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 - 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 - 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 - 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 - 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 - 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 - 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 - 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.
How would you manage this patient?
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 - Fall from a ladder ( approx 2m), landed awkwardly on her left lower limp in a muddy puddle
How to proceed?
HPI - 45 y/o male with elbow pain after a fall.
HPI - Simple fall on the ground 3 months ago
Analgesics and bed rest since that time
What further investigations would you order in this patient?
HPI - Initial trauma was 3 months ago. Patient was not treated properly because she was in a remote area. Partial weight bearing starting 1 week after the trauma. Full weight bearing now.
How would you manage this patient given she is now 3 months from the injury?
HPI - Fall from stairs 3 days ago.
What classification is this fracture?
HPI - While walking the patient twists her ankle and had a bimaleolar ankle fracture 6 months ago. The fracture was treated with ORIF 3 weeks after the fracture (XRays shown). She progressed well until 2 months ago when she notes heel deformity and ankle swelling.
What is your diagnosis?
HPI - A 71-year-old female presents with pain and swelling in the wrist and forearm after a ground-level fall 2 days ago. She was initially treated with closed reduction and cast immobilization. Radiographs are shown before and after reduction.
How would you treat this fracture based on the post-reduction radiographs?
HPI - A right knee injury occurred while running hurdles. He experienced immediate pain and swelling along with right foot numbness and weakness. An obvious knee deformity was recognized.The patient was transferred by ambulance to the local emergency room.
What would you do first in the ER?
HPI - A 54-year-old female presents pain and swelling in the wrist and forearm after a ground-level fall 7 days ago. She was initially treated with closed reduction and cast immobilization. Radiographs are shown before and after reduction.
How would you treat this fracture based on the post-reduction radiographs?
HPI - Fall from height
HPI - The patient suffered a comminuted humeral shaft fracture 9 months ago which was neglected. He presents now with pain and loss of function in his arm.
HPI - Heavy weight injury 18 days ago, immediate pain, swelling ; diagnosed with left ankle fracture.
Is this a case of a simple lateral malleolus fracture?
HPI - Driver of a bike who hit a car and fell on the road
What do you think of the reduction of this fracture?
HPI - Motorcycle vs. car; immediate pain, swelling and deformity; diagnosed with right ankle fracture.
What Lauge-Hansen type of ankle fracture is this case?
HPI - History of fall down on left wrist one month ago.
The patient is neurovascular intact. The fracture was an open fracture (type 1) with a small wound on the volar aspect of the distal ulna. At the time of the injury, this was treated operatively with irrigation and debridement and placement of an ex-fix spanning the fractures.
Currently, the wound has healed. There is no sign of infection.
CRP and ESR are normal. XRays are shown.
How would you manage this patient at this time?
HPI - Traffic accident resulting in an injury to the right knee and ankle.
What is your preferred management of the Pilon fracture?
HPI - Fell while hiking 9 days ago; immediate pain, swelling and deformity; went to outside hospital and diagnosed with right ankle fracture.
How would you have addressed the syndesmosis in this patient?
Which approach do you prefer for the fracture of the radius ?
HPI - An 18 year old male presents for follow-up 6 months after suffering a transverse femur fracture in a motorcycle accident. He was treated with an external fixator as he was diagnosed with a pulmonary embolism soon after his admission.
HPI - A 34 year old healthy, active female presents to clinic on crutches after a fall yesterday where she injured her ankle. She has no significant past medical history. She is otherwise healthy.
Would you order additional imaging in this patient?
HPI - RHD female who complains of elbow pain after falling off her bike onto her left elbow
Assuming you only had the injury radiographs, what additional imaging would you obtain in this patient?
HPI - Injury occurred two day ago - crush injury to the big toe.
What is your treatment plan for this patient?
HPI - 6 months hx of postoperative ankle pain
If there is evidence of infection, what is the best choice of treatment for this case?