HPI - 10 year old patient presents with a painful foot after a fall from height.
The foot is severely swollen and he is unable to bear weight on his affected leg due to significant pain.
What further imaging would you order in this patient?
HPI - 48 year old male present with a 12-month history of predominantly lateral-sided knee pain.
The pain is aggravated with activity and worse when flexing the knee beyond 80 degrees.
The patient previously underwent a left knee arthroscopy in 2011, with a partial lateral meniscectomy (posterior 1/3 80% excised).
He recently had a diagnostic arthroscopy which confirmed posterolateral wear involving both the tibial surface and the posterior aspect of the lateral femoral condyle.
What conservative treatment would you recommend, if any, in this patient?
HPI - Witnessed fall from ladder while at school.
What is your preferred management of this case?
HPI - Patient slipped and fell, injuring his left ankle, 1 week ago.
How would you manage this fracture?
HPI - 16F presents in January of 2015 with Left Ankle pain. No history of trauma/injury. Xrays are normal. MRI showed Bone Marrow Edema (BME). Non-weight bearing is advised.
In October of 2015, she presents with right hip pain/limited movement of her right hip because of pain. No history of trauma/injury. MRI’s (Right hip & Left ankle) show BME in her right hip and improved BME in her left ankle. Non-weight bearing and rest in advised.
In January of 2016 screening MRI’s (Right hip & Left ankle) are performed. They show an improvement of her previous BME in her right hip and eradication of the BME in her left ankle. Clinically, she is getting better.
In May of 2016 she presents with Right ankle pain with limited movement due to the pain. No history of trauma/injury. MRI is performed and it again shows BME of her Right ankle and Right calcaneus.
Lab tests (lupus, ACA, β2 GPI, thyroid hormones, protein electrophoresis, CRP, RA-test, C3, C4, Anti-CCP, ANA, FBC,ESR, PT/APTT, INR, D-dimers) are all normal.
Her symptoms were getting better until today. We have already planned MRIs of both her ankles and Right hip.
Xrays & MRI pics are attached.
What is the likely diagnosis in this patient?
HPI - 38M presents with right-sided groin pain of 4 months duration. He states that his pain has been escalating in severity over the past 4 months. He is now limping due to pain on the right side.
The patient underwent ORIF for a posterior column fracture 6 years ago.
He had a right hip resurfacing for post-traumatic arthritis via an anterolateral Hardinge approach 4 years ago.
Based on the information provided, what is the most likely diagnosis?
HPI - 43M presents to our hospital after being involved in a road traffic accident 3 days ago.
He has an isolated right leg injury with a small opening in the skin (1 cm) on the anteromedial aspect of the middle third of the leg.
What would be your initial management of this patient?
HPI - 45M presents with insidious onset of lower back pain and pain over his trochanteric region of the left hip. His symptoms have been progressing over the past 3 months.
The patient noted a fever of a week's duration at the onset of his symptoms, but this has resolved. Currently, no fever.
His pain is worst at night.
He notes 4kg (8.8 lbs) unintentional weight loss over the past 3 months.
No trauma. No sciatica. No cough or other constitutional symptoms.
No other joint pains, bladder or bowel symptoms, haematuria, or swelling in other parts of body.
What is the likely diagnosis?
HPI - 43M patient presents 3 years after a high energy right femur fracture sustained in a car accident.
The performed surgery was the dynamic locked intramedullary femoral nail. The dynamic screw was removed six weeks after the primary surgery, due to lack of dynamization, in order to promote healing of fracture.
Xrays and CT scans are shown.
How would you manage this patient?
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.
HPI - MOTOR BIKE ACCIDENT
What would be your initial treatment of this patient?
HPI - The patient is a 42 year old male who gives a history of injury to his right buttock after sustaining a fall while playing volleyball approximately 6 months ago.
He recovered well from the initial injury and was able to run and continue training.
He subsequently developed activity-related mild right buttock pain that began about ~1 month after the initial injury.
The patient feels his current pain may be related to his previous injury.
No fever / night pain / weight loss / rest pain / systemic symptoms.
HPI - Patient presents by ambulance following a simple fall from his bicycle.
Unable to ambulate following the fall secondary to pain.
This acetabular fracture is which of the following:
HPI - Patient presents with limping of 2 years duration with intermittent right knee, hip, groin and thigh pain.
HPI - Injured left ankle 3 months ago.
The fracture was treated in a cast with NWB for 8 weeks.
Currently, patient complains of continued pain and inability to weight bear on the affected extremity.
No further injuries to the left ankle since the initial fracture.
How would you manage this patient at this point?
HPI - Patient presents with forearm pain after FOOSH injury when he fell while playing in the schoolyard.
HPI - 60M present with inability to weight-bear on his right leg following a tibial plateau fracture 8 months ago.
At the time of the fracture, patient underwent ORIF of the fracture with a lateral plate.
ORIF was complicated by a post-operative infection with a discharging sinus.
Hardware removal and debridement was performed 4 months after the initial ORIF.
The infection has now resolved. The wound has healed, no further discharge, CRP = 6.
Bone marrow injection was performed twice, 3 weeks apart, and the patient was kept in a cast for three months.
The patient now presents with an unstable, mobile nonunion of the proximal tibia with pain and inability to weight-bear on the right leg.
Currently in an above knee cast, hyperbaric oxygen sessions have been done.
HPI - 48M, chronic alcoholic.
4 days post-op following ORIF for a right transcervical proximal femur fracture with 3 cannulated screws.
The patient developed delirium tremens in the post-op period and had another fall.
AP X-Ray of the right proximal femur is shown.
How would you have managed the initial fracture on presentation (see Pre-Procedure Images ABOVE) in this chronic alcoholic?
HPI - Direct injury right thigh while playing handball 02 weeks back. Was able to continue with the game. Developed pain right thigh along with painful restriction of knee flexion. No fever.
HPI - 70M, fell at home.
Unable to ambulate following the fall secondary to right hip pain.
No previous falls.
No other injuries. Isolated right hip fracture.
What further imaging would you order for this patient?
HPI - Patient slipped on kitchen floor at home and fell.
Right hip injury.
Unable to ambulate following the fall secondary to pain.
What fracture type is depicted in the preoperative images?
HPI - no memory of wrist injury, last 2 years progressive wrist pain, decreased grip strength, decreased active flexion of thumb IP joint
What procedure would you suggest for this patient?
HPI - Swelling and pain right thigh - Spontaneous onset, gradually progressive over 03 months. Pain thigh is mild, activity related. No fever/ night pain/ recent trauma / puncture injury. Able to walk full weight bearing.
Likely diagnosis on clincal presentation and plain radiographs
HPI - Fall from own height 48h before visiting our emergency department
Intra-articular distal tibia fracture
Segmental fibula fracture
A spanning external was put to allow the soft tissues to heal
What would be your initial treatment for this patient?
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 - 32M presents with medial-sided left knee pain.
He previously underwent a partial medial meniscectomy for an "irreparable tear" at age 18 after a soccer injury.
He returned to his regular activities and has continued playing soccer since his initial surgery, but over the past 3 years has complained of progressive left knee pain, isolated to the medial side of his knee.
He also notes a mild bow-legged deformity of his left leg.
Currently, he rates his pain as 9/10 in severity which is aggravated by activity.
3-foot standing XRays are obtained, which illustrate significant isolated medial compartment arthrosis.
A diagnostic arthroscopy is undertaken - images of the medial and lateral compartments are shown. Significant bipolar lesions of the medial compartment are seen, with full thickness articular cartilage loss in addition to meniscal pathology.
HPI - 81F presents with Left shoulder pain after falling while gardening.
HPI - Injury 18 months ago treated with DCS
Patient has been walking for last year
Had new fall 2 days ago
What is your recommended treatment?
HPI - Fall on outstretched left hand. Nondominant side, relatively high functioning lady for her age.
How would you treat this injury?
HPI - A 21-y/o RHD male c/o recurrent left shoulder instability. He reports ~20 instability events (all self-reduced) prior to arthroscopic Prior Bankart repair + remplissage. Now 9 months s/p stabilization, he reports recurrent instability that began ~5 months post-op. Now reports instability while sleeping. He has taken a medical leave from college due to symptoms.
He plays golf, soccer, and basketball.
How would you treat this patient?
HPI - s/p MCC with Grade IIIA open pilon fracture. Isolated injury, physiologically stable
How would you classify this injury in the Ruedi and Allgower system?
HPI - Fall from bicycle onto elbow . immediate onset of pain and deformity
how would you treat such an gustilo type I Open fracture of olecranon splitting fracture .
HPI - 55 yo male farmer 14 months s/p ORIF ankle with subsequent infection at 3 months. Outside surgeon removed hardware and patient underwent 8 surgical debridements through old direct medial and lateral incisions. IV abx treatment has continued for last 11 months at time of presentation. He has drainage from medial wound. 1 month prior previous surgeon performed biopsy to confirm osteomyelitis. Previous cultures reveal MRSA osteomyelitis. Patient wishes to keep leg.
MRI/Bone Scan: Reveal focal edema/increased signal within 2 cm of tibiotalar joint.
CT: Reveals nonunion fibula
What management strategy would you offer?
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 - 56 year old lady fell downstairs, after few drinks earlier, so considered low energy injury . High BMI 31
otherwise good health,
What is your Schatzker classification?
HPI - 30M is transferred to your institution 10 days following a motor vehicle collision where he sustained an Open, highly comminuted left femoral shaft fracture.
The fracture was initially managed by another physician with application of an external fixator frame (Ilizarov apparatus) - see XRays attached.
How would you manage this injury?
HPI - He was involved in MVA 2 weeks ago, isolated injury to Lt elbow, he got degluved injury to his soft tissue from mid arm to proximal forearm, bone loss from mid shaft humerus including both condyles, comminuted proximal ulnar, radius is intact.
Post op: He was operated by debridement and external fixator. At the time being, his wound in clean, no discharge and no skin necrosis.
His ESR: 12, CRP:7
what is the defenitife management after eradication infection?
HPI - 50M patient presents to the trauma bay following a road traffic accident.
XRays confirm isolated, ipsilateral, displaced left femoral neck and shaft fractures (see XRays).
What additional imaging (if any) would you order on this patient?
HPI - The patient reported an injury of the right forefoot ( her foot caught in the wheel of the quadbike) and she presented 10 hours after the incident
In light of the fact that the tendon and joint are exposed, how would you treat this wound?
HPI - 60 yo male patient had heel pain last fall and had a cortisone injection done in October and then with vigorous activity ruptured plantar fascia in December 2015. He is wearing arch supports which allow walking but still start up pain felt laterally and in the arch every day and after sitting for 10 minutes. Walking 20 feet loosens it up. He has had MRI which shows ruptured plantar fascia at the calcaneus and x-rays show mild loss of arch.
Do you think the steroid injection was the primary cause of the rupture
HPI - Fell while trying to climb up a wall
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 - pain in the right hip since few days . no injury walking with a limp
HPI - Attempted suicide 45 days ago.
Politrauma : L3 L4 burst fractures (stabilization L2-L5), fracture transverse processes L1 to L4. Exposed comminuted fracture of left patella (k wires synthesis). Closed fracture of right and left calcaneus.
15 days later, the left foot was treated with percutaneous pinning for severe skin lesions, the right foot was untreated because impossible to make open surgery or percutaneous k-wire, given the comminution of the fracture and the extended skin problems with large blisters
Secondary exposure right and left foot, after debridement and removal of eschar. Program on the left: removal k w , debrid. and skin graft.
In progress: left foot normobaric oxygen therapy, right foot vac therapy
How would You treat the right calcaneus ?
HPI - Fall from height (ladder) with immediate onset of pain and limited function
What is your Mason classification of this injury?
HPI - left hip pain 8 months duration - no trauma - no systemic symptoms -
what will be your treatment option
HPI - Patient fell onto left knee and had immediate pain, swelling, and deformity. Unable to bear weight
Based on the information provided, what do you think is the most likely cause for the fracture?
HPI - RTA - 2 wheeler rider - fall onto right outstretched hand - painful right shoulder movements - closed injury - neurovascularly intact
How would you classify this scapula fracture?
HPI - rotational injury
What is the accepted malrotation and angulation in distal tibial fracture managed by nail?