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A 13-year-old boy falls from an ATV and sustains the injury seen in Figure A. The injury is closed and the patient is neurovascularly intact with soft compartments. You are planning to treat the injury with elastic intramedullary nails. Which of the following is the most accurate with regard to his immediate postoperative care?
He will be in a soft bandage and be weight bearing as tolerated
He will be in a soft bandage and non-weight bearing
He will be in a knee immobilizer and be weight bearing as tolerated
He will be non-weight bearing in a splint or cast
He will be weight bearing as tolerated with a supplemental external fixator
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A 3-year-old patient fell out of a tree and sustained a closed right tibial shaft fracture. Approximately 30 hours after the injury, the floor nurse calls stating the patient is complaining of severe right leg and foot pain despite adequate analgesia with IV morphine and NSAIDs. The splint was removed by the previous on-call resident and the right leg elevated over three pillows. On examination, the right leg is well-perfused but is firm on compressibility. The patient has strong dorsalis pedis and posterior tibial pulses. What is the next appropriate step?
Increase dose of narcotic medications
Call regional anesthesia team to provide a nerve block
Perform 4-compartment fasciotomy
Initiate a patient controlled analgesia pump
Observe and repeat examination in 1 hour
A 2-year and 11-month old child fell while playing with friends 2 hours ago and has avoided bearing weight on the right leg since that time. The child is afebrile and exam reveals tenderness along the distal tibial shaft with no significant swelling. Radiographs are shown in Figure A and B. What is the most appropriate treatment?
MRI of the tibia
Aspiration of the tibia
Referral to child services
Long leg cast application
Serum vitamin D, calcium, and phosphate levels
A 23-month-old girl refuses to bear weight since falling on the playground yesterday. The child is afebrile and her WBC and erythrocyte sedimentation rate (ESR) are within normal limits. On physical exam the leg has no erythema, but does have mild tenderness along the distal tibial shaft. Plain radiographs are negative. What is the most appropriate management?
vitamin D and calcium levels
MRI of the pelvis
long leg cast
aspiration of the knee
A 3-year-old male presents with inability to bear weight on his right leg for the past 3 days. They deny any known injury at that time. Examination reveals full motion of the right hip, knee, and ankle. He has tenderness to palpation over the anterior tibia with minimal swelling. No erythema is appreciated. His temperature is 99.6°F. He has no leukocytosis and CRP and ESR are normal. Radiographs of the right leg are seen in Figure A. What is the most likely diagnosis?l
Nondisplaced oblique or spiral fracture of the tibia with an intact fibula