100 Cases in Orthopaedics and Rheumatology by Parminder J Singh, Catherine Swales

By Parminder J Singh, Catherine Swales

A 24-year-old lady attends rheumatology outpatients with an eight-week historical past of painful fingers. On exam she is tearful and skinny. you're the medic on duty...

100 situations in Orthopaedics and Rheumatology provides a hundred eventualities ordinarily visible via clinical scholars and junior medical professionals in orthopaedic and rheumatology clinics, or within the emergency division. A succinct precis of the patient's background, exam and preliminary investigations, with medical and/or imaging images, is via questions about the analysis and administration of every case. the reply incorporates a certain dialogue on each one subject, with extra representation the place applicable, offering an important revision reduction in addition to a realistic advisor for college students and junior medical professionals.

Making medical judgements and selecting the easiest plan of action is likely one of the so much tough and tough components of educating to develop into a physician. those situations will educate scholars and junior medical professionals to acknowledge very important indicators and symptoms and, the place applicable, their courting to different health conditions, and to advance their diagnostic and administration talents.

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This patient had been lying on a hard floor for 6 hours and is deemed to be at high risk of pressure sores. She should be nursed on a large-cell alternating-pressure air mattress or comparable pressure-reducing surface. Soft-tissue surfaces should be used to protect the heel and sacrum from pressure damage. The patient should be kept warm, be provided with adequate analgesia and early assessment and correction of any fluid and electrolyte disturbances. Ideally during the preoperative period the patient should be managed on an orthopaedic ward with orthogeriatric medical support.

At 3–4 weeks, the k-wires are removed and follow-up scheduled at 6 weeks for further X-rays. A return to full activity is allowed once the fracture has united radiographically. KEY POINTS • Humeral condyle fractures occur most commonly between 6 and 10 years of age. The distal humerus is predominantly cartilage at this stage of development. • Fractures often appear subtle on radiographs. • Displacement of less than 2 mm can be treated with immobilization in a cast. Operative management is essential for all other displaced fractures.

For greater displacement, the fracture should be opened and reduced. 28 Orthopaedics CASE 11: A PAINFUL HIP FOLLOWING A FALL History A 72-year-old woman tripped, fell and landed on her left hip. She reported pain in her proximal thigh and was unable to bear weight. An ambulance was called and she has been taken to the emergency department. Examination This elderly woman is in some obvious pain which appears to be arising from her hip. She has evidence of shortening of the left leg and the leg is lying in external rotation.

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