HPI - Proximal tibia metaphyseal-diaphyseal junction open fx due to farm accident
What is the Gustillo classification of this injury?
HPI - Fall from height (ladder) with immediate onset of pain and deformity
Would you obtain any advanced studies to help determine treatment in this case?
HPI - Noticed bony swelling and deformity since two month. No pain.no fever wt loss or loss of appetite.
What is your diagnosis is the most likely diagnosis based on the information provided?
HPI - none
How long after fasciotomy do you perform revision of the skin incisions? (we've made a shoelace closoure)
HPI - Simple fall
How would you have confirmed the diagnosis of a coronoid fracture in this pediatric patient?
HPI - Pain and inability to weight bear on RIGHT hip after simple fall.
What is the abnormality present in this type of bone?
HPI - Elderly gentleman sustained a fracture of his left femur when he had fall from a standing height. He underwent open reduction and internal fixation with a 130 degree hip screw and side plate with placement of synthetic hydroxyapatite bone graft on 12/05/2015
How would you classify this nonunion?
HPI - The patient has a history of spinal stenosis at L3/4 that was treated with a bilateral foraminotomy and disckectomy at L3/4 and L4/5 back in 2013.
The patient did well for a year or two but now has worsing bilateral buttock pain that extend down to the posterior aspect of his knees. His symptoms are worse with prolonged walking and improve with sitting. His symptoms have worsened to the point that he is unable to walk long distances.
He also complains of urinary "leaking".
How would you treat this patient?
HPI - Two years post DHS fixation of old proximal femoral fracture.
No signs of infection, CRP 9, WBCs 7000, HB 9.7
Skin is healthy with scar of previous surgery
What is the most suitable surgical option?
HPI - 69 ys old female patient ..complaining of LBP with rt sciatica
Based on the MRI shown, what do you think is the lesion seen in the right paracentral space with displacement of the thecal sac.
HPI - • Fell at home with no prodromal symptoms or head trauma
• Admitted under hospitalist team
• Partner consulted initially
• Patient and family refusing surgery
• 72 hours later I was consulted
• Baseline: ambulates with a walker
Given the delay in surgery, would you have done any further preoperative testing?
HPI - isolated injury to right femur. closed - neurovascularly intact - initial hypotension resuscitated.
What would be your choice of implant?
HPI - • 88 year old woman presented to the ER with chief complaint of left hip pain
- Patient denied any hip pain prior to this fall
• Symptoms began after a mechanical fall directly onto her hip
• Independent community ambulator
• CT head done due to left hand weakness and stroke ruled out
• Cleared by medicine and anesthesia to undergo surgery
Are the xrays above adequate to proceed with treatment?
HPI - o Sudden onset of moderate-to-severe pain the right leg following a mechanical fall from standing
o Presented to the emergency room with isolated pain and deformity in the right leg
o Specifically denied numbness or tingling or pain out of proportion
o Denies pain in other extremities
o Denies loss of consciousness, chest pain or dizziness prior to falll
On initial presentation, would you get any further preop imaging?
HPI - Right hemiplegic patient with known absence of leg extension before a fall, but able to walk before with a walker.
Complaining of weak quadriceps since a fall 2 months ago and unable to walk since. Never had pain. Was treated conservatively for a partiel quadriceps rupture/atrophy seen on MRI (leg brace in extension for walking). Normal knee x-ray.
Finally had long leg x-ray done at 3 months because of progressive shortening of the limb to mesure the LLD ! Can now ambulate with a leg brace, but difficult. No pain.
What would be you preferred method of treatment at this time?
HPI - Right hip pain x 4 weeks, worsened by ambulation
Do you agree this right hip fx is an atypical femur stress fracture associated with prolonged use of bisphosphonates?
HPI - A 14-year old male presents on the same day as a left wrist injury. Injury films are shown (excuse poor quality). Closed reduction is performed, and a splint is placed. Post reduction films are shown below immediately after the reduction and after 5 days when the patient returns to clinic.
Now that the patient returns 5 days later, how would you treat him based on the Post-procedure P2 films below?
HPI - o 72 year old right hand dominant presents to clinic with a 1 week history of right shoulder pain
o Her symptoms began after a mechanical fall onto her right shoulder
o Moderate pain and difficulty with activities of daily living
o Very active lifestyle involving gardening and apple picking on her farm
How would you treat this fracture?
HPI - • 90 female with right hip groin pain x 2 years. Unable to weight bear over last several months
• History of right THA performed in 1996 which provided her with durable pain relief for 18 years
• Initial radiographs demonstrated significant wear and a loose acetabular component with screw breakage
• Given her age, function status and medical comorbidities, she and her husband elected to proceed with nonoperative management
• 3 months after initial presentation, she returned in severe pain after hearing a loud crack in her hip while bending over. Radiographs demonstrated a fracture thru the ischium and suggested pelvic discontinuity
What surgery would you have offered?
HPI - fall on side of left shoulder... 03 days
HPI - fall on outstretched arm
HPI - 15 year old with 4 months of anterior left knee pain. there is pain consistent with typical patellofemoral pain syndrome in an adolescent. there is pain along the medial plica region and palpable mass similar to lipoma. no constitutional symptoms or injury starting the pain. XR and MR arthrogram shown.
What is the most likely diagnosis?
HPI - fall from a ladder from a height of 2 meters
What system would you use to classify this injury?
HPI - 2 days history of hit by bike . Closed injury
How would you treat this injury?
HPI - known above knee amputation rt. femur since 26 years, he fell down at home 2 days ago on the stump, complaining of pain by movements rt. thigh and hip.
HPI - The patient presents with intermitten right dull hip pain for the last month.
Based on the imaging provided, and the MRI report shown (under MRI image), what is the most likely diagnosis.
HPI - This is the case of a 10 month old girl with a hypotrophic malformation syndrome of the left half of the body.
She has thumb duplication with a second inter-digital space angle of about 80 degrees, a radial club hand, and a hypoplastic radius.
Hallux duplication deviated 88 degrees medially, tibia hypoplasia with a 3 cm leg length discrepency.
She underwent surgical treatment (by non-expert hands) of these duplications without correcting the deviations. She is now 7 months post-op.
Do you think that this is Silver-Russell syndrome?
HPI - Pt fell from tree about 30 feet while intoxicated. On arrival was moving b/l extremities. Injuries include
1. L1 and L3 burst fx
2. type 1 hangman's fx
3. non-displaced fx of posterior arch of C6
4. R proximal humerus fx
5. left distal radius fx
6. nonoperative subdural hemorrhage.
After 2 days in hospital went into DTs and went into respiratory distress. Pt has pneumothrax and chest tube was placed. Pt was intubated to protect airway due to agitated state. Sedation required. Pt developed right lobe pneumonia, possibly from aspiration.
Orthopaedic spine consulted after pt intubated and sedated. While very difficult to determine examine, pt appeared to have slowly increasing weakness on bilateral lower extremity. During state of agitation initially would bring knees off bed. This was slowly lost over course of several days. Difficulty to tell if it was due to a systemic process (sedation, mental status changes) or due to stenosis at L3.
Would you perform operative L3 decompression +/- stabilization on this patient at this time (mental status changes, likely progressive weakness but unreliable exam)?
HPI - Pt fell from tree about 30 feet while intoxicated. After day in hospital went into DTs. By report patient moving all fours but now intubated due to ETOH withdrawal
Would you classify the C2 fx as a Traumatic Spondylolisthesis of Axis (Hangman's Fracture)?
HPI - Motor vehicular accident 2 months and 10 days ago. Grade I open injury
How would you like to manage this case upon the first visit (before surgery in this instance)?
HPI - FOOSH-type injury that was managed at another hospital.
Patient was placed in the below-elbow cast.
Referred to our institution for a second opinion and further management.
Would you have accepted the original reduction? (See Post-Procedure P1 XRays above - AP and Lateral)
HPI - 59 yo iron worker with recalcitrant right knee pain and interested in TKA. CT scan obtained to detail large tibia plateau cyst.....CT scan shows that it breaks through the cortex. patient denies constitutional symptoms or prior knee injury.
Would you obtain further studies prior to TKA?
HPI - 33 yo female with fall on flexed LEFT elbow 4 days ago with immediate pain and decreased ROM, ecchymosis and ulnar dysesthesias. has history of unknown bilateral elbow fractures as a 12 year old that were treated in casts. no elbow pain or ulnar nerve complaints prior to fall. patient admitted and pending CT scan and MRI with plan for exploration.
suspect possible left chronic medial epicondyle nonunion from childhood with new incarceration and cubital tunnel symptoms
what is your diagnosis?
HPI - Fall at work site.injury to the left arm.inablity to move left arm
HPI - FOOSH injury 4 months ago.
What is the correct diagnosis?
HPI - Fall on the ground about 1 month ago leading to fracture of left distal radius. He went to a hospital then reduction under anesthesia was done and cast applied for 3 weeks. He now returns complaining of wrist deformity.
Would you obtain any additional imaging to determine treatment?
HPI - 35M presents complaining of left knee instability.
16 years ago, he suffered an ACL tear, MCL tear, and medial meniscal tear that occurred in a motorcycle accident. Around the time of the accident (at age 20), he underwent an ACL reconstruction via transtibial drilling with an ipsilateral Bone-Patella Tendon-Bone (BTB) autograft and a partial medial meniscectomy; his MCL injury was managed non-operatively. Metallic screws were used for ACL graft fixation on both the femoral and tibial sides.
The surgery was successful and the patient achieved a full recovery, until 4 years ago when he re-injured his left knee while playing basketball. At the time of the injury, the patient noted immediate knee pain and swelling, and has since complained of subjective instability of his left knee.
An MRI reported a tear of the lateral meniscus, as well as tears of both the reconstructed ACL and the native PCL.
Given that the patient has subjective instability of his knee and has failed a course of non-operative management, how would you choose to manage this patient operatively?
HPI - Patient with pain in his groin for 6 months. He has abnormal gait pattern. Pain on his groin when adducting his thigh with a bump. He had done physical therapy with poor results.
What is the best treatment?
HPI - Pain left forearm for 5 months
No fever or discharge
Do you think this is infected?
HPI - Fall from 10 feet while on ladder. Isolated injury to right lower extremity.
How would you treat this calcaneus fracture?
HPI - history of domestic fall due to slip in bathroom
How would you have treated this original fracture?
HPI - MOTORCYCLE ACCIDENT
HPI - Fall from height; injury to the right knee. Unable to stand or move the knee
How would you classify this according to the AO classification?
HPI - Rt. Hip pain and limping after falling on his rt. Side
Would you obtain a CT scan to help determine your surgical plan?
HPI - Knee trauma 2 weeks ago while playing sports. Felt a pop. Now has pain, swelling and limited range of motion.
Given the information above, how would you treat this athlete?
HPI - Long standing knee OA symptoms - neglected - patient sustained a medial condyle fracture of the right knee 3 months ago which was fixed with interfragmentary screws and an antiglide plate. she wishes to proceed with knee replacement now due to the pain she experiences in both knees.
she is due to have a CT scan of her knees next week before a TKR. I am planning to do the left side first and then the right after 6 - 12 weeks once she is rehabilitated. My plan is to do a PS femur and a stemmed tibia with wedges for the medial tibial plateau defect.
How would you sequence the TKR of each knee?
HPI - Since on week ago sudden gait and walking disturbance
How would you treat this patient
HPI - pedestrian hit by a car 4 days earlier. Isolated orthopaedic injury. Has solid organ lacerations. Currently day one post op.
IT DHS performed an no GT fx noticed intra-op.
Now post op xrays show a displaced GT fx.
How would you treat the postop displaced GT fx (seen in Post-procedure P1 films below) given the patients abdominal injuries?
HPI - Patient complain of hip pain and LOM
Would you rule out infection in this case and how?
HPI - MVC, polytrauma treated at other hospital
Right side: Femoral neck fracture with infraisthmal femur fracture, tibial shaft fracture
Left side: tibial shaft fracture
Right side treated with femoral neck screws, femoral plating, tibial casting
Left side treated with a tibial nail
Subsequently, the femoral neck fracture was infected and the screw was removed; the infection was diagnosed as treated at outside hospital
Now unable to walk.
How would you have treated the right femur fractures?