HPI - Patient sustained compound grade 3 Segmental fracture right tibia 4 months back.Treated with external fixator and rotational flap.fixator removed about 1 month back.
How would you treat this patient considering the poor soft tissue condition over fracture sight
HPI - RTA , collision of bike with another bike.
How would you initially treat this injury?
HPI - felt home
How to treat this fracture?
HPI - high velocity gun shot wound, inlet on the left hip above greater trochanter, presented with right hip pain.
what is the appropriate treatment?
HPI - Walker-assisted low-level community ambulator, mildly demented 79 y/o female who had non-syncopal fall while walking to bathroom.
What would you do with this fracture?
HPI - MVA , isolated injury right ankle, neurovascular free.
HPI - 2008 rev TSR, full function, after fall from height periprosthetic fx
how would You proceed
HPI - 25 yo laborer that was dancing at his bachelor party with first-time patella dislocation. evidence of large (approx 2cm)chondral loose body from medial facet with small amount of bone attached to small portion of loose body. TT-TG ratio is normal. In addition to MPFL repair/recon how would you treat the largely chondral fragment with small amounts of bony attachment.
would your treatment include attempted fixation of segments with attached bone, debridement, OATS, microfracture?
would you use bioscrews or acutrax metal screws for any attempted refixation??
deNovo is not available due to insurance restriction.
what would your treatment be for the largely chondral defect with small areas of bony attachment?
HPI - Bilateral club feet treated by multi-surgeries in the early childhood.
How would you treat this patient?
HPI - She was riding motorcycle with her daughter.She lost control and fell hit her knee and head. She lost consciousness for 30min and regain it in peipheral hospital. Had facial bruises. No bleeding from craniofacial Os.The knee was swollen and painful
How would you treat this injury?
HPI - Young football player fall on his forearm during a match
HPI - Pt. Came one year back to ER complaining from a acute right hip pain following a minor trauma. He was diagnosed to have fracture neck of right femur with a suspicion of a metabolic bone disease, fixed with cannulated screws, been referred to endocrine, been followed for 2/12, then he disappeared for 10/12, then he came again to ER with an acute left hip pain again following a minor trauma. He was lost his follow up with endocrine. Pt. Was diagnosed to have a fresh Pathological fracture neck of left femur together with nonunion fracture neck of right femur. Pt. Was referred again to endocrine and he was started on medications with the impression of a metabolic bone disease.
How to treat fracture in left femoral neck.
HPI - MVA since 5 days with comminuted proximal femur , patient underwent fixation of an ipsilateral supracondylar fracture 9 years ago which is healed in varus and shortening with bend plate
Best way to fix the proximal fracture
HPI - Patient was operated in Feb 2014 for supraspinatus tear right shoulder arthoscopically.Sympotms improved after surgery .At about 3 weeks post op patient developed sudden pain following physiotherapy which subsided after rest for few days.Three months after surgery patient developed severe sudden pain in right shoulder which progressively increased and was also present on rest.
Patient had no fever .
ESR was 50 and crp was negative ,counts were normal
Repeat MRI ON 26 JUNE 14 showed tear of supraspinatus infraspinatus and subscapularis along with signal changes at greater tuberosity.
After course of iv antibiotics symptoms subsided and pain releif was about 70%. After shifting to oral antibiotics pain also increased after about one week .At present pain is about 50%better and movements have slightly improved .
Serial xrays show increasing erosion around greater tuberosity
What is the diagnosis of this post operative complication
HPI - severe pain in the wrist
inability to move the wrist
what is the best treatment option ?
HPI - A 58 year-old lady, well in herself, sustained 2 1/2 years ago, an open fracture (Gustilo I) of the right ankle (medial, lateral and posterior malleoli). She was managed with an ORIF of the lateral and posterior malleoli but the medial malleolus was not fixed due to poor skin condition above the incision area.
What is the appropriate treatment method?
HPI - fall from bike
How would you fix this coronal shear fracture?
HPI - history of fall on semiflexed elbow
What approach would you use for this particular injury?
HPI - S/P snowmobile accident. C/O severe LBP, R leg pain, parasthesia and weakness.
What would be your choice of treatment?
HPI - injury at work site the knee was crushed between two heavy objects at low velocity. Was seen at our hospital 3 hrs after the injury
Following soft tissue optimization, how would you definitely treat this injury?
HPI - 20 yo male s/p 3 close range shotgun blasts. Massive soft tissue loss medially at level of defect. STAT angiogram revealed peroneal artery is only vessel intact to foot. Underwent I&D, bead placement, partial closure and exfix. Patient with good family support, but he is currently unemployed and not college educated. He appears to have poor coping skills.
What would be your next step in treatment?
HPI - Closed tibial fracture with moderate swelling deep ecchymosis
HPI - falling from the last stair,hip replacement since 2002,treatment of the femoral pseudarthosis since 2011
HPI - case of fall 2 mths ago operated elsewhere for hip fracture.post surgery 2 mths complaining of pain increasing on weight bearing(on walker support)
Would you continue with observation or revise at this time.
HPI - 27 yr F. Multiple knee instability episodes. Many patellar dislocations when teenager. Was a dancer. Has generalized ligamentous laxity.
Had MPFL repair and lateral release 12 years ago. Did not do well after surgery.
Main complaint is instablity.
On exam very lax patella. + apprehension. 4 quadrant excursion.
Failed conservative tx.
+ patella alta
Caton deshamps 1.3
Trochlear dysplasia Dejour type C
+ acl tear
What to do now?
Tibial tubercle tx with distalization and revision mpfl reconstruction
When to reconstruct ACL? Do all one surgery or stage?
HPI - swelling over left upper back for last 4 yrs increasing in size.first noticed by his mother.
history of fall from tree 4 yrs back about 12 feet height didnot seek any medical advice.he was asymptomatic till today except swelling which doesnot interfer with his daily activities.
what is your provisional diagnosis?
HPI - Patient suffered from closed distal 1/4 both bones fracture 6 weeks ago treated by closed reduction and percutaneous pinning by k wires
First presentation in our clinic with obvious angulation and limited supination 6 weeks after trauma with subluxation of distal radioulnar joint
HPI - An active elderly lady. Fall from cot
How would you treat this fracture?
HPI - A 15 years old football player injury his ankle during a match because of a fallen on the ball causing a forced inversion of the foot
HPI - Accidental shotgun injury to right lower leg
HPI - Twisting injury of ankle
HPI - Swelling at distal femur with obvious knee swelling and deformity
When to start knee range of motion, weight bearing
HPI - 2011 ORIF
2013 implant removal
What would be the best treatment options?
HPI - fall from height ( 3 feet). at presentation in ER we attempted to reduce peritalar dislocation in iv. sedation, and due to a relative anatomic position of the foot we assumed that it was fine (marked swelling). finally, at the Rx control we realized that instead of reducing the subtalar joint, we dislocated the tibio-talat joint
how would you describe this lesion?
HPI - was playing beach volleyball at 2am in the morning.when he injured his right knee after jumping for a smash
Assuming no vascular injury, how would you treat this patient?
HPI - Pain of 2-3 months
What is the most likely diagnosis based on the images provided?
HPI - case of capitellar trochlear fracture operated orif 2 weeks ago thru olecranon osteotmy
What would be your next step in managment?
HPI - MVA; bike vs bike.
HPI - bike vs bus MVA 10 days ago. Was unable to bear weight on the leg immediately after the fall
How would you treat this patient`s ACL?
HPI - MVA 3 days ago - intact neurovascular state with moderate edema slight ecchymosis
HPI - 44 y/o s/p MVC with bilateral ankle injuries. + concussion but otherwise no obvious injuries.
How would you treat his original pilon injury?
HPI - Fall on outstretched arm at home.
HPI - Motor vehicle accident since 5 days with closed comminuted subtrochanteric fracture femur with ipsilateral medial mallelous fracture
HPI - h/o of RTO, sustained left distal radius intraarticular fracture. ORIF done with LCP. 1 1/2 month followup xray showing fixation failure. Patient was not immobilized post op.
HPI - twisting injury on stairs today.attempts by another referring hospital at closed reduction unsuccessful under sedation
What would be your next step after reviewing the available imaging?
HPI - Road traffic accident 1 wk back.
closed fracture calcaneum right
valuable comment pls !
HPI - 17 year old obese female. BMI 37.2
Playing football with friends. Twisted knee and heard a pop and swelling.
MRI shows acl tear and medial meniscus tear, but standing xrays show significant lateral joint widening.
Full length scanogram shows significant varus alignment.
Difficult to really evaluate posterior lateral corner structures due to obese knee. I did not appreciate any increased external rotation.
What to do for this young pt?
ACL reconstruction alone?
ACL and HTO?
What surgery would you perform?
HPI - Fell from a motor bike in a road accident
What method of treatment would you advocate?
HPI - Inability to walk, severe unstable hind foot with type 3 Charcot Foot underwent TTC fusion 6/12 back, failed with exposed tip of one calcaneal screw.
HPI - Fall from motor bike 4 mths ago. Patient refused surgery and got it treated by a bone setter who put him in a cast for a month.Minimal to no motion at the elbow.