Case Studies

A 31-year-old female patient reported severe pain in the left forearm, right hand, right knee, right hip, and lower back following a fall sustained three days before presentation. The patient had a history of end-stage renal disease (ESRD) and received maintenance hemodialysis. Medical records revealed that she had poor compliance with her diet, medications, and dialysis treatments. Laboratory values were significant for marked elevation in serum parathyroid hormone level (1735 pg/mL), as well as hyperphosphatemia and normal serum calcium levels.

These symptoms are most consistent with which of the following disease?

a) Renal failure
b) Hyperparathyroidism
c) Brown tumour

22min read    

A 41-year-old Albanian man was admitted to the emergency department following a pedestrian-vehicle accident five days earlier. He had severe upper thoracic pain, chest deformity, dyspnea, tachycardia, subcutaneous emphysema, and hematoma. Hypoventilated lung fields and minor pleural effusion was detected in the chest radiography. As per the computed tomographic scans, there were displaced fractures of right lateral ribs 5 –11, hyperdensity regions from bone fragments, and pulmonary contusion. The treatment comprised of surgical fixation of ribs 7–10 using titanium reconstruction plates and cortical locking screws. The patient’s clinical condition improved postoperatively. After six weeks follow-up, a full return to preoperative daily activities and high quality of life was confirmed.

What will be most helpful in the treatment of multiple rib fractures?

  • Small notch titanium reconstruction plates
  • Precontoured locking plates of the MatrixRIB™ Fixation System (DePuy Synthes)
29min read    

A 79-year-old Caucasian retired physician presented to the clinic with a severe complaint of bilateral hip pain that had been persisting since last 2 years with unbearable episodes of pain over the previous three months. His pain was dull and achy, and started anteriorly in both the hips with occasional radiation to the groin. The pain ratings at its most severe point were 7 and 5 on a ten-point scale in the left and the right hip, respectively. The pain was most severe in the morning, when the patient woke up and in the evening after completion of all day to day activities. Acetaminophen 650mg bid as well as tid was no longer effective in relieving his pain. However, Ibuprofen 400 mg tid did show some improvement. The patient was unwilling to begin NSAIDs because of the fear of having gastrointestinal (GI) adverse events. Tramadol, hydrocodone, and oxycodone in the past lead to troublesome lightheadedness.

What will most likely explain the symptoms reported by the patient in this case?

  • Bilateral Hip Osteoarthritis
  • Spinal Stenosis
  • Greater Trochanteric Bursitis
  • Osteonecrosis

23min read    

A 17-year old male athlete participating in a fall league ice hockey game reported that he and an opponent, who had the puck, skated towards each other at high speed. The athlete tripped over a teammate's stick, fell forward, and the top of his helmet forcefully impacted the opponent’s leg at approximately mid-thigh.

At the time of impact, his neck was straight and his stick was held in front of him with both hands. His stick broke upon contact with the opponent, likely the lower leg, at approximately the same time the head impact occurred. He was unable to get up and reported feeling pins and needles in his hands and upper arms. The patient reported approximately 1 minute of functional quadriplegia. Neck pain after the impact was minimal. He had transient quadriplegia until external stabilization and distraction could be applied with a well-fitting halo-vest. His leg function returned prior to arm function.

What is the most likely diagnosis of this case presentation?

  • Vertebral dislocation
  • Teardrop fracture
  • Vertebral compression fracture

39min read    

A 43-year-old man presented to the orthopedic outpatient clinic with 2-months history of pain and limited range of motion in his left shoulder. His pain was insidious in onset, mild to moderate in intensity, aggravated by activities and associated with moderate rest and night pain. There was no history of direct or indirect trauma to the left shoulder. Patient was diagnosed as frozen shoulder at an outside facility and had been given intraarticular Depomedrol 40 mg injection for the same 40 days ago with no improvement in his symptoms. He had no fever, chills or rigors. He had no weight loss or loss of appetite. He was diabetic and had liver cirrhosis and was on treatment.

What is the most likely diagnosis of this case presentation?

  • Muscular pain

  • Shoulder Fracture

  • Septic Arthritis

23min read