By Parminder J Singh, Catherine Swales
A 24-year-old girl attends rheumatology outpatients with an eight-week heritage of painful arms. On exam she is tearful and skinny. you're the medic on duty...
100 situations in Orthopaedics and Rheumatology provides a hundred eventualities normally noticeable through clinical scholars and junior medical professionals in orthopaedic and rheumatology clinics, or within the emergency division. A succinct precis of the patient's heritage, exam and preliminary investigations, with scientific and/or imaging pictures, is by means of questions about the prognosis and administration of every case. the reply contains a particular dialogue on each one subject, with additional representation the place applicable, offering an important revision reduction in addition to a pragmatic consultant for college students and junior medical professionals.
Making medical judgements and selecting the simplest plan of action is likely one of the such a lot hard and hard components of teaching to turn into a physician. those instances will educate scholars and junior medical professionals to acknowledge vital signs and indicators and, the place applicable, their dating to different health conditions, and to improve their diagnostic and administration talents.
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Extra info for 100 Cases in Orthopaedics and Rheumatology
How would you classify this injury? • Describe the blood supply to the femoral head • How would you manage this patient’s injury? • How would you manage a patient with an extracapsular fracture of their proximal femur? 41 100 Cases in Orthopaedics and Rheumatology ANSWER 15 The diagnosis is a fractured neck of femur. The leg is short, externally rotated and she is unable to bear weight, and the X-ray shows a displaced intracapsular fracture of the proximal femur. Hip fractures are the most common reason for admission to an orthopaedic ward, usually caused by a fall by an elderly person.
Prior to the treatment of supracondylar fractures, it is essential to identify the type. Examination of the degree of swelling and deformity as well as a neurological and vascular status assessment of the forearm is essential. A vascular injury may present with signs of an acute compartment syndrome with pain, paraesthesia, pallor, and pulseless and tight forearm. Injury to the brachial artery may present with loss of the distal pulse. However, in the presence of a weak distal pulse, major vessel injury may still be present owing to the collateral circulation.
The ascending cervical branches ascend on the surface of the femoral neck anteriorly along the intertrochanteric line. Posteriorly, the cervical branches run under the synovial reﬂection towards the rim of the articular cartilage, which demarcates the femoral neck from its head. The lateral vessels are the most vulnerable to injury in femoral neck fractures. Management of this patient should follow the national recommended guidelines. An early assessment in the emergency department or ward should include a formal assessment of the pressure sore risk, hydration and nutrition, ﬂuid balance, pain, core body temperature, continence, coexisting medical problems, mental state, previous mobility, previous functional ability, social circumstances and whether the patient has a carer.