HPI - Trauma since 5 days with good local skin conditions
How would you treat the right sided distal radius fracture
HPI - Left hip pain for 14 years with draining sinus tract.
How would you treat this patient?
HPI - She has bilateral knock knees since 9 yrs of age. Frequent falls due to crossed legs. She has no complains in the hips.
HPI - RTA----1 dday
How would you treat this injury?
HPI - DM type 1 , 24 hrs prior to admission front seat passenger , RTA , abdominal , pelvic , rt femur and lt tibia pain and tenderness and swelling
How would you treat this patient's femur fracture?
HPI - pain rt clavicle inability to raise rt shoulder after fall
If performing surgical fixation, what would you do for this injury?
HPI - fall at his work site on outstretched hand.injury rt elbow
How would you treat this patient and injury?
HPI - Male pt 48 y old , manual worker (high demand), Rt handed, fell over his Rt hand
HPI - 12 yo with low lumbar spina bifida (L4-S1), who ambulates without any supports. Parents report a progressive cavus deformtiy more on the right than the left. They feel it is progressing rapidly. She has sensation to most of her foot, somewhat decreased on the lateral part of the dorsum of the foot, but normal in all toes and plantar surface. Complains of frequent ankle sprains. She has had de-tethering procedure 9 months ago, but parents feel it is still progressing. MRI scans and neurosurgical consult completed recently suggest no evidence of residual tethering.
Normal motor function on EMG of peroneals and tib ant and gastrocsoleus. Normal peroneal nerve and sural nerve conduction.
HPI - Hx of RTA 8 years ago, had Surgery around the left hip, pt remained symptomatic and had another surgery on the hip in other center 5 years ago.(No Medical record or X-rays were available with the pt.
Pt presented with left thigh pain, limping, quadricep waisting, limited Abduction.
What would be your next step in management of this patient?
HPI - Was injured in a car accident two years ago and sustained left hip fracture-dislocation. Was immediately treated with reduction and ASNIS screw fixation. Screws were already removed at the time the patient seeked our opinion.
HPI - Road trafic accident 6 months ago. Intially treated by "bone settler."
Would you initially treat both injuries (femur fracture and malunion) simultaneously?
HPI - Swelling medial aspect of right arm. Approximate mass/swelling is 6x2 cms. No erythema or tenderness. Full range of motion of right shoulder and elbow.
What is the most likely diagnosis for this lesion based on radiographs alone?
HPI - Sustained injury 2 yrs. ago. Treated conservatively
How would you classify this nonunion?
HPI - 37 year old Male s/p shoulder dislocation and closed reduction.
How would you classify this bony bankart?
HPI - 45 yo RHD laborer with hx of fall 4 weeks ago with worsening pain. evidence of AC joint separation and displaced coracoid fracture.
What are your pearls for coracoid reduction and screw fixation? Would you use standard deltopectoral approach and release CA ligament and pec minor? Would you perform a distal clavicle excision to assist with clavicle reduction? Tips on use of hook plate for AC joint??
What would be your treatment of combined AC joint and coracoid frx?
HPI - A 60 year old psychiatric patient (Schizophrenia) lived in an institution and mobilized independently, sustained a mechanical fall on her right femur.
How would you treat this fracture?
HPI - fall 3 days ago seen at another centre was put in a slab and advised to see the ortho consultant.patient seen by me after 3 days
What would be your FIRST line of treatment for this injury?
HPI - undiagnosed capitellum fracture 7 months ago.
Excision of the capitellum fragment 3 months ago followed by physioteraphy
How would you treat this patient now?
HPI - Patient was treated in a private setup for septic hip 1 year back. He now presents with a painful hip and limp. He reports current intermittent fever.
What would be your next step in treatment, considering his ESR and CRP are still abnormal?
HPI - NOF fx 2 years back fixed with screws.patient had traumatic dislocation 6 months back,which was reduced closely but dislocation after 1 week.again reduced.
he didt came back to follw up untill now.it has been tried to reduce it which it does easily but dislocates on table.very unstable
MRI cant be done as the screws are of steel(locally made,not 316L for sure )
How would you treat this chronic dislocation?
HPI - She had a Fx NOF 2 years back,quack treated.
Now has difficulty in activities of daily living.
No fever,no other joint involvement
What to do?
HPI - Two years back patient had a traumatic injury to his Rt knee.at that time no finding was picked and he was given compressive bandage.
Gradually valgus deformity occurred and now he walks with a limp.
HPI - Pain started in Rt knee .gradual swelling.
no trauma. no fever.
No other body joint involvement
What would be your next step in managment?
HPI - there is h/o RTA 6months ago.Initially treated by pop.Now c/o pain and inability to perform routine activities
HPI - h/o fall injury to rt shoulder. Pain and inability to move rt shoulder
what kind of surgery
HPI - case of fall 3 mths ago.sustained injury tio left leg was diagnosed with left tibia fracture. was advised surgery by another surgeon.patient refused surgery and was put in a cast for 3 mths.now unable to bear weight on affected leg and complaining of pain
How would you treat this patient at the current time?
HPI - fall from height
traction in Thomas splint for 12 days
Is this position accepted ?
HPI - road traffic accident 1 year ago and there is fracture right distal radius.intially treated by bone settler. Now complaint of pain and deformity and difficulty in performing daily activities.
what is the best treatment?
HPI - 3 mt fall over outstretched right hand, also presents not displaced isquial and pubic bone fracture
HPI - Patient slip off,(minor trauma)
Anamensis: 1988 THA( posttraumatic AVN of the femoral head)
1999 revision hip arthroplasty(Wagner revision stem+cerclage) because of aseptic loosening
Problem: atrophic femoral cortex around stem!!
What treatment would you suggest ?
HPI - Severe Back pain since 12 days, with particular exacerbation at night. No history of trauma. Doesn't complain of any numbness in any of her limbs. No Bladder/ Bowel involvement. Has Loss of appetite. No loss of weight recently. Had a febrile illness for three days 15 days ago.
What treatment would you suggest for her Back pain?
HPI - 18 yo following patella dislocation with 12x11mm chondral defect at the median ridge with several chondral loose body fragments. TTTG is 14. In addition to MPFL advancement and lateral release what would be your cartilage restoration technique of choice? Insurance carrier in this region will not pay for DeNovo.
Which cartilage restoration technique would you select?
HPI - Otherwise healthy 6 year old boy who fell at the playground on his left elbow. He has had elbow pain since with any ROM. No prior elbow injury known.
What do you think this is?
HPI - jumping from the second floor
what is the best treatment option ?
HPI - Sustained atraumatic patellar dislocation while walking at age 10. Full dislocation, self-reduced. Underwent PT. Sustained another while running. Underwent PT. Then a third dislocation.
What is the next step in treatment?
HPI - Fall from a height of 30 feet. Complained of immediate loss of all sensation below waist, severe pain in the back and no movement in both lower limbs.
Transferred from another hospital, 20 hours after injury.
Surgery performed 40 hours after injury
Would you consider stem cell treatment for this patient`s neurological recovery?
HPI - 16-mos old female, normal developmental milestone and now walking normally, presents with border images and possible developmental hip dysplasia.
How would you treat this 16-mos female with borderline DDH?
HPI - h/o fal;l at play. injury rt elbow. pain inability to move elbow after fall
milch anatomical classification
HPI - Presents with pain in the left shoulder, initially milder and occasional but now constant and increases with activity and at NIGHT, unable to use his left arm for ADL, for the last two years.
No H/O fever, appetite or weight loss.
Underwent left shoulder Arthroscopy and biopsy two years ago in another hospital at the start of the complaints. The biopsy was reported as "nonspecific chronic inflammation and fibrosis". Was advised to do exercises post-biopsy.
Had undergone Nerve Conduction and EMG studies twice for wasting along the upper limb. These were reported as "chronic denervation potential seen" in deltoid, biceps and triceps muscles.
What is your possible Differential Diagnosis?
HPI - History of fall at home. Immediate pain and swelling left arm.
HPI - History of fall from a 5 feet height at 9 years of age.? supracondylar ? radial head fracture(third world) No radiographs available,pre or post op. Had some form of fixation with k wires.C/O cubitus valgus deformity of non dominent side,
What would you recommend at this stage?
HPI - 36 year old active male with lateral knee pain. Previous hx of acl recon. Did well with that. Recently started to have lateral knee pain.
Initial arthroscopy did reveal Grade 3-4 lateral joint chondromalacia. Well contained lesions. This was debrided and microfractured. ACL graft was intact.
Continued to have pain. all pain is lateral knee.
Now my Plan is for ACI vs DeNovo.
Full length scanogram films shows mechanical axis falls through the lateral joint. Not terrible but not normal either.
Any indication for distal femoral osteotomy along with cartilage restoration? Stage or do at same time?
Plan of care?
HPI - Fall from standing height 24hours ago
How would you classify this fracture?
HPI - Operated 3 weeks ago for a peroprosthetic fracture of the femur (Vancouver C).
No weightbearing since the operation. Rx failure of the osteosynthesis.
What is the best treatment? (We do not have allograft)
HPI - 34 y o male 20 years post both distal femur fracture operated many times. Now, complain of inability to sit on floor or use Indian toilet. he is not in pain.
what type of procedure will you do for him
HPI - Had MVC 2 year ago. Operated with DHS twice leading to failure.
Best procedure for revision
HPI - Standing fall. Tripped on the foot of a wheelchair.
Cannot bear weight on the right lower limb
Severe pain right Hip
What method of treatment would you choose?
HPI - child had a fall 4 weeks ago was treated after initial xray in a slab with advise weekly check xray.patient however followed up 2 weeks later xray was done another surgeon saw her and continued slab after taking xray.
child seenagain after another 2 weeks (total 4 weeks in slab) . now she has restricted motion 20 degrees to 90 degrees flexion passively.
How would you treat this patient now that 4 weeks have passed since the injury?
HPI - 21 yo male, volleyball injury.
Closed reduced in OR.
CT scan post reveals posterior medial talus fracture.