HPI - Sports bicycle accident with direct blow to his left shoulder. No other injuries
Operative vs. Conservative treatment?
HPI - Optd at a different center with DHS fixation for subtrochanteric fracture right femur.
Reinjury in 1st week Feb 2015. Reported to us after 01 month of injury.
What would be your fixation method of choice for the initial injury
HPI - Operated for Comminuted Subtrochanteric fracture of right femur in Dec 2014 at different center. DHS fixation was done.
Sustained slip and fall in Feb 2015 during rehabilitation. Presented 15 days after re injury to our center.
Pain and inability to bear weight.
How would you have fixed the initial fracture.
HPI - 08 y/F. History of developing abscess left arm 02 yrs ago. Treated at different center with drainage. Reemergence of abscess after 02 months which had been again treated with drainage. Was given anti tubercular treatment for 09 months (Details of indications and medical records not available with patient at the time of presentation to us).
What is your preferred procedure for reconstruction of such cases in paediatric age group following resection of pseudoarthrosis.
HPI - tetraplegic pt - Heterotopic ossification of both hip joints...
what is the preferred treatment choice for this patient?
HPI - Falling from height (4M) two days ago
No other Musculoskeletal abnormal data
NV is okay, no signs of compartment syndrome
How to manage?
HPI - Sustained comp grade 3 fracture both bone right leg 3months back.Extetnal fixator was applied flap coverage was done.External fixator was removed 2weeks back
How would you treat this patient at this point?
HPI - 20years ago, slip down injury
--> intermittent pain during exercise
He has no problem ordinary life
What is the optimal treatment at this time?
HPI - Patient fell and sustained a dislocation of the shoulder 3 weeks ago.
Shoulder reduced on its own.
Non-contact, recreational athlete.
How would you treat this patient?
HPI - 2011 was diagnosed with osteonecrosis of the right knee - no treatment then, kept bearing weight and the pain resolved - till now symptom free - ambulates well, tolerates the pain
HPI - A 56-year-old male suffered a closed fracture of the left humeral shaft which was treated by antegrade interlocking intramedullary nail 1.5 years ago. The patient now presents with persistent pain and inability to work.
How would you treat this humeral shaft nonunion?
HPI - Fell at home, multifragmentary and bifocal fracture of distal radius with complete articular involvement, multifragmentary fracture of distal ulna.
What would be the choice treatment?
HPI - RTA 3 yeas ago result in closed femoral supra-condylar # type (A III) treated by conservative management( was pregnant and refuse surgery).On physiotherapy an iatrogenic patellar tendon avulsion occur few months back.
what is your treatment plan ?
HPI - Pt had fusion hip 10 yrs back
Has pain rt hip for 2 mths
What is the best treatment option
HPI - s/p skiing accident, had LOC at the site. R shoulder and chest pain currently.
How would you treat this injury?
HPI - A 64 year old female patient presented to our dept. complaining of pain in the right ankle after falling downstairs.
How would you proceed?
HPI - case of MVA sustained 3 weeks ago was treated in another hospital with debridement & knee spanning external fixator and wound closure over shaft.
HPI - Pain ulnar aspect right wrist from 6 months, no trauma,no fever, no other significant history, patient unable to carry weight, And from 3 last months also difficulty in writing
Diagnosis and Management
HPI - 51 year old LHD male presents one day following an acute injury to his right elbow (non-dominant) when lifting a heavy object. He felt a pop near his elbow and had immediate pain and swelling. On physical exam, he has decreased ROM and significant ecchymosis around the elbow. Radiographs are negative for fracture or dislocation.
How would you treat the distal biceps avulsion in this patient?
HPI - 40 yr old active female with groin pain with activity. No major trauma. Pain getting worse for past few years. All in groin. + pain in groin with FADIR of hip.
Clear hip impingement but with significant protusio / global pincer.
Also with pubic symphysis sclerosis.
LCEA is 49 deg
Classic Contre-coup lesion in posteroinferior acetabulum and posteromedial femoral head.
Hip arthroscopy with acetabular bony resection? Will that lead to futher instability? Labrum will likely be ossified and crappy. Be prepared for labral reconstruction?
Send to open surgeon?
Next step after failing conservative treatement.
HPI - Case of 77 year old female patient previoisly known to have HTN,DL,CAD had left femur trauma s/p car accident,had DHS since 6 years on the same side where she was ambulating well with no complaints
What is the best option for treatment?
HPI - incidental finding on xray. follwing which a ct scan was done
Based on xrays alone would you recommend further investigations?
HPI - Mentally challenged. Came from rehabilitation center with history of epileptic Fitts, followed by fall and sustained trauma to right leg.
HPI - FALL DOWN - A LOT OF SIMILAR SMALL TRAUMATIC FALLDOWNS IN THE PAST- TKA BEFORE 12 YEARS
WHAT IS YOUR IDEAL TREATMENT FOR THIS CASE?
HPI - Patient sustained fracture distal 3rd right tibia 1week back.C/R and A/K pop cast was applied.patient developed swelling and blisters and cast had to be removed.blister over the fracture site has almost dried
HPI - fell from a height years ago, neglected till pain became worse ,morning stiffness started one year ago ,pain now is uncontrollable with NSAID. also she took lots of muscle relaxants but, improvement was temporary and very little
patient own words"while walking", i feel a click on my lower back, like friction of 2 objects".
-pain has been felt for one year now
-she is a house wife with 3kids, she has a lot of work to do every day with no help.
How would you treat this Grade 1 adult isthmic spondylolithesis with back pain only, and a negative neurologic exam.
HPI - fall from horse on right shoulder today, pain and limitation of movement of dominant right shoulder, no other injury
HPI - Patient sustained galeazzi fracture right radius 8months back.he was operated but implant got infected and loose.About three months after initial surgery he was operated for implant removal and antibiotic impregnated cement was inserted .patient again developed reinfected one month after surgery and was advised redribedment again.but he did non report for surgery.
Now he has presented 2days back with increased deformity and infection
HPI - Came to the ER after a road traffic accident ,general condition is good,discovered after routine x-ray
Do you need any additional imaging studies in addition to the radiographs? If so, what?
HPI - non treated vertical talus
What is the best treatment?
HPI - 22 yo fall on ice. how would you treat this fracture pattern with fibula fracture 13cm proximal from mortise??
How would you treat this fracture pattern with fibula fracture 13cm proximal from mortise?
HPI - fall on out stretched hand, distal radius and ulna fracture
How would you treat this fracture?
HPI - 2years ago fell on out stretched hand, supracondylar left humeral fracture ,treated by above elbow cast for one month
How would you treat this malunion?
HPI - 46F with a chief complaint of right knee pain that began when she heard a pop while performing yoga. She states she subsequently further injured her knee while running and now has a moderate effusion as well as mechanical symptoms. She has been unable to fully extend her right knee, lacking approximately 8 degrees of terminal extension. She is otherwise healthy, enjoys running, and has a BMI of 21.
In a 46 year old avid runner with a medial bucket handle tear, what is the preferred treatment option?
HPI - History of fall while playing 2 days back
HPI - 18 month old girl with scoliosis
The curve measures 63 degrees and has been stable for 6 months. How would you treat this at this time?
HPI - 18 months with persistent pain in hand and wrist left.
denied history of trauma.
What is the most likely diagnosis?
HPI - history of fall from bike on 01/14/2015 . primary treatment given by surgeon locally who reduced the wrist and applied plaster slab.
HPI - The patient sustained a comminuted open gustilo III fracture of the left tibia due to a motorbike accident two and a half months ago. He was operated on an emergency basis. Thorough debridement of the trauma was performed followed by osteosynthesis with a ring external fixation .
What is the best treatment option for this patient?
HPI - Fell from 4 meters height 2 WEEKS AGO, treated in the emergency setting only with splints.
What would be the best treatment at this time?
HPI - RHD, retired independent woman.
12/22/14 - slipped on the floor at home.
Pain in the left shoulder.
HPI - Progressive on set of right shoulder pain started 4 months ago. Was treated as a rotator cuff tendinopathy with rest, anaelgesia, antiflammatory medications and courses of physiotherapy.
The pain was initially intermittent but after a short period became constant.
There is no known history of trauma.
What would the next step be?
HPI - 10 years ago the patient had taken chemotherapy and radiotherapy and went under a bone marrow transplantation due to ALL diagnosis. He has been totally cured for 10 years and no relapse. He has not been using any immunsuppresive agent since then. (10 years)
What would be your first choice for treatment of this patient?
HPI - This collegue riding on the bicycle had a elbow trauma falling on his extended dominant elbow
HPI - 2013/10 Bipolar-hemiarthroplasty d/t
2014/09 ORIF c cable grip d/t periprosthetic fx
2014/10/7 CRP was elevated(8~10mg/dl).
2014/10/24 wound problem(redness, pus)
10/31 cable grip removal & antibead insertion
-> Pus was seen lateral aspect of
We considered focal infection due to
We did not expose and irrigate intra-
After latest surgery, CRP elevation(8~10mg/dl) was continued using 1st cephalosporin. After changing 3st cephalosporin, recently two weeks CRP was decreased (1~2mg/dl, above normal)
How would you treat this patient at this time?
HPI - 3 weeks of pain. Limping.
Based only on the radiographs, what is the most likely diagnosis?
HPI - Hit flexed right knee on a metal guard rail whilst skateboarding down a hill at 40 km/hr
HPI - History of fall on left outstretched hand while playing football on 08-01-2015.
HPI - 25 year-old lady who had been injured in an explosion in Syria, presented us complaining unable to use her left leg. She also had femoral shaft fracture which had been fixed by IMN.
Which treatment would you prefer previously for this patient?
HPI - 89 year old right hand dominant female fell while at home. She hit her head hardest then landed on her left shoulder and elbow. Patient refused CT of the head. She walks without assistive device but does use the walls and railings. Her two daughters live with her at home.