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

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.

How would you manage this? (Be honest here!)

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What advice would you give her about getting it going?

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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

What do you suppose the mechanism of injury here was?

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Why do you think this patient has knee pain (the primary reason)?

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CT of the knee is done (shown). What (single) most useful investigation would you want to plan Tx?

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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

What is your proposed treatment for this lady?

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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:

Problems on arrival included pain and discharge around half pins – MRSA infected.  Non wt bearing.  No NV deficit.

What classification do you think this fracture had at day-1?

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Consider how you might have treated him at this point (3-months)?

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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. 

Radiographs at 5 months

So, what now?

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Case 5 – distal radius malunion

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)

Why do you think that this probably wasn't a great case for non-op treatment in the first place?

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What do you think this man's main complaint was (ie the most troublesome thing) at the 10-month mark?

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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?

So, having sorted out your operative plan, what does your post-op x-ray look like?

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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!

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