By Parminder J Singh, Catherine Swales
A 24-year-old girl attends rheumatology outpatients with an eight-week historical past of painful palms. On exam she is tearful and skinny. you're the medic on duty...
100 circumstances in Orthopaedics and Rheumatology provides a hundred eventualities normally noticeable by way of scientific scholars and junior medical professionals in orthopaedic and rheumatology clinics, or within the emergency division. A succinct precis of the patient's heritage, exam and preliminary investigations, with scientific and/or imaging images, is through questions about the prognosis and administration of every case. the reply contains a specified dialogue on each one subject, with extra representation the place acceptable, supplying an important revision relief in addition to a realistic advisor for college kids and junior medical professionals.
Making scientific judgements and selecting the easiest plan of action is among the so much demanding and tough components of educating to develop into a physician. those situations will train scholars and junior medical professionals to acknowledge vital indicators and indicators and, the place applicable, their courting to different health conditions, and to advance their diagnostic and administration abilities.
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Additional info for 100 Cases in Orthopaedics and Rheumatology
Undisplaced fractures are treated conservatively. Most of the displaced one- or two-part fractures are treated with closed reduction and pin ﬁxation or open reduction and internal ﬁxation. The treatment options for threepart proximal humerus fractures include proximal humeral plate and screws or proximal humeral intramedullary nail. The preferred treatment of four-part fractures is humeral head replacement if ﬁxation with a plate and screws is not possible. This is primarily because of the high risk of osteonecrosis and secondarily because of the difﬁculty in obtaining secure internal ﬁxation.
This patient should have an open reduction and internal ﬁxation with a plate and screws. Multiple options exist for the deﬁnitive treatment of distal femur fractures. They include external ﬁxation (for patients with open fractures and bone loss, vascular injury, associated signiﬁcant soft-tissue injuries, or extensive comminution), intramedullary nailing (for fractures with enough intact distal femur to allow for interlocking screw ﬁxation), and plate osteosynthesis with either open reduction and internal ﬁxation or minimally invasive plate osteosynthesis.
If you could not see the injury clearly on plain X-rays in a patient with pain, what investigation would you request next? • How would you classify this injury? • Describe the blood supply to the femoral head • How would you manage this patient’s injury? • How would you manage a patient with an extracapsular fracture of their proximal femur? 41 100 Cases in Orthopaedics and Rheumatology ANSWER 15 The diagnosis is a fractured neck of femur. The leg is short, externally rotated and she is unable to bear weight, and the X-ray shows a displaced intracapsular fracture of the proximal femur.