HPI - STRUCKED BY COW, SUSTAINING INJURY OVER RIGHT KNEE DUE TO FALL
What should be ideal way of management keeping in consideration age and osteoarthritis?
HPI - Patient had trouble decelerating while skiing and crashed onto ice
What would be your preferred method of definitive treatment for this injury?
HPI - The healthy 35 years old man, that 3 years ago underwent MVI.
He was diagnosed with a Subcapital fracture RT HIP with Posterior wall of Acetabulum and was treated urgency with 3 cannulated screws and pass one week with ORIF of acetabulum.
Through several month he develop a AVN of head and it was converted to THA RT.
He continued all time with pain of his hip , until he presented with joint sinus rt hip.
One year ago he underwent operation FIRST STAGE OF PJI RT ( the stem was well fixed – and was done ETO) with plate remove.
In his culture was grown MRSA – and he got 3 month DAPTOMICIN treatment.
how proceed with this young patient?
HPI - Grade 5 splenic lac (IR treated)
Some ipsilateral ribs
Is supposed to go to Japan in 4 weeks to help with R&B star media relations
How would you treat this patient?
HPI - Brought to ER, pain and injury isolated to leg.
Would you fix the tibia or femur first?
HPI - fall of heavy object on a flexed knee
In addition to Xrays, what advanced imaging would you get in this patient?
HPI - Patient brought to trauma bay with isolated injury
How would you position the patient?
HPI - The patient brought to trauma bay following a MVC. He complains of knee pain isolated to the knee.
Which classification system would you use to guide treatment?
HPI - Patient brought to Trauma Bay following MVC
HPI - 44yo female falls from 6 feet.
In addition to the AP and Lateral radiographs above, what additional imaging studies would you do?
HPI - 32-year-old male brought to trauma bay in stable condition.
HPI - Trauma in the right thumb playing soccer 3 weeks ago, pain and local edema
What treatment would be indicated?
HPI - 22 years girl who after a vaccine done in childhood developed an equinovarus left foot and paralitic left hand.She came to me and insist to do something so she can walk better. I told her i have no experience in foot deformity but she doesn't want to go to someone else. She want's to have a better walk, without a limp. She is independent, don't need any crutch.No active dorsiflexion. By manipulation, without analgesia,sedation or relaxation i can brig her foot at normal position and neutral dorsiflexion..no more than that...the pictures done are in the OR with the C-ARM.I have read a lot about SPLATT technique but also about tibialis posterior tendon transfer for foot deformity...whichone is better? i don't have a collegue to ask because in Roumania usualy we have to do everything so nobody is specialised in something. What i was thinking was a SPLATT technique with a percutan Achille lenghtening.
What procedure should i choose for the patient?
HPI - Otherwise healthy
A 23 years old female with evident genu-varum and Limb Length Discrepancy .Which treatment option would you prefer for correcting of the deformity and Limb Length Discrepancy.
HPI - Pain in left hip after a fall, following open reduction and IM fixation (short Gamma nail) four weeks after the fall. Additional bone grafting with allograft cancellous chips was done primarily
Assuming an infection workup is performed and is negative, how would you treat this nonunion at this time (See 9 month postop films below)?
HPI - 68y/o patient, treated for a chondrosarcoma of the left pelvis/acetabulum in 1997 (radiotherpay + resection + hemi-pelvis allograft and total hip implant).
- 1998 : necrosis of the allograft with implant failure, resulting in revision surgery with a new allograft and total hip revision using a Kerboull cross plate
- 2002 : fracture of the Kerboull cross and implant mobilisation. Revision surgery using a Bursch cage implant
- 2014-2015 : mobilization seen on radiographs, biopsie finding deep infection (Staphylococcus Epidermidis). Revision surgery consisting of implant extraction and resection of the hip
- 2015 : reconstruction using more allograft and cemented total hip acetabular implant and non-cemented femoral implant
- 2016 : acetabular implant mobilization on radiographs. Revision surgery using Lepine Integra acetabular implant
- 2018 : failure of the Integra implant.
As of today, patient has -5cm length discrepency of the left limb. He is medicated by suppressive antibiotherpay by Clindamycine since 2015.
What could be reconstruction options ?
What could be a good treatment option ?
HPI - 59M with 3 years of right knee pain. Due to bilateral knee pain, he uses a motorized cart to get around outside the house and a walker inside the house. He rates his pain as a constant 5/10, worse with walking, and awakens him from sleep.
What type of implant would you expect to use in this patient.
HPI - Chronic low back pain
If performing a THA, what would be your surgical approach?
HPI - Long h/o right hip pain
Right leg always “a little short”
Tried PT / injections / NSAIDS without success
What is your major concern going into surgery?
HPI - Evaluated by rheumatology, dx’d with scleroderma
Started on Methotrexate daily
What would be your surgical approach?
HPI - Retired general surgeon falls of bike suffering a right hip fracture.
What are your treatment next steps?
HPI - Remote history (30 yrs) of left “knee injury”
Left distal 1/3 femur fx 6 years ago
Treated with retrograde IM nail
When performing a TKA in this patient, I would use a:
HPI - Severe bilateral knee pain s/p multiple osteotomies for valgus deformities
When performing Total Knee Arthroplasty in this patient, should the deformity be corrected and how?
HPI - This 62 year old lady mentioned pain with walking stairs and now at rest.
Pain has worsened, despite the following treatments: HA injections, Cortisone injection, Prolotherapy, NSAID, PT.
What further treatment would you recommend?
HPI - The traffical accident
How would you treat this closed tibia shaft fracture?
HPI - Fall from height (ladder) with immediate onset of pain and limited function
HPI - Patient stepped into a hole 6 weeks ago. Reports has had medial knee pain and events of "instability" ever since.
What further radiographic studies are required to determine treatment?
HPI - Severe CP and Developmental Delay Trach
Would you use a classification system to guide treatment?
HPI - Scoliosis noticed at 3 year old well child visit.
What additional study would be most helpful and most likely to confirm the diagnosis/etiology of this Early Onset Scoliosis (EOS)?
HPI - 42 yrs old gentleman, with congenital recurvatum of the left knee as well as Rt DDH. Muscle power 3-4/5, His main complain is the cosmetic problems related to the bizarre shape of the knee while standing. He knows the function of the lower limb will not be restored totally and his expectation is limited to treating the knee hyperextention by any means other than arthrodesis.
What procedure would you do to address the
HPI - 9 year old pre-menarchal female presents with severe left tibia vara without any symptoms of knee pain. She has had no prior treatment. She is able to do all activities and sports without limitations.
What is the optimal treatment for this child's deformity?
HPI - Patient is a 43 year old male with 10 year history of left hip pain, groin pain, and restriction in motion. He had hip scope 3 yrs ago which led to no significant improvement. He is married and still plays recreational hockey.
What additional studies do you want to determine treatment?
HPI - Patient had a fall at home and sustained a distal femur fracture. She was manged with ORIF. 4 weeks postop patient had fall again due to psychosis. New radiographs showed the implant was intact but a varus deformity was noticed at 6wk after an additional fall again due to poor compliance with non-weightbearing restrictions.
Considering her psychiatric illness and poor compliance with non-weightbearing, how will you treat this patient at this point (see 4 week postop xrays below)?
HPI - Presents with 5 year history of knee pain. Patient walks 10 blocks a day and does not reciprocate stairs. Pain has worsened despite non-operative treatment including NSAIDS, Physical Therapy, and Corticosteroid Injections.
At this time, how would you manage this patient?
HPI - Felt a pop when landing after a layup in basketball. Had some immediate pain and inability to push off his left ankle. Was seen in urgent care and given an ankle brace for a "sprain." Little pain at rest, but difficulty walking. After a week of not getting better, PCP orders and MRI and referred patient.
What treatment options would you recommend for this patient?
HPI - The patient suffered an open tibial fracture 12 weeks ago.
He underwent application of an external fixator for 5 days following the injury for damage control, followed by ORIF with Titanium LCP + fibular plating (XRays shown).
The patient is now 12 weeks post-op. He is still experiencing significant pain in his leg. An XRay and CT scan show minimal callus at the fracture site.
How would you manage this patient at this point?
HPI - Bisphosphonate therapy (more than 10 years), ambulatory patient without any disability. The patient fell-down while she was walking on normal ground (low energy trauma) injuring her left leg.
According to the patient's history and radiologic findings, which of the signs suggests atypical femur diaphysis fracture (Bisphosphonate induced fracture)?
HPI - 60 year old female suffered a mechanical fall. She is unable to bear weight on the right leg following the fall.
XRays are shown.
Operated in elsewhere 6 months ago: ORIF
How would you manage this patient?
HPI - 17M involved in car accident.
No visible fracture.
No intracranial bleeding.
No neurologic deficit.
HPI - She admitted yesterday night to emergency department with sudden pain and disability of right shoulder after an epileptic seizure .
Would you manage this patient surgically or attempt a course of conservative treatment?
HPI - This 34 year old lady mentioned occasional left hip and knee pain at our outpatient clinic on 2017-04. An X-ray of the left hip and knee at that point showed early stage osteonecrosis of left hip and no obvious bony lesion of the left knee. Conservative treatment was given initially. However, left knee pain worsened over the past month. Hence, she came back to our clinic. X-ray and MRI of the left knee were checked and showed osteonecrosis over the lateral & medial femoral condyle and the lateral and medial tibial plateau. She denied any autoimmune disease or steroid or alcohol consumption.
How would you manage this patient's knee pain?
HPI - 19 yr old male patient presents following an air gun machine injury with subcutaneous emphysema throughout the right upper limb, bilateral upper chest, and neck. No fracture, no neurologic or vascular deficit.
HPI - 2 years post-traumatic proximal humeral malunion.
He cannot live with it anymore because of pain.
What is the best surgical option for this patient?
HPI - This 28 year-old gentleman with neglected scoliosis came to our outpatient clinic for the first time. He denies any pain, subjective weakness, or bowell and bladder symptoms. Cobb angle 67 degrees. We have no prior radiographs on record.
How would you treat this patient at this time?
HPI - s/p fall from ladder while painting at home. No previous shoulder pain or complaints. Works part-time in a special-needs school.
In addition to an AP radiograph, what additional imaging studies would you obtain to dictate treatment?
HPI - Fell down from bike during cycling
The prospect of this case post-ORIF with K-wire for the distal radioulnar joint (DRUJ) is:
HPI - Acute injury in motorcycle accident 5 days ago
What additional Xrays would you get in this case?
HPI - PARENTS START TO NOTICE BOWING OF THEIR SON ABOUT 2 YEARS BACK AND INCREASE GRADUALLY WITH AGE ESPECIALLY DURING LAST GROWTH SPUR
WHATS THE MANAGMENT
HPI - Fall from a ladder ( approx 2m), landed awkwardly on her left lower limp in a muddy puddle
How to proceed?
HPI - run over trauma 5 weeks ago, NV intact. treated in a rural area with skin traction.
How would you treat?