HPI - patient sustained an intraarticular distal humerus fracture a year back for which he was treated with a single screw(??).since then he has limited range of motion which he has difficulty for his toilet hygienic purposes.
the screw was removed under GA and range of motion was assessed. no difference in range of motion under GA and when patient is conscious.
patient has been on physiotherapy for long with no improvement in range of motion
operative intervention or leave it alone
HPI - Rugby injury, 2 opponents fell on pt's knee and felt immediate pain.
What is the diagnosis?
HPI - s/p nonsyncopal fall at work earlier today. No prior knee pain or injuries.
How would you treat this injury?
HPI - Gradual onset pain while standing for longer time, gait abnormality
Plan of management
HPI - I have a patient with a bilateral flexion contracture of the knee. Range (-40º to 110º).
What is the best treatment?
HPI - case of fracture femur sustained 6 months ago .fixed with interlockin nail.now comes with occasional pain very minimal.patient is walking full weight bearing without any support
has the fracture healed completely or is this delayed healing
HPI - Several months painfull left ankle, no new trauma. Progressive pain after playing soccer and presenting at the Emergency Department.
How would you treat this patient?
HPI - Slip and Fall on the ice
What implant would you use to fix this fracture?
HPI - -
What additional studies would you perform prior to going to the operating room?
HPI - Insidious right knee pain without trauma 4 weeks ago
Whati is the diagnosis?
HPI - Fall while playing with immediate right elbow pain
lateral condyle fracture or not
HPI - h/o fall at play injury to the left foream.pain at wrist motion
HPI - Fall on outstretched arm. Unable to move the right shoulder. Swelling and Pain
How would you treat this fracture?
HPI - Polytrauma patient after severe head-on collision in a motorcycle accident. He suffered: 1)a right sacral ala fracture involving the foramina with right leg neurologic deficit 2)both pubic and ischial bones comminuted fractures with pubic symphysis displacement 3)severe perineal wound 4) open (grade I) left radius and ulna diaphysis fracture 5)comminuted intraarticular distal right radius fracture with DRUJ diastasis 6) open (grade IIIB)comminuted right tibia and fibula fracture
How would you deal with the anterior pelvic ring disruption 6 months post injury
HPI - Patient had sustained a fall 2 months prior was seen at another center treated conservatively. Now presents 2 months later with pain with shoulder movements.
How would you have treated this fracture initially?
HPI - Patient is 32-year old orthopedic surgeon with history of right side S1 radiculopathy for 8 months that progressed to bilateral S1 radiclopathy for last 3 months. Epidural steroid injection after 1st 2 month did not lead to improvement in sign and symptom. No complaints of muscle weakness and no bladder or bowel involvement.
Paraesthesia improved after first 3 month. Pain last 2 month increase , interfere significantly with daily activity
Lumbar discectomy performed in 4 / 12 / 2013.
Fenestration done and sequestrectomy done .
Surgeon how did the surgery tell me he found all disc sequestrated annulus healed no any further compression on root .
Bleeding from epidural vein occur , gel foam
Postop. No any improvement ,still bilateral S1 radiculopathy more sever in right side with intermitten throbbing pain in right paraspinal area at level of sacral ala at rest With Backache
The pain even more intense than preoperative p
what your opnion about the case
HPI - Fall at home, landing on left elbow.
Is routinely used as temporary treatment the transolecranic skeletal traction in you Centre?
HPI - Patient was hit by a car while crossing the street.
What Schatzker classification would you give this fracture?
HPI - Patient had a subtrochanteric femur fracture treated 5 years prior to presentation. The patient did well initially but then slowly developed progressive deformity & limping following that.
What will be the treatment option?
HPI - deformity noticed at left ankle six months back , no h\o of trauma ,deformity gradually increasing,with instability of ankle &inability to attend his daily routine, pain at leg after walk for few meters.(5m)
what is treatment of choice?(pt demand is stable ankle)
HPI - 58 yr f with lateral knee / leg pain. No trauma. Pain now getting worse.
MRI shows large proximal fibular synovial cyst. Looks like it communicates with the knee joint.
Has failed conservative treatments.
What would be the next step in the management of this patient?
HPI - Patient presented with a lateral malleolus fracture, SER IV, Weber B, about a week ago after rotational trauma to his left ankle.
What is your choice for fixation of such fracture? (initial treatment)
HPI - Polytrauma patient with ipsilateral rib fractures and mild brain contusion
Would you treat this patient with ETC (Early total care) or DCO (Damage control orthopaedics)?
HPI - 40 yo active teacher that sustained proximal hamstring avulsion 7 weeks ago. no sciatic nerve symptoms. Would you use a horizontal incision or vertical incision? Does anyone have experience with the healing rate of the T shaped incision described in Bradley's Article
Evaluation and management of hamstring injuries. Ahmad CS, Redler LH, Ciccotti MG, Maffulli N, Longo UG, Bradley J.
Am J Sports Med. 2013 Dec;41(12):2933-47. doi: 10.1177/0363546513487063. Epub 2013 May 23.
How would you treat this 7 week old injury?
HPI - No childhood trauma, no infection, no inflammatory diseases
What is the plan of management ?
HPI - RHD male with Left distal radius ORIF hardware failure 6wks postop after fall on ice. Interesting that he doesn't have much pain and ROM is suprisingly good at 55 flex/ext and 20 of ulnar/radial deviation.
what is the next step with revision?
HPI - 35 yo left hand dominant male that fell on the ice 1 week ago with left shoulder glenoid fracture with displacement
What is the best treatment for this patient?
HPI - road traffic accident
What further imaging if necessary would you obtain?
HPI - He had septic arthritis of hip joint in early childhood. Now infection has resolved.
Is there any procedure to reconstruct his hip joint
HPI - Polio since childhood,treated in braces previously
HPI - fell and sustained left elbow fracture (open -gustilo 1).
How would you handle this small olecranon fragment?
HPI - No H/O trauma, fall or fever.
HPI - 19 year female sustained left femoral head fracture.
No other fractures
How would you classify this femoral head fracture?
HPI - Alleged Motorvehicle Accident (frontal collision between cars)
Patient was sitting in cross-legged position.
The Right lower limb hit the gears and dashboard. Following the accident the patient was unable to ambulate
Which classification system do you prefer for this fracture?
HPI - trauma at work in April 2010, initially only treated for scaphoid fracture with plaster removed one month later , request tac 3d. August 2010 triple arthrodesis.
HPI - Child presented with hallux valgus deformity which is painful and is difficult for him to wear shoes
what pocedure should be performed
HPI - Sustained fracture 8 months back. Underwent an open interlocking nailing and primary bonegrafting. 8 months after the primary surgery, radiographs fail to show any signs of healing.
What should be the treatment plan
HPI - Patient developed pain and stiffness in the wrist joint 8 yrs back. The pain has gradually increased and so has the deformity. The patient has been on ATT for 2yrs and was also on disease modifying agents for rheumatoid arthritis.
Now patient has tenderness at just the distal radio-ulnar articulation which is the only problem that the patient has.She is not worried about the stiffness of the wrist joint or deformity.
What should be the treatment plan for this patient?
HPI - history of injury right wrist joint 1 yr back. no treatment was taken
HPI - The patient sustained a right distal femur fracture 1 year prior to presentation and underwent closed reduction and intramedullary nailing. She continues to have significant pain.
What should be further treatment plan
HPI - Intra- articular fracture operated 1 year ago at an outside hospital.
How would you currently treat this patient?
HPI - 48-year-old male s/p ORIF calcaneus and subsequent flap coverage approximately 3 years ago at outside hospital. Infection developed and he underwent a Burgess-type transtibial amputation at the same facility.
He has continued pain in his limb which limits his activity. He notes instability between his tibia and fibula when he wears his prosthetic (chopsticking). Of note, he is employed by a prosthetist as a tester of new equipment and prosthetics.
What would you do for this patient?
HPI - 18 yo fell on flexed knee skateboarding.
How would you treat this PCL injury with small bony avulsion
HPI - Motor vehicle accident(3 weeks ago) resulting:
- comminuted proximal tibial fracture with diaphyseal component, transarticular external fixation.
- vascular compromise with popliteal artery injury, Vascular Surgery performed saphenous vein grafting successfully with Plastic Surgery grafting on the medial aspect of the tibia.
How would you definitely treat this injury?
HPI - RTA, patient as the driver. Inittially managed at a regional hospital, then transferred to our hospital. Diagnosed with left acetabular post. wall fracture (already fixed), left 2, 3, 4th MTT diaphyseal fractures, right pilon fracture C3, right distal radius fracture C3. All fractures closed, no other injury diagnosed.
How would you manage the distal radius fracture?
HPI - had a fall 2 days ago on her left hip,
How would you classify this fracture?
HPI - The patient has a history of untreated hypothyroidism and had an unknown trauma to his hip three months prior to presentation.
What would be your next step in treatment of this patient?
HPI - 8 month old male presents with 4 day history of decreased movement of left hip, intermittent fever measured up to 101.5 F, and general fussiness.
How would you next proceed?
HPI - Patient fell down the stairs, no other complaints apart from the painfull left wrist.
How would you treat?
HPI - An 83F presents to you 2 weeks after ORIF for a supracondylar left femur fracture after a fall downstairs. The patient was managed at a hospital in a neighboring city, but has come to you for follow-up as it is more convenient for her rather than travelling long distances for her follow-ups. This is her first follow-up since ORIF. The incision is CDI, with no drainage and no sign of infection; she would like to have her staples removed today.
She continues to complain of pain in the distal left thigh at the site of the fracture. She is unable to ambulate secondary to pain, and utilizes a wheelchair. She complains of pain with palpation at the fracture site around the incision.
An AP radiograph of the left thigh is shown.
After assessing this patient in fracture clinic, what is your next step?