case based discussion during Covid19!

1. Q 10
 A 45 years old male
known alcoholic patient
presented to you with
bilateral hip pain more on
the right side of one year.
He has history of smoking
for the past 10 years.
Pelvic x – ray taken and
shown on the picture
below
a) Explain the x – ray
findings?
b) What is the most likely
diagnosis?
c) What are the possible
etiologies?
d) What are the common
classifications?
e) Discuss the possible
management options?

2. Explain the x – ray findings?
 Ap x ray of pelvis
 Irregular femur head
with sclorosis and
lucency with in the
head

3. What is the most likely
diagnosis?
 Bilateral femur head
osteonecrosis

4. What are the possible etiologies?
 traumatic
 chronic corticosteroid
therapy
 alcoholism
 Smoking
 SLE
 Hyperlipidaemias
 HIV
 Hemoglobinopathy
 CRF
 DM
 pregnancy-related

5. classification

8.  Discuss the possible
management options?
 Non operative
 Operative
 Non operative
 RWB
 Decrease activity
 Medical therapy
 Osteoporotic drug
 Cholesterol decreasing
agent
 Steroid….
 New way
 PEMF….considered
 ECSW….considered
 Hyperbaric oxygen therapy

9.  Core Decompression
 for Ficat stages I and IIA small central lesions in
young, non obese patients who are not taking
steroids.
 Bone Morphogenic Proteins
 Bone marrow mesenchymal cell grafting
 BONE GRAFT
 Structural
 Non structual
 Tantalum rod

10.  Porous tantalum rod
insertion
 A novel approach in the
treatment of stage I & II
precollapse osteonecrosis
 rod functions analogously
to a Cortical Strut Graft
allowing structural &
osteoconductive properties

11.  Various Nonvascularized & Vascularized Bone
Grafting Procedures
 Grafting through lateral core track
 Grafting through femoral neck window- light bulb
window
 Grafting through articular surface window -trap
door technique
 NON VASCULARIZED
 Iliac crest
 VASCLARIZED
 FREE FIBULAR
 MUSCLE PEDICLE BONE

14.  Osteotomy Procedures
 Total Hip Arthroplasty
 Hip Resurfacing Procedures
 Stage iii and above
 More than 30% involvement

15.  valgus-extension
intertrochanteric
osteotomy combined
with curettage of the
avascular segment
and autogenous bone
grafting was reported
to have an 87%
success rate at 65
months.

16.  A transtrochanteric rotational osteotomy of the
femoral head
 reposition the necrotic anterosuperior part of the
femoral head to a non–weight-bearing locale.
 Femoral head and neck segment is rotated
anteriorly around its longitudinal axis so that the
weight-bearing force is transmitted to what was
previously the posterior articular surface o

17. Q11.A 34 years old patient presented to your clinic eight weeks
post injury complaining of pain over her wrist. X – ray of the wrist is
shown below
a) What do you see?
b) What are the x ray
views ued to diagnose
this fracture?
c) What are the poor
prognostic factors for
nonunion?
d) How would you manage
this patient?
e) What are the indications
for internal fixation of
these fractures?
f) What approach would
you use?

18. What do you see?
 PA x ray view of wrist
 fracture of scaphoid at the level of
waist
 Displaced
 No sclorosis or cyst formaed

19. What are the x ray views ued to
diagnose this fracture?
 Lateral
 Scaphoid view
 Oblique view
 Supinated
 Pronated
 Ziter view/banana view

20. What are the poor prognostic factors
for nonunion?
 Displacemennt
 Proximal
 delayed
 Fracture dislocation
 DSCI
 Scapholuniate
angle>60 deg
 UNSTABLE
FRACTURE

21. How would you manage this patient?
 CT AND MRI
 Articular surface
 Open reduction with
bone graft
 Cast
 Short arm
…scaphoid cast
 Time depending
fracture type 4wk to
4month

22.  What are the indications for internal fixation of
these fractures?
 Any fracture in young medical fit with sign of
instablity

23.  What approach would you use?
 Open vs percutaneous
 Volar vs dorsal
 Headless canulated screw
 With or with out graft

24. Q12
 A 32 year old Rt handed
female housewife
sustained FDA with
outstretched hand and
injured her right wrist
area.
 She arrived at the
EOPD with swollen and
painful Rt wrist.
 distal neurovascular
exam is intact.
 Xray is attached below.

25.  What is the most
likely diagnosis?
 What additional
injuries are you
most concerned
about?
 Distal radial fracture –
colls type
 Distal radio ulnar joint
 TFCC

26.  What is the most
appropriate initial
treatment for this
patient?
 ATLS
 Analgesic
 Proper evaluation
 Closed reduction with
bier block or
hematoma block
 And splinting

27.  When do you consider
operative treatment in this
patient?
 displaced intra-articular fx
 volar or dorsal
comminution
 articular margins fxs
 severe osteoporosis
 dorsal angulation >5° or
>20° of contralateral distal
radius
 >5mm radial shortening
 comminuted and
displaced extra-articular
fxs (Smith's fx)
 progressive loss of volar
tilt and loss of radial
length following closed
reduction and casting
 associated ulnar styloid

28.  What will be your
operative plan for this
patient?
 Joint spaning ex fix
 CT scan
 AUGMENT WITH
ORIF
 VOLAR PLATE
 PERCUTANEOUS
PIN

31.  What potential
complications could
this women will suffer
?
 OA
 stiffness
 CTS
 Malunion
 Tendon irritation

32. Reference
 Rockwood and Green’s Fractures in Adults 8ed.
 Campbel's 13th ed.
 Orthobullet

33.  THANK YOU!