These cases are aimed to discuss the consequences of non-operative management of orthopaedic injuries during the current COVID-19 pandemic. In our first ever webinar we discussed the impact of C-19 and the role of conservative management of orthopaedic injuries.
In the next webinar we will be discussing the management of C-19 injuries after the pandemic: what now?
These cases are designed to get you thinking about the topics we plan to discuss on the webinar in advance. We are grateful to our faculty for their help in creating these case scenarios.
Case 1 – elbow injury
Elbow AP and Lateral
21 y/o girl. Keen climber and skydiver. Fall from a climbing wall at the gym. There was a history of possible elbow dislocation at scene but self-relocated. NV intact and comfortable.
Loading ... Loading ...Consider what would you tell her to look out for?
Consider what would you look out for when examining her?
Drop the answers in the comments box below! Let’s start a discussion.
Case 2 – tibial plateau malunion
43 yrs male. Fall 40m off a mountain in Ecuador 1 year ago. Right femur fracture and L1 burst fracture treated with fixation at the time (healed well).
Left tibial plateau fracture was missed at the time. He has bilateral foot drops, treated with AFO’s.
Main ongoing complaint is left knee pain
AP and Lateral 
CT
Loading ... Loading ... Loading ...Case 3 – knee pain with femoral deformity
55 year old lady who sustained a right femur fracture, aged 17. It was treated non-op.
She has been living happily but now has mechanical medial pain in her right knee. Medial joint line tenderness.
Clinical impression is that she has some medial compartment OA and a 2cm LLD
Loading ...Case 4 – neglected tibial plateau
43 yr old man slipped on a wet floor when he was holidaying in bulgaria on 8/08/2019. He was managed with an knee spanning exfix in Bulgaria and presented at 3-months to us:
Initial presentation AP Xray 
Initial presentation lateral Xray
Problems on arrival included pain and discharge around half pins – MRSA infected. Non wt bearing. No NV deficit.
Loading ... Loading ...It was decided to remove the ex-fix and mobilise him
The bottom x-rays show him at 5-months post-injury. Pin sites all healed now
Problems at this point were: Valgus instability. Pain on wt bearing.
CT scan at 5 months 
CT scan at 5 months
Loading ...Case 5 – distal radius malunion
Wrist AP 
Wrist Lateral
51 yr old man. Non-dom wrist. Overweight, diabetic patient with hypertension and GORD. He sustained a displaced distal radius fracture 10m previously, which was treated non-op in cast.
(injury x-rays not shown)
Loading ... Loading ...Consider the elements of this deformity separately:
How might you correct the shortening of the radius (positive ulnar variance)?
How might you correct the volar angulation on the lateral?
How might you correct the radial tilt on the AP?
Loading ...Sign up for this weeks webinar here, and head over the to webinars page to find out more.
Have a great week, and look after yourself! Before you go, have a read of our new wellbeing section. More on this coming soon!
One response
Good discussion