HPI - ski injury
How would you treat this fracture?
HPI - swelling both lower legs for 1 year, worse by long standing and walking, no significant pain.
Based on the images provided, what do you think is the most likely cause of the edema?
HPI - While running the patient twisted his ankle and had an immediate onset of pain and swelling.
How would you treat this fracture based on the Preoperative Radiographs alone?
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
HPI - s/p fall from ladder while painting at home. No previous shoulder pain or complaints. Works part-time in a special-needs school.
In addition to an AP radiograph, what additional imaging studies would you obtain to dictate treatment?
HPI - Acute injury in motorcycle accident 5 days ago
What additional Xrays would you get in this case?
HPI - pain and swelling staretd gradually two monthes earlier
pain excaserbate with standing walking activity and settle with rest and pain killer
What is the most likely diagnosis?
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 - Patient fractured his left humeral shaft and saw an outside surgeon, undergoing IM fixation. Fracture site initially looked promising, but soon went on to nonunion. One of the distal screws never seated properly and began to back out soon after his initial surgery.
At 3 months post-op, the patient returned to the outside facility and was pronounced healed by the PA.
3 years later, he presented to my clinic with significant pain and dysfunction.
Would you recommend surgery in this patient?
HPI - Fall from height (ladder) with immediate onset of pain and limited function
What is your Mason classification of this injury?
HPI - isolated injury to right femur. closed - neurovascularly intact - initial hypotension resuscitated.
What would be your choice of implant?
HPI - 45 y/o male with elbow pain after a fall.
How would you treat this patient?
HPI - Acute knee pain after an injury during a soccer match.
How would you treat this injury?
HPI - Patient was skiing when he fell with a twisting mechanism to left ski, had immediate and severe pain in knee. Went to ER where radiographs done. MRI done shortly after.
MRI report is shown below.
In addition to the plain radiographs above, what additional imaging studies would you obtain to dictate treatment?
HPI - A 56-year-old male suffered a closed fracture of the left humeral shaft which was treated by antegrade interlocking intramedullary nail 1.5 years ago. The patient now presents with persistent pain and inability to work.
How would you treat this humeral shaft nonunion?
HPI - 44yo female falls from 6 feet.
In addition to the AP and Lateral radiographs above, what additional imaging studies would you do?
HPI - A 54-year-old female presents pain and swelling in the wrist and forearm after a ground-level fall 7 days ago. She was initially treated with closed reduction and cast immobilization. Radiographs are shown before and after reduction.
How would you treat this fracture based on the post-reduction radiographs?
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 - Trip and fall down steps leaving her house
What would be your definitive management?
HPI - 51 year old LHD male presents one day following an acute injury to his right elbow (non-dominant) when lifting a heavy object. He felt a pop near his elbow and had immediate pain and swelling. On physical exam, he has decreased ROM and significant ecchymosis around the elbow. Radiographs are negative for fracture or dislocation.
How would you treat the distal biceps avulsion in this patient?
HPI - 40 year old male presents with an ongoing history of right knee pain. He describes a 2 year history of aching knee pain that has recently gotten worse after injuring his knee while lifting a heavy object at work. He works as a general laborer in a warehouse. He does not describe any mechanical symptoms related to the knee (no clicking, catching, popping, or locking). His MRI does not reveal a meniscal tear. He isolates his pain to the medial aspect of his knee.
What is the diagnosis?
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 - Patient is a 43 year old male with 10 year history of left hip pain, groin pain, and restriction in motion. He had hip scope 3 yrs ago which led to no significant improvement. He is married and still plays recreational hockey.
What additional studies do you want to determine treatment?
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.
How would you manage this patient?
HPI - Patient fell and sustained a dislocation of the shoulder 3 weeks ago.
Shoulder reduced on its own.
Non-contact, recreational athlete.
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.
HPI - Presents with 5 year history of knee pain. Patient walks 10 blocks a day and does not reciprocate stairs. Pain has worsened despite non-operative treatment including NSAIDS, Physical Therapy, and Corticosteroid Injections.
At this time, how would you manage 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 - 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 - 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 - THA after femoral neck fracture, pain following start of mobilization 5 days after surgery. No subsidence of the stem after WB
How would you treat this intraoperative peri-prosthetic fracture?
HPI - Fall at work site.injury to the left arm.inablity to move left arm
HPI - Left knee injury six years ago playing basketball, but did not seek medical attention. He continued to play basketball & volleyball despite numerous giving way episodes. He presents with pain, swelling and the feeling of instability. No specific treatment to date.
Radiographs and MRI images are shown.
At this time, how would you manage this patient?
HPI - 45-year-old male with severe ankle pain following nonoperative treatment of ankle fracture when he was 23 years old. Patient has received cortisone injections, stem cell treatments, and has used a brace on/off for the last 2 years
Would you try additional nonoperative treatment modalities in this patient?
HPI - The patient brought to trauma bay following a MVC. He complains of knee pain isolated to the knee.
Which classification system would you use to guide treatment?
HPI - Patient stepped into a hole 6 weeks ago. Reports has had medial knee pain and events of "instability" ever since.
What further radiographic studies are required to determine treatment?
HPI - A left knee injury occurred during a football game when he jumped over an opposing player and landed with a valgus twisting force to his left knee. He felt a pop and experienced immediate pain and swelling.
Radiographs, MRI images & arthroscopy photos are shown.
What would be your definitive management for this patient? (See arthroscopic view of meniscal tear below)
HPI - 46yo F in MVC. Presents with severe head injury, thoracic injury and deformity to left hip/thigh.
How would you classify this acetabular fracture pattern?
HPI - Trip and fall whilst hiking
HPI - 52-year-old female presents with left wrist pain since a fall at work 4 months ago.
The pain is exacerbated by extremes of motion.
Associated with wrist clicking in extension.
Prior to referral to a hand specialist a trial of nonoperative treatment was attempted but did not lead to significant improvement.
After a period of several months of nonoperative treatment patient continued with pain and mechanical clicking during wrist motion & gripping
What further imaging after radiographs, if any, would you order on this patient?
HPI - 60 year old male, household ambulator previously, confined to the bed for past 2 years, complained of pain in his right hip when he sat on a chair.
How would you manage this patient ?
HPI - Patient presents to the emergency room with acute left knee pain after low energy trauma.
Would you perform a needle biopsy in this patient prior to surgical intervention to confirm the diagnosis?
HPI - 10 days old injury left middle finger, treated with finger splint
Would you get a CT scan to determine proper treatment?
HPI - RHD female who complains of elbow pain after falling off her bike onto her left elbow
Assuming you only had the injury radiographs, what additional imaging would you obtain in this patient?
HPI - fall 3days ago from a ladder
HPI - Truck driver
Fall getting out of truck
Complex femoral shaft fracture 30 years ago
Treated with unreamed, unlocked nail -> non-union
Revised to locked Russell-Taylor nail -> united in maligned position
Hardware removed 20+ years ago
Medullary canal obliterated at level of malunion
How would you manage this subtroch fracture shown in the P2 images above?
HPI - Sustained a wrist fracture after a MVA. person was in the vehicle.injury to the wrist was taken to another hospital where under sedation they reduced the fracture and put her in a slab.
seen at our hospital 1 week following the injury
How would you treat this fracture at this time (one week after injury)?
HPI - The patient had a right hip arthroscopy 5 years ago that included a femoral head re-contouring, os acetabuli resection, and labral reconstruction. Patient has had persistent pain and stiffness ever since that limits his ability to walk distances.
HPI - A 30 year old male patient presents with right shoulder pain following an MVA. At the behest of his mother, patient wants surgery. He specifically requests an IM nail. After reviewing his radiographs, I recommended non-operative treatment.
The patient traveled to another surgeon for a second opinion, which resulted in IM fixation of his clavicle fracture. 4 weeks s/p IM nail, patient presents to the ER with complaints of pain, fever, and chills.
Physical exam yields erythematous incision, purulent drainage and wound dehiscence. Skin is warm and tender to palpation near clavicle.
How would you address the infection in this patient?
HPI - 50M, RHD.
Known history of rotator cuff tear about 2 years ago.
History of 3 prior right shoulder surgeries (? RCR).
History of successful RCR on opposite (left) shoulder >1.5 years ago.
+ painful ADLS, + night pain, + pain with overhead activities.
Difficulty raising his right arm in forward flexion and abduction. Significant weakness.