HPI - This unfortunate 28 year-old-male was shot by a machine gun in September 2014 in the Libyan civil war and sustained this isolated injury.
No surgical intervention was performed at that time.
How would you classify the scapula fracture?
HPI - Twisting injury of left ankle while playing football
What is the best management option?
HPI - 21 year old involved in motorcycle crash. He reports hitting his knee against the bumper trying to avoid the stopped car in front of him.
What are the treatment options for this patient?
HPI - Patient was a front passenger injured his limb while hanging out of vehicle during the accident when it hit a metal fence.
We're 6 weeks down the road. Skin graft is taking (85%) no signs of infection clinically or lab wise. MRI & Nerve conduction studies weren't done due to technical difficulties (skin condition and ex fix) although clinically there was no improvement neurologically. Ex fix was removed from the forearm a week ago for definitive fixation.
Given the unfavourable skin condition and the neurological status (flail limb), how would you treat the BOTH-BONE FOREARM Fx at this time?
HPI - Fall on outstretched hand
What is the best treatment?
HPI - Fall from 4meters, reception on the left foot
How would you treat the patient?
HPI - Patient presented after a fall from a slide on his left arm. Patient denied any other trauma. Patient's parents think he fell on an outstretched arm.
What is the most likely diagnosis?
HPI - Pain and weakness right hip during last two years. Limping gait since 10 years old but was doing very well.
What was the most likely cause of his hip dislocation and deformation?
HPI - Fall from height. Injury to the rt elbow. Inabilty to move the rt elbow
Would you get addition imaging before proceeding with treatment?
HPI - Right ankle sprain 9 months ago. 1 month of rest with cast
What is the most likely cause of the cysts in the talus?
HPI - Patient with a history of hip and tibial plateau fracture, this six months ago periprosthetic fracture that was treated with LCP plate and then evolves with this failure osteosintesis
What would be your treatment of choice?
HPI - parents noticed a swelling of the righ wrist around a month,no h/o fall
What is the most likely diagnosis base on the radiographs alone
HPI - Trip and fall down steps leaving her house
What would be your definitive management?
HPI - An 84-year old female fell while walking up the stairs. She presents with neck pain and ankle pain. She reports she fell she recalls hitting her lateral leg on the edge of the stair.
How would you determine the stability and treat this ankle (fibular) fracture?
HPI - s/p MVC on Thanksgiving, transferred from outside hospital with proximal humerus injury.
How would you operatively treat this fracture?
HPI - Pain in the knee present since 2 months postop; with stiffness in the knee in mornings. patient walks with a limp, but no pain in thigh when walking.
Should the patella implants be removed?
HPI - Motor vehicle collision while she was bicycling
In this multi-trauma patient, how would you treat the SCAPULA fx?
HPI - Operated 4 months ago of proximal humerus fracture.
What do you think is the most likely cause for lack of active motion?
HPI - Twisting injury 4 hours ago
No prior pain or history of trauma
HPI - Had knee revision three years following aseptic loosening
HPI - History of injury 3 months ago by sharp instrument. Simple skin closure was done. Swelling appeared one week after stitch removal gradually increased in size. Clawing of the little and ring fingers appeared gradually later on.
What is the most likely diagnosis and cause of the ulnar clawing?
HPI - 35 year-old-male referred from outside hospital following road traffic accident. Large open wound of the plantar foot that was primarily closed. Failed trial of closed reduction at outside institution
What is the best management of this injury?
HPI - The patient has had right hip pain for the past two years. The pain is worse with exertion.
What is the most likely primary cause of his symptoms?
HPI - previous elbow injury 3 y ago treated in slab
What management should be offered?
HPI - Lives independently with no walking aids. Plays tennis 3 days per week. Trip and fall 5 days ago with isolated injury. No previous foot pain.
How would you treat this patient?
HPI - 33 yr old with traumatic initial dislocation about a year ago. Passed out and shoulder hit a dresser. Was reduced in ER. Since then has been managed non op by other surgeons. Has had about 7 dislocations since almost all of them have to be reduced under sedation bc of engaging hill sachs. Presents to me after seeing two other orthopods.
After reviewing images it seems there is a large engaging hill sachs. The anterior glenoid rim is without large bony bankart. MRI does show labral tearing.
I believe this needs surgical fixation. My question is how to address the engaging hill sachs. Will remplissage be enough or should I be thinking about allograft / bony procedure?
Thank you in advance for the input and advice.
How would you address the instability?
HPI - H/o fall down on LF thigh
Would you biopsy the non-union site to rule out infection?
HPI - fall from a ladder a meter height.injury to rt knee .(Aspiration of 80 ml blood from knee done.splinted)
What surgical approach would you use for this fracture?
HPI - minor fall
What approach would you use to treat this fracture?
HPI - Symptomatic for last two years. Before that period she managed to compensate her bilateral hip dysplasia.
Which classification is more suitable for this DDH?
HPI - MBA 6 years ago
Patient isn't the best historian and, as his injury was sustained in another state, we have not been able to access his imaging or notes
Right proximal humerus fracture, treated non-operatively
Associated with brachial plexus injury of uncertain extent (patient describes complete paralysis of right upper extremity)
Plexus treated expectantly with recovery over 12-18 months
States reasonable shoulder function after plexus recovery for 1-2 years, but lasts 4 years has developed increasingly severe right shoulder pain with associated stiffness
Previously a fisherman, unable to work due to pain for 12 months
States had been placed on waiting list for "rotator cuff repair" in the other state 3 years ago, but never called for surgery
Having moved from the other state to NSW, now presents to us "only" wanting more movement and less pain
HPI - Trauma 7 years ago, in another state, treated with reduction and casting only. Always painful; is worsening.
How would you treat this?
HPI - Polytrauma 1,5 years ago. Fracture of left ribs (1st-8th). Fracture of C7, D1 and D2 vertebrae. Fracture of external maleoli of right ankle. All treated conservatively. And displaced fracture of left scapula which is also treated conservatively
At this time, the patient presents with moderate pain in the scapular area which referres to the lateral and anterior part of the chest together with sensation of numbness in the chest area. This symptoms appear after the mobilisation of the left shoulder
What is the cause of the patient´s symptoms?
HPI - Fall from standing height
How would you treat this fracture?
HPI - RTA for 8 weeks ago, operated by ex fix.
HPI - Acute knee pain after an injury during a soccer match.
How would you treat this injury?
HPI - Type 3 C fracture distal 3rd left femur treated by debridement and external fixator application and antibiotic impregnated bone cement insertion 3 months prior to presentation.
The patient then underwent removal of external fixator and removal his antibiotic cement spacer.
There continues to be serous discharge from the lateral aspect of distal thigh
What should be the treatment plan considering that there continues to be discharge from the lateral wound?
HPI - History of injury to right hip joint 15 yrs back.Fixed with Moore's pin
Went into avascular necrosis
How would you remove the screws during surgery?
HPI - 80F complains of left knee pain and inability to bear weight after a fall off of a malfunctioning chair lift 2 days prior. She lives independently and has used a walker in the community and a cane in the house the past 4 months due to bilateral knee pain that has been present and worsening for the past 8 years. She denies any other pain or injuries.
What is your management for the left tibial plateau fracture?
HPI - Recent history of playing football since 2 weeks with no direct injury or twist.
What is the most appropriate net step investigation?
HPI - H/O RTA on 10/10/2015
HPI - When the patient was about 3 years old the mother noticed multiple bony prominence/swelling in upper and lower limbs. The prominence/swelling were painless and slightly increased in size over time. The girl was diagnosed to have hypothyroidism and is on thyrozine therapy
What is the most likely diagnosis in your differential?
HPI - 1.5 year back RTA. open Fracture tibia fibula ( gustilo information not available) managed by ex fix at some hospital . Later developed osteomyelitis with multiple discharging sinuses.
What further radiologic work-up would you perform?
HPI - Gradual onset of pain in the hand, continous at present, difficult to hold an object in the palm
What would be the most likely diagnosis in your differential?
HPI - Fall down on rt abducted rt shoulder while playing football
Where and how would you have performed the closed reduction.
HPI - Condition started 6 months ago with minor trauma to right hand after falling. After one month of medical treatment there was no improvement and a cast was placed for another 2 months. Cast immobilization did not lead to any improvement so surgery was performed. Excision of the lunate was performed with postoperative immobilization for one month. Physiotherapy until now. Despite this, the patient continues to complain of weakness, stiffness, and pain with exertion of right hand.
What Lichtman Classification of Kienbock's Disease would you call this patient in the preoperative images?
HPI - Condition started back in 2005 with lower back pain which was treated conservatively and slightly improved. In 2009 the patient had progressive left hip pain. In 2012 pt was diagnosed to have stress fracture of left femoral neck and had percutaneous fixation of the neck. The patient had slight improvment of symptoms for a short period of time. Now the patient continues ot have bilateral hip pain and low back pain. Current radiographs show an incomplete fracture of the right femoral neck and L5 pars defect. Lab studies have been normal.
What do you think is the most likely cause of the patients current symptoms?
HPI - History of fall from height while working with building blocks.
What Young-Burgess Classification would you assign this fracture
HPI - The condition started many years ago by painless swelling in the lt litlle finger with slight stiffness of the PIP. One month ago after minor trauma the condition became painful.
Based on the information provided, what is the most likely diagnosis?
HPI - Fall from standing height 3 years ago
Complaints of constant pain almost every day at the coccygeal region
The dimension of the mass is increasing with the passing time
Bone scanning ( - )
Temporary pain relief at NSAID
No local inflammation signs
WBC normal values
CRP above limit
What is the MOST LIKELY diagnosis based on the limited information provided?