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 - 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 - run over trauma 5 weeks ago, NV intact. treated in a rural area with skin traction.
How would you treat?
HPI - The condition started 6 months ago by pain in both hips during exercise that gradually increased and affected her performance. This pain improved with rest and analgesics and reccurs with activity. Not present at rest or during sleep.
Would you obtain addition imaging studies in this patient?
HPI - Fall on bent knee
Would you order further imaging in this patient?
HPI - -Multiple discharging sinuses from distal thigh 1 year ago, healed after debridement and dressings.
- Presently has deformity of the knee with painful gait
How would you manage this patient?
HPI - A 2 year old girl presented with abnormal gait - her initial XRays are shown.
She underwent open reduction of the LEFT hip after the diagnosis of DDH was made (at age 2).
Follow-up Xrays are shown below, which illustrate osteonecrosis of the left hip following open reduction.
The patient is relatively asymptomatic with normal gait following open reduction of the left hip.
She is currently 3 years old.
How would you treat this child?
HPI - Fall and injury to left ankle
Is the closed reduction acceptable?
HPI - 7 year old male patient. Presented with history of supracondylar fracture of Left elbow 5 months ago. ORIF was performed and removal of K-wires done after 2 months. Physiotherapy done after surgery, but with little benefit and minimal improvement of ROM.
How can we obtain better elbow motion for this patient?
HPI - Patient suffered from a trauma 3 months ago. First, the parents went to an alternative medical center. 2 months after the trauma, patient presented to the hospital for assessment.
Would you order a CT-scan?
HPI - 2 year old boy, fell off a two wheeler, was brought in by parents with complaints of not moving the right upper limb. No other significant injuries
How would you manage this fracture?
HPI - This patient had a fall and sustained a lateral condyle fracture which was treated in a peripheral hospital with cast immobilization.
She is now 14 months post injury.
No ulnar nerve symptoms at the moment.
Her primary complaint is a significant elbow deformity.
How would address this problem surgically?
HPI - 5 y/o male patient is brought in with progressive scoliosis. Diagnosis of spondyloepiphyseal dysplasia (SED) is confirmed by genetics.
HPI - A 9 year old boy is brought in by his parents with asymmetry and tilting of his head since birth.
When evaluating a patient with Sprengel deformity, what imaging is required?
HPI - Limping of 5 days duration.
HPI - Witnessed fall from ladder while at school.
What is your preferred management of this case?
HPI - 2yo girl presents with her mother following sudden onset of tip-toe gait 2 days ago.
This is her first episode of tip-toe gait; she was previously ambulating normally.
No history of trauma.
She has hit all relevant milestones; no delay in development.
Had a recent upper respiratory tract infection 1 week earlier, which has resolved.
What is the likely diagnosis?
HPI - Patient presents with limping of 2 years duration with intermittent right knee, hip, groin and thigh pain.
HPI - Patient presents with forearm pain after FOOSH injury when he fell while playing in the schoolyard.
HPI - 11M presents with a recent history of trauma to his Right foot with subsequent pain in the midfoot area near the 2nd metatarsophalangeal joint.
Xrays are taken which reveal the findings shown at the base of the 5th metatarsal.
There is no pain to palpation at this area of the foot.
What is the diagnosis?
HPI - 12 yo boy presents with Left elbow pain and a history of an ulna shaft fracture 3 years ago.
He was treated with closed reduction and casting at the time of the initial injury. The boy's parents report that his arm never looked right after the injury. He continued to have pain in the lateral aspect of his elbow, with an associated prominence anterolaterally. They were advised to wait two years which did not yield significant improvement, so they finally sought treatment elsewhere.
The patient presents with his parents with complaints of left elbow pain with movement and inability to participate in sports. The patient is right hand dominant and this is a left-sided injury.
Only one XRay is available from the initial injury, which is shown.
Three current XRays are shown.
Would you order further imaging on this patient?
HPI - Progressive bowing of his lower extremities.
Initially presented with bilateral genu valgum and had a corrective osteotomy at 2 years.
Bowing started after surgery. It is associated mild pain following activity.
No other deformity.
No family history.
How would you manage this young boy with painful deformity of his bilateral lower extremities?
HPI - 17yoM with quadriplegic CP GMFCS level 5, with chronic right hip dislocation suffered a mildly displaced R hip intertrochanteric fracture while being positioned. He is very high surgical risk due to seizure d/o, recurrant pneumonia, and Crohn's disease.
How would you treat this?
HPI - Simple fall
How would you have confirmed the diagnosis of a coronoid fracture in this pediatric patient?
HPI - Pain and inability to weight bear on RIGHT hip after simple fall.
What is the abnormality present in this type of bone?
HPI - A 14-year old male presents on the same day as a left wrist injury. Injury films are shown (excuse poor quality). Closed reduction is performed, and a splint is placed. Post reduction films are shown below immediately after the reduction and after 5 days when the patient returns to clinic.
Now that the patient returns 5 days later, how would you treat him based on the Post-procedure P2 films below?
HPI - This is the case of a 10 month old girl with a hypotrophic malformation syndrome of the left half of the body.
She has thumb duplication with a second inter-digital space angle of about 80 degrees, a radial club hand, and a hypoplastic radius.
Hallux duplication deviated 88 degrees medially, tibia hypoplasia with a 3 cm leg length discrepency.
She underwent surgical treatment (by non-expert hands) of these duplications without correcting the deviations. She is now 7 months post-op.
Do you think that this is Silver-Russell syndrome?
HPI - FOOSH-type injury that was managed at another hospital.
Patient was placed in the below-elbow cast.
Referred to our institution for a second opinion and further management.
Would you have accepted the original reduction? (See Post-Procedure P1 XRays above - AP and Lateral)
HPI - Fall on the ground with pain and deformity of the LT knee. Pt. presents with the injury films show. Closed reduction was performed. See closed reduction below.
What would you do for definitive treatment of the distal femur physeal following the closed reduction films below?
HPI - Since childhood
How would you treat this 13 years old boy with neglected DDH?
HPI - Pain Bilateral hip joint since 5yrs
What was the likely underlying etiology?
HPI - Patient presents with slow and progressive swelling of left thigh that started 9 months ago. The swelling only in left thigh .Equal lower limb length
What is the most likely diagnosis?
HPI - History of swelling and discharging wound over the left gluteal region at the age of 2 months. Treated only with dressings. No surgical decompression done. Started walking with a painless limp at 1.5 years of age. Affected limb noted to be shorter.
How would you classify this lesion?
HPI - 13 year-old male experienced trauma two weeks ago and suffered both bone fracture. The patient was initially treated in a long let cast.
Based on the 2 week xrays, how would you treat this pediatric tib-fib fracture?
HPI - Twisting injury of left ankle while playing football
What is the best management option?
HPI - Patient presented after a fall from a slide on his left arm. Patient denied any other trauma. Patient's parents think he fell on an outstretched arm.
HPI - Pain and weakness right hip during last two years. Limping gait since 10 years old but was doing very well.
What was the most likely cause of his hip dislocation and deformation?
HPI - Twisting injury 4 hours ago
No prior pain or history of trauma
HPI - The patient has had right hip pain for the past two years. The pain is worse with exertion.
What is the most likely primary cause of his symptoms?
HPI - Acute knee pain after an injury during a soccer match.
How would you treat this injury?
HPI - Fall down on rt abducted rt shoulder while playing football
Where and how would you have performed the closed reduction.
HPI - Child age 8 sustained supracondylar fracture on 20 July 2015, admitted in Hospital and urgently operated. Due to lack of C arm in operation theatre doctor didn't check fracture position and somehow decided not to reoperate later when he confirmed position of fracture by x rays.
How would you treat this patient
HPI - h/o fall in the park a week before presentation.was treated in a slab in another hospital.
How would you treat this fx now that it is seven days old?
HPI - neglected clubfoot treatment in childhood
HPI - Patient had a sudden onset of pain in the right hip 14 days back.. she felt a clicking sensation while having her bath, no history of trauma... by the next day she developed an increase of pain and mild swelling of the hip and had developed fever and had pain in performing movements of the right hip.... usg report show hemarthrosis
Based on the clinical presentation and radiographs above, what is the most likely diagnosis?
HPI - The patient had a history of a fall in childhood that was treated nonoperatively by the village bone setter. Patient went about his life with deformity but no limitation to his work.
Then 7 months ago the patient fell again and developed acute pain in his right elbow. Patient did not seek immediate treatment.
Three months after the fall, he returned to his native country and surgery was performed. (see Postop Procedure 1 films).
He now presents with persistent pain and hardware prominence.
Do you think the large lateral condyle fragment represents an acute nonunion (from fall 7 months ago) or a chronic nonunion from his pediatric lateral condyle fx?
HPI - S/p car accident 5/4/2015
How would you classify this fracture on initial injury?
HPI - Fall on outstreshed hand 3ms ago
ORIF by k wires
Slap for one and half ms then removal of slap and wires
Physiotherapy till now
How would you treat this patient?
HPI - 10 year old girl fall on ground 3 weeks ago. She was treated with closed reduction and long arm case in full pronation. She is now 3 weeks out and presents with the radiographs shown.
How would you treat this fracture now that it is 3 weeks out from the fracture.
HPI - 2 yo child with PFFD right leg and no femoral head and dysplastic acetabulum.
How would you classify this problem?