet onto right side in December 2014. Presented in clinic after returning back to his home area in Feb 2015 with painful right clavicle despite cuff and collar treatment.
Came back in March with no improvement in symptoms and no progression of callous formation.
How do you treat the majority of displaced midshaft clavicle fractures in your practice?
HPI - Blast injury to both legs of 3 month duration treated initially with
Ex-fix, transfered to our hospital one week after her injury in which there was an ongoing infection.
radical attack on infection established, weeks after the infection subsided plastic was consulted for soft tissue coverage
What is the best choice of fixation to use right now?
HPI - History of fall
How would you treat this patient?
HPI - RTA ... with right shoulder injury
HPI - Trapped his right leg in wheelchair while moving to bed - deformation, came to hospital after 2 days. Xray spiral distal femoral diaphysis fx 31A1.
What type of implant would you use for 1st operation?
HPI - MVA
What is the initial treatment?
HPI - Sustained injury 02 months back ..on 03 May 2015
Optd at another center on 09 May 2015 with dorsolateral approach - Plating radius was done. No bone grafting done. Post op early movements was started by the surgeon.
Presently has restriction of forearm motion. Mild pain on load bearing
Management options ... do we need to do surgery now or wait till Myositis mass consolidates further
HPI - The patient was brought two days ago with GSW, the wound is infected and bone exposed, he was shot 10 days befor,
What would be your next step in management?
HPI - GSW since 2nd of July, through the left inguinal region, there injury to the bowl, colostomy was done, X-ray reveal fracture to both ischial rami, and right proximal femur
What are the possible fixation options?
HPI - Fall at home 01 week back
HPI - Mild renal failure,motorcycle accident before 5 years this catastrofic injury left untreated
what is the best choice of fixation-reconstruction?
HPI - h/o twisting injury going down stairs and fell
HPI - Otherwise healthy male s/p motorcycle accident
How would you classify this acetabular fracture?
HPI - Sub trochanteric fracture treated by long gamma nail 1 year ago.
Patient lost of FU
Come to ER for right hip pain.
How would you manage this case ?
HPI - MVA 2 days ago
Elbow Treatment options?
HPI - 55yo male with fall from height resulting in subtroch fracture. Treated with CMN and cerclage cabling. Non-compliant with initial WB status. 3 months postop had distal interlock screw breakage but no significant pain with WB. Follow up films showed decent callous and maintained alignment. Lost to follow up. 8 months post-op felt a pop and pain while walking. New films show breakage of proximal nail.
How would you treat this initial fracture?
HPI - Healthy woman, she received a tombstone on her rear leg and injured her left ankle. She was operated on 3 days later
Would you rather do ORIF to the fibula despite the intact syndesmosis
HPI - MVA 3 days ago
Best treatment possible
HPI - fall 3days ago from a ladder
How would you treat this injury?
HPI - Sustained closed injury left ankle in a RTA on 18 Jun 2015.
What implant if any would you choose for the fibula fracture?
HPI - Patient had previous distal tibia fracture treated with a DCP.
Now presented with tibia shaft fracture at proximal end of the plate.
HPI - Road traffic accident, fall from bike. no other injury. patient vitally and systemically stable.
HPI - Had sustained the injury on 1-2 june. Since it was in a distant village didnt seek medical advice. Presented to trauma outpatient center on 6 june.
How would you manage this fracture?
HPI - On September 2013 right humerus fracture during seizure. Initial consrvative treatment with sarmiento splint. On March 2014 ORIF DCP 3.5 with 6 screws and iliac autografts. On September 2014 fixation failure. On November 2014 ORIF DCP 4.5 with 8 screws and iliac autografts. On May 2015 hardware failure.
Which is the best treatment plan for this patient?
HPI - The patient had a closed fracture of the left femur following road traffic accident 3 month ago. The patient was treated by open intramedullary nailing which was complicated by iatrogenic fracture of the neck of the femur. Pinning of the fractured neck femur was done on the second day.
3 days later the patient had yellowish discharge from the wound used for reduction of the fracture. C & S: Klebsiella treated by imipenem and cilastatin for 15 days.
Labs on April 15th:
CRP: 2 ( N LESS THAN 0.5)
Labs on May 17th:
CRP: 1.7 (N LESS THAN 0.5)
In your opinion, what is the best treatment option?
HPI - H/O RTA 02 yr back
Sustained Galeazzi # R side with lacerated wound at rt forearm
Distal radius ulna # in the left forearm
Managed by close reduction and casting somewhere else
Multiple debridement and closure of soft tissue injury
After 02 month cast removed and physiotherapy started
Kept on conservative Rx & physiotherapy for 02 yr
what should be the treatment plan??
HPI - Sustained fracture ulna shaft right Oct 2014.
Optd at another center using a posterior approach with ORIG with Plating of ulna.
HPI - RTA in 2012 - Open fracture distal femur with bone loss.
Initially managed with debridement, acute shortening (bone lost at the incident site) and K Wire fixation of fragments at different center ...
Later on put on Extenal fixator at another center ...
Patient consulted another center in 2013 ... Open reduction + Distal femoral locked plating was done .. bone grafting was not done.
continued to have pain and features of infection at the fracture site... Implant failure
Feb 2015 - Implant removal and debridement was done.. followed by antibiotics
Presently wound healed, no pain or discharge, ESR, CRP normal.
Ambulant with axillary crutch and brace support ... 12 cm of shortening.
How would you manage this patient at this time?
HPI - Fell from her height
What is the best treatment?
HPI - Polytrauma patient, rib fx, pneumothorax, open left femur fx, closed right femur fx. Has chest tube currently, admitted to ICU (on 5/11/15)
Definitive treatment of left femur?
HPI - Fall on outstretched left hand
Is this a known pattern of injury ?
HPI - 18 y/o male who presents with knee pain s/p football injury. MRI ordered by primary care doctor for evaluation of MRI - showed fracture and ACL tear. No prior injury.
How would you treat this fracture?
HPI - Vehicular Accident. Fell from a motorcycle.
How will you treat this multiply Injured patient?
HPI - Level fall 2 weeks ago, because of a operating room lack we could not fix it earlier.
HPI - Continuos secretion through a medial fistula on his tibia for the last 2 years
What is the best approach?
HPI - 58 male with left knee. Diagnosed with back issues and was given multiple spinal injections. Eventually, the physician examined him and decided to xray his left knee
HPI - A 26 years old male involved in RTA , generally stable , with closed comminuted proximal RT femur fracture and ipsilateral tibial shaft closd non displaed fracture
whats the best option to treat the femure fracture?
HPI - Patient has a mechanic fall in Asia in April 2014. Treated with ORIF with proximal locking plate done there.
What is your preferred treatment for femoral subtrochanteric fractures?
HPI - H/o of RTA on4/4/2014',pt admitted to hospital c/o inability to walk .x ray shows f/x upper tibia.f/x treated with T plate.
What would you do for this patient at the current time with the imaging available?
HPI - 69-y/o male status-post 10-foot fall from the roof. He has a history of CABG 3 years ago, and minimal intermittent pre-existing left hip discomfort but not inhibitive to daily activites and is currently not requiring any treatments for DJD of the hips.
Would you attempt to fix (cephalomedullary nail) or proceed with total hip arthroplasty with calcar replacing femoral stem?
HPI - RTA on 4/8/2015.Pt presented to ER complaining of difficulty to move his rt shoulder,
How you will manage this fructure.?
HPI - not known
what is the best choice of fixation ?
HPI - Patient sustained injury right knee joint 2months back for which he was treated with above knee pop cast.Now patient has presented with stiffness of knee joint and pain
What should be the treatment plan
HPI - slip down injury
He was diagnosed distal clavicle fracture and treated CRIF c k-wire 6 weeks ago
At POD 6 weeks, X-ray reveals k-wire loosening & gap maintenance
According to the Neer classification of distal clavicle fractures, what Type is this?