He has an equinus contracture. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. A 25-year-old male sustains a humeral shaft fracture and is treated with the implant seen in Figure A. test by stressing elbow with forearm in pronation to lock the lateral side. A 60-year-old male with a history of diabetes presents to the trauma bay after sustaining a ground-level fall onto his right arm. He has not done any physical therapy nor received a corticosteroid injection. The body of the talus is extruded medially through a large linear open wound. optional films. To avoid impingement with the proximal ulna, you need to carefully place your fixation. often used prior to reconstruction to evaluate for intra-articular pathology. (OBQ09.183) At what time point after the injury does the lack of callus formation and motion at the fracture site first become concerning for nonunion? Examination reveals lateral elbow tenderness, and an 80 degree arc of flexion-extension and 60 degree arc of prono-supination, with extremes of motion limited by pain. Her soft-tissues and neurological examination are normal. (OBQ12.91) He is treated conservatively in a Sarmiento functional brace. the medial and lateral plantar nerves can be compressed in their own sheath distal to tarsal tunnel. Which motor function would be expected to recover last? (SBQ12TR.6) Tibiotalar Impingement indicative of entrapment or irritation of the first branch of the lateral plantar nerve (Baxter's nerve) Imaging. lateral ankle pain due to subfibular impingement is a late symptom. lateral brachial cutaneous/posterior antebrachial cutaneous nerve serves as an anatomic landmark leading to the radial nerve during a paratricipital approach. may show structural changes. 68% (1724/2534) 4. NSAIDs and bracing have provided her temporary relief. His current imaging studies are shown in Figures E and F. Which of the following is the best next step in management? Which of the following is the most appropriate management? Continue current splint for 3 weeks and transition to hanging arm sling for additional 3 weeks, Transition to functional brace for additional 6-8 weeks, Open reduction internal fixation with compression plating, Staged procedure with humeral external fixator, then open reduction internal fixation with compression plating. He underwent operative fixation of his fracture. (OBQ16.1) A 65-year-old female returns to the office with continued medial and lateral hindfoot pain. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. (SBQ18FA.45) stabilizes ankle against plantar flexion, external rotation and pronation Anterolateral soft-tissue impingement. The midfoot is hot to touch and mildly tender with palpation. ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT. On exam, his wounds are well healed with no erythema. However, passively correctable contractures persist and the braces are causing skin problems on the leg. (OBQ11.253) A 17-year-old ballet dancer presents with 5 months of pain in the posterior aspect of the right lower extremity that is exacerbated with the ballet position shown in Figure A. AP, lateral and oblique views of the foot. (OBQ10.125) Webanteriorinferior tibiofibular ligament impingement. Thank you. (OBQ05.95) pes planus . The midfoot is warm, red, and swollen with no skin disruptions on physical exam. hindfoot valgus deformity. On physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. Diagnosis can be made with plain ankle radiographs. Nailing is associated with a decreased rate of surgical site infections, Nailing is associated with a higher rate of transient radial nerve injury, Plating is associated with a higher rate of fracture union, Plating is associated with a higher re-operation rate, No difference between rate of radial nerve palsy between plating or nailing this injury. The brachial artery is disrupted and requires urgent attention in the operating room. Elevation of the extremity reduces the hyperemia. Current radiographs demonstrate a united fracture with no evidence of ostenecrosis, subtalar or tibiotalar arthritis. (OBQ07.193) She has no history of ankle or foot trauma, and medical history is significant only for delayed menarche. Talar neck fractures are high energy injuries to the hindfoot that are associated with a high incidence of talus avascular necrosis. A 21-year-old male reports right ankle pain after sustaining an inversion ankle injury 2 years ago. She denies any specific injury and she does not have any foot ulcerations or wounds; her foot and ankle are edematous with erythema that resolves upon elevation. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Using the 'damage-control' approach to orthopaedic trauma, what would be the best initial management for the injury seen in Figure A? subchondral sclerosis and cysts. What initial management is most appropriate? ankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT. (OBQ09.207) With respect to open reduction and internal fixation with a plate versus intramedullary nailing, what advice can you offer him? often limited secondary to pain or effusion. Treatment can be nonoperative or operative depending on patient age, patient activity demands, severity of arthritis, and presence of tibiotalar deformity. Which muscle function is expected to be the LAST to return in this patient? (OBQ08.197) Lisfranc injury. Non-operative management of the humerus and plating of the femur, Plating of the humerus and intramedullary nailing of the femur, Non-operative management of the humerus and intramedullary nailing of the femur, Intramedullary nailing of the humerus and plating of the femur. Figure C shows the corresponding MRI. His injury films are shown in Figures A and B. inspection & palpation. However, for the last six months, he has developed persistent ankle pain with intermittent swelling. Radiographs of the foot are seen in Figures A and B. To avoid impingement with the proximal ulna, you need to carefully place your fixation. (OBQ13.245) MRI. Operative. Injection of platelet rich plasma. 7.5% of patients with diabetes and neuropathy, typically presents in 5th decade (20-25 years following diagnosis), typically presents in 6th decade (5-10 years following diagnosis), often leads to ligamentous instability and bone loss, body unable to adopt protective mechanisms to compensate for microtrauma due to abnormal sensation, inflammatory cytokines may cause destruction, IL-1 and TNF-alpha lead to increased production of, Involves tarsometatarsal and naviculocuneiform joints, Collapse leads to fixed rocker-bottom foot with valgus angulation, Involves subtalar, talonavicular or calcaneocuboid joints, Unstable, requires long periods of immobilization (up to 2 years), Late varus or valgus deformity produces ulceration and osteomyelitis of malleoli, Late deformity results in distal foot changes or proximal migration of the tuberosity, Radiographs show osseous fragmentation with joint dislocation, Radiographs show coalescence of fragments and absorption of fine bone debris, Radiographs show consolidation and remodeling of fracture fragments, average of 3.3 degrees C warmer than contralateral side, Semmes-Weinstein monofilament (5.07) testing, sensitivity of 40-95% in diagnosing neuropathy, obtain standard AP and lateral of foot, complete ankle series, degenerative changes may mimic osteoarthritis, scattered "chunks" of bone in fibrous tissue, may be positive for a neuropathic joint and osteomyelitis, negative (cold) for neuropathic joints and positive (hot) for osteomyelitis, most sensitive in diagnosing soft tissue and/or osteomyelitis, difficult to differentiate infection from Charcot arthropathy on MRI, detritic synovitis (cartilage and bone distributed in synovium), total contact casting, shoewear modifications, medications, casts changed every 2-4 weeks for 2-4 months, Charcot restraint orthotic walker (CROW) boot can be used after contact casting, in Eichenholtz stage 3 double rocker shoe modifications will best reduce risk for ulceration at the plantar apex of the deformity, resection of bony prominences (exostectomy) and TAL, "braceable" foot with equinus deformity and focal bony prominences causing skin breakdown, goal is to achieve plantigrade foot that allows ambulation without skin compromise, deformity correction, arthrodesis +/- osteotomies, failed previous surgery (unstable arthrodesis), goal is for a partial or limited amputation if vascularity allows, used when bone quality is poor or soft tissues are compromised, Posterior Tibial Tendon Insufficiency (PTTI). What is the next best option at this point? (OBQ16.1) A 65-year-old female returns to the office with continued medial and lateral hindfoot pain. (OBQ04.145) often limited secondary to pain or effusion. Treatment can be nonoperative or operative depending on location of fracture, fracture morphology, and association with other ipsilateral injuries. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. What would be the most appropriate definitive treatment? Webtest by stressing elbow with forearm in pronation to lock the lateral side. (OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. Web(OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. WebHindfoot Talar Neck FX Talus Fracture (other than neck) AIIS pins can place the lateral femoral cutaneous nerve at risk. (OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. 1% (21/2534) 3. (OBQ09.210) (OBQ04.173) He reports that his physician released him to full activity 8 weeks ago because he had no pain. Cellulitis; erythema decreases after elevation, Cellulitis; abnormal Semmes-Weinstein monofilament testing, Complex regional pain syndrome (CRPS); erythema decreases after elevation, Charcot arthropathy; erythema decreases after elevation, Charcot arthropathy; erythema increases after elevation. An orthotic with lateral hindfoot posting and first metatarsal head recess. Hallux MTP dorsiflexion. Radiographs reveal no evidence of talus subchondral sclerosis or collapse. He has not done any physical therapy nor received a corticosteroid injection. hindfoot valgus deformity. A 43-year-old male presents with painless swelling and erythema of his ankle which resolves with elevation. The patient reports that 12 weeks ago he sustained a similar injury and underwent surgery on his foot by a different surgeon. (OBQ04.126) (OBQ19.251) both the superficial and deep layers individually resist eversion of the hindfoot. stabilizes ankle against plantar flexion, external rotation and pronation Anterolateral soft-tissue impingement. (SBQ12TR.12) A 30-year-old man is brought to your level 1 trauma center with a closed left diaphyseal humerus fracture, a closed left midshaft femur fracture, right sided rib fractures, and multiple facial fractures following a motorcycle accident. can try a period of short-leg cast. A 25 year-old-male presents with the injury seen in Figure A. ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT cavus hindfoot alignment. A 27-year-old male is involved in a motor vehicle collision and presents to the ER with the right lower extremity injury shown in Figures A and B. A clinical photo of the patient and lateral radiograph of the foot are provided in Figures A & B. Radiographs are unchanged from prior evaluation. He has been placed into a total contact cast for extended periods without resolution of the ulcer. What would be the most appropriate treatment for this injury? 3% (132/4454) 5. Physical exam. 13% (OBQ05.236) A 65-year-old female developed a right foot deformity 3 years ago following a cerebrovascular accident. 4% At 2 years follow-up, he presents with a supination deformity with decreased eversion of the foot at rest. Hip abductor weakness. Lower rates of malunion. Hindfoot Talar Neck FX Talus Fracture (other than neck) AIIS pins can place the lateral femoral cutaneous nerve at risk. Webankle inversion and dorsiflexion during axial load creates shearing of lateral talar dome and lateral OLT. Closed reduction and splinting in the emergency room, Irrigation and debridement, then splinting in the operating room, Irrigation and debridement, then spanning external fixation in the emergency room, Open reduction and internal fixation with a compression plate in the operating room, Irrigation and debridement, then intramedullary nailing of the humerus in the operating room. (OBQ12.74) He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. A 57-year-old male has right ankle pain for 6 years and has failed conservative management. Closed management with a coaptation splint, Closed management with a coaptation splint followed by transition to a functional brace after 7-10 days, External fixation of humeral shaft fracture until brachial plexus injury resolves, Open reduction, surgical fixation with plating, Closed management with a sling until brachial plexus injury resolves. Physical exam is notable for ambulation on the lateral border of the right foot with hindfoot varus, midfoot 2% (103/5321) 4. Which of the following statements are true regarding this injury? cause of impingement able to be identified in 80% of cases. Radiographs at the time were negative and his pain improved over the next two months. (OBQ05.74) He has currently has no ulcerations on his foot. Anatomy. Upon presentation, he is unable to extend his thumb, fingers, and wrist. You can rate this topic again in 12 months. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. At long-term follow-up, patients undergoing the procedure shown in Figure A have been shown to have significant rates of findings of which of the following? A post-reduction radiograph is seen in Figure C. Which of the following is the most appropriate treatment at this time? posteromedial impingement lesion of ankle. Web(SBQ06TR.1) A 36-year-old rancher is involved in a tractor roll-over accident and sustains the injury shown in Figure A to his dominant right arm. Kathryn OConnor 1University of Pennsylvania, Posterior Tibial Tendon Insufficiency (PTTI). Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. He presents at 2 months after surgery. 50% (957/1903) L 5 (OBQ12.214) Dynamization of the implants to allow controlled compression, Removal of the implants and placement of a hindfoot arthrodesis nail or plate, Revision ankle arthrodesis with bone grafting as needed. Posterior tarsal tunnel. anteriorinferior tibiofibular ligament impingement. (SBQ12FA.100) He is neurovascularly intact. 19% (147/766) 5. Orthobullets Team Lower rates of shoulder impingement. (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. What physical exam test is most appropriate? He is currently tender to palpation on the lateral border of the foot. (OBQ06.173) A 20-year-old male collegiate basketball player presents with a 1 day history of left foot pain. A decision is made to delay surgery until soft tissues are stabilized. loss of joint space. test by stressing elbow with forearm in pronation to lock the lateral side. What is the next appropriate step in the management of this patient? Hallux MTP dorsiflexion. both the superficial and deep layers individually resist eversion of the hindfoot. An orthotic with lateral hindfoot posting and first metatarsal head recess. Tibiotalar Impingement Midfoot Arthritis lateral, and obliques. Figures A and B show his preoperative and postoperative radiographs. (OBQ05.247) (OBQ11.10) (OBQ05.226) A 26-year-old professional ballet dancer presents with insidious onset of right midfoot pain which began 6 months ago. Custom orthotic with Jones bar and medial posting, AFO (ankle foot orthosis) with posterior leaf spring, Accomodative plastizote insole with depression cut into the midfoot and extra-depth shoes. Decreased risk of post-operative elbow pain. A 35-year-old male sustains an isolated injury depicted in Figure A after a motor vehicle accident. procedure. What is the most likely deformity causing these symptoms? weight bearing axial and lateral films of hindfoot. Weblateral brachial cutaneous/posterior antebrachial cutaneous nerve serves as an anatomic landmark leading to the radial nerve during a paratricipital approach. He has a temperature of 100.3 degrees Fahrenheit. He is only able to ambulate with the assistance of crutches or a walker. Recent midfoot and hindfoot weightbearing radiographs are seen in Figure B. pedicle screws with internal subcutaneous bar may be used. Lumbosacral instability. What is the most appropriate treatment for him at this time? He undergoes the treatment shown in Figures A and B. He states that since he began weight-bearing he has progressive lateral foot pain and developed calluses on the lateral side of his foot that have become painful. EMG and nerve conduction tests followed by possible surgical exploration, 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Humerus Shaft Fracture ORIF with Anterolateral Approach, Humerus Shaft ORIF with Posterior Approach, Type in at least one full word to see suggestions list, Rockwood And Greens: Fractures in Adults, Rockwood and Green's Fractures in Adults. Which of the following is true regarding plating of humeral shaft fractures compared to intramedullary nailing? After undergoing rigid anatomic fixation of the fracture, the distal radio-ulnar joint (DRUJ) remains incongruent. After undergoing rigid anatomic fixation of the fracture, the distal radio-ulnar joint (DRUJ) remains incongruent. radiographic findings include. A 45-year-old man presents to your clinic with a closed mid-shaft humerus fracture after a fall 1 week prior. Examination reveals lateral elbow tenderness, and an 80 degree arc of flexion-extension and 60 degree arc of prono-supination, with extremes of motion limited by pain. Her symptoms returned with ballet activity following a 1 month course of full rest, nonsteroidal anti-inflammatory medication, and physical therapy. All of the following are considered contraindications to the use of functional bracing of a humeral shaft fracture EXCEPT: Mid-diaphyseal segmental fracture with ipsilateral pilon fracture, Mid-diaphyseal fracture with radial nerve palsy from nonballistic penetrating injury, Mid-diaphyseal closed fracture with a radial nerve palsy on presentation, Mid-diaphyseal fracture with a L1 burst fracture and paraplegia on presentation. Hallux MTP plantarflexion . Initial radiographic evaluation discovers a femoral shaft fracture, distal tibia fracture, and the injury shown in Figure A. An MRI is performed that reveals nerve root avulsions from C5-T1. Orthobullets Team Lower rates of shoulder impingement. optional. Which of the following statements is most accurate when comparing his treatment with open reduction and internal fixation? Femoroacetabular impingement. Operative management is indicated for recurrent infections, deformities, and severe skin breakdown. (OBQ07.173) A 34-year-old female has an insidious onset of heel pain when first getting out of bed and at the end of the day after prolonged standing. After 4 months of non-operative management, the fracture has healed, but his physical exam is unchanged. 19% (147/766) 5. However, passively correctable contractures persist and the braces are causing skin problems on the leg. Hindfoot varus . pes planus . He is treated with ankle arthroplasty but continues to have pain and limited ambulation 10 months following surgery. may show plantar heel spur. 13% (273/2180) 4. Anatomy. Radiographs are shown in Figures A-B. All of the following are possible etiologies for this condition EXCEPT: 2023 Bobby Menges Memorial HSS Limb Reconstruction Course, Type in at least one full word to see suggestions list, 30th Annual Baltimore Limb Deformity Course, Midfoot Charcot Rocker Bottom: Hexapod Frame - Noman A. Siddiqui, MD, Failed TTC (tibio-talo-calcaneal)fusion left foot. Which of the following is an option for reconstruction of this patient's deformity? A radiograph is shown in Figure A. Spanning external fixation of the ankle and hindfoot. may be useful for surgical planning. Hindfoot varus . Web(OBQ11.178) A 25-year-old man presents one year after undergoing open reduction and internal fixation of the fracture seen in Figure A. Custom orthotics with first ray recession and lateral heel posting, Total contact cast and non-weight bearing, Talonavicular and tarsometarsal arthrodeses. What is the advantage of this treatment choice as compared to antegrade intramedullary nailing? He has not done any physical therapy nor received a corticosteroid injection. What is the next best option at this point? During an open reduction internal fixation of a humerus fracture using the posterior approach, a surgeon can identify the posterior antebrachial cutaneous nerve and trace it proximally to which of the following nerves? During his workup, an MRI shows a 1x1 cm lateral talar osteochondral defect (OCD). Physical exam. He denies any constitutional symptoms and his pain is well controlled. She has a gastrocnemius contracture noted on Silverskiold testing. Web(OBQ17.175) A 22-year-old collegiate football player presents with persistent left lateral ankle pain 6 months after sustaining an ankle sprain during a game. (SBQ12TR.13) debride impinging tissue. (OBQ08.177) (OBQ18.141) A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. She initially underwent early intervention with physical therapy and splinting. Removal of the implants and placement of a hindfoot arthrodesis nail or plate. (OBQ13.89) A 38-year-old concert violinist presents after falling onto a pronated, outstretched hand this morning. (OBQ11.178) (SBQ12TR.18) He recalls catching his foot on astroturf with a dorsiflexion and inversion moment about his ankle. What can the patient be told about his condition? collapse of the medial longitudinal arch. He was treated with physical therapy and a controlled ankle motion boot for several weeks following the (SBQ12FA.32) She has no history of ankle or foot trauma, and medical history is significant only for delayed menarche. criteria for acceptable alignment include: see relative operative indications section, radial nerve palsy is NOT a contraindication to functional bracing, increased risk with proximal third oblique or spiral fracture, varus angulation is common but rarely has functional or cosmetic sequelae, closed humerus fractures, including low velocity GSW, should be initially managed with a splint or sling, type of fixation after trauma should be directed by acceptable fracture alignment parameters, fracture pattern and associated injuries, ipsilateral forearm fracture (floating elbow), periprosthetic humeral shaft fractures at the tip of the stem, polytrauma or associated lower extremity fracture, allows early weight bearing through humerus, burns or soft tissue injury that precludes bracing, short oblique or transverse fracture pattern, overlying skin compromise limits open approach, adequately applied splint will extend up to axilla and over shoulder, common deformities include varus and extension, valgus mold to counter varus displacement, extends from 2.5 cm distal to axilla to 2.5 cm proximal to humeral condyles, sling should not be used to allow for gravity-assisted fracture reduction, shoulder extension used for more proximal fractures, weekly radiographs for first 3 weeks to ensure maintenance of reduction, anterior (brachialis split) approach to humerus, deep dissection through internervous plane of brachialis muscle, lateral fibers (radial n.) and medial fibers (musculocutaneous n.) in majority of patients (~80%), used for proximal third to middle third shaft fractures, distal extension of the deltopectoral approach, radial nerve identified between the brachialis and brachioradialis distally, used for distal to middle third shaft fractures although can be extensile, triceps may either be split or elevated with a lateral paratricipital exposure, radial nerve is found medial to the long and lateral heads and 2cm proximal to the deep head of the triceps, radial nerve exits the posterior compartment through lateral intramuscular septum 10 cm proximal to radiocapitellar joint, lateral brachial cutaneous/posterior antebrachial cutaneous nerve serves as an anatomic landmark leading to the radial nerve during a paratricipital approach, plate osteosynthesis commonly with 4.5mm plate (narrow or broad), absolute stability with lag screw or compression plating in simple patterns, apply plate in bridging mode in the presence of significant comminution, full crutch weight bearing shown to have no effect on union, nonunion rates not shown to be different between IMN and plating in recent meta-analyses, IM nailing associated with higher total complication rates, increased rate when compared to plating (16-37%), functional shoulder outcome scores (ASES scores) not shown to be different between IMN and ORIF, while controversial, a recent meta-analysis showed no difference between the incidence of radial nerve palsy between IMN and plating, radial nerve is at risk with a lateral to medial distal locking screw, musculocutaneous nerve is at risk with an anterior-posterior locking screw, no callous on radiograph and gross motion at the fracture site at 6 weeks from injury has a 90-100% PPV of going on to nonounion in closed humeral shaft fractures, increased incidence distal one-third fractures (22%), neuropraxia most common injury in closed fractures and neurotomesis in open fractures, iatrogenic radial nerve palsy is most common following ORIF via a lateral approach (20%) or posterior approach (11%), 85-90% of improve with observation over 3 months, spontaneous recovery found at an average of 7 weeks, with full recovery at an average of 6 months, indicated as initial treatment in closed humerus fractures, useful to determine extent of nerve damage, baseline of function, and to monitor recovery, brachioradialis first to recover, extensor indicis is the last, open fracture with radial nerve palsy (likely neurotomesis injury to the radial nerve), closed fracture that fails to improve over ~4-6 months, persistent radial nerve palsy - optimal timing debated, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Avascular necrosis is more common following this injury than post-traumatic arthritis, Delayed internal fixation of displaced fractures does not increase the risk of avascular necrosis, Fracture comminution is associated with a decreased avascular necrosis rate, Delayed internal fixation increased the risk of secondary surgical procedures, Fracture displacement is not associated with avascular necrosis. 19% (147/766) 5. WebTibiotalar Impingement Midfoot Arthritis lateral, and obliques. A 45-year-old female presents to the office wearing a right upper arm splint with radiographs shown in Figure A and B. (SBQ18FA.64) 33% (1730/5321) 5. Femoroacetabular impingement. A current clinical photograph is seen in Figure A. Webcause of impingement able to be identified in 80% of cases. ankle inversion, external rotation, and plantarflexion during axial load creates shearing of medial talar dome and medial OLT cavus hindfoot alignment. Thank you. indications. WebOn physical examination the patient is unable to feel a 5.07 gm monofilament on the plantar aspect of his foot. Figure A is the AP radiograph of a 32-year-old right-hand dominant male who was involved in a motor vehicle accident and sustained an isolated injury. On examination, she has severe pain and stiffness of her great toe, with crepitation. Chapter 36: HUMERAL SHAFT FRACTURES, Orthopaedic Summit Evolving Techniques 2020, Evolving Technique: Distal Articular Fractures Of The Humerus: 7 Tips & Tricks For A Great Outcome - Michael McKee, MD, Cleveland Combined Hand Fellowship Lecture Series 2021-2022, Humerus Fractures with Radial Nerve Palsy - Michael Webber, MD, The Reproducible Humeral Exposure: 7 Tips, 7 Minutes - Joseph Iannotti, MD, Middle Atlantic Shoulder & Elbow Society Annual Meeting, Left diaphyseal humeral shaft fracture in a 25M. posteromedial impingement lesion of ankle. On examination, she has severe pain and stiffness of her great toe, with crepitation. Injection of platelet rich plasma. Copyright 2022 Lineage Medical, Inc. All rights reserved. Copyright 2022 Lineage Medical, Inc. All rights reserved. Copyright 2022 Lineage Medical, Inc. All rights reserved. Diagnosis is made with radiographs of the foot but frequently require CT scan for full characterization. (SBQ18TR.6) 12/11/2019. (OBQ04.44) Webforward shift of more than 8 mm on a lateral radiograph is considered diagnostic for an ATFL tear. Thank you. (OBQ13.14) A clinical photo of the patient and lateral radiograph of the foot are provided in Figures A & B. Radiographs are unchanged from prior evaluation. WebTibiotalar Impingement Midfoot Arthritis Neurologic Conditions occurs with forefoot fixed and hindfoot or leg rotating. A 62-year-old gentleman with a 10-year history of Type II diabetes complains of warmth, swelling, and pain in his right foot that has progressively worsened over the past 6 weeks. (OBQ07.90) A 45-year-old diabetic male has a Wagner type 3 heel ulcer shown in Figure A that measures 4x2cm and is recalcitrant to debridements and total contact casting for 4 months. Associated conditions. Copyright 2022 Lineage Medical, Inc. All rights reserved. procedure. Hawkins sign is positive. MRI. She sustained an isolated closed injury to the right arm 9 days ago. Operative. He has been treated for the past four months with the modality seen in Figure A (Panel A) for the condition seen in Figure A (Panel B). pedicle screws with internal subcutaneous bar may be used. He states that since he began weight-bearing he has progressive lateral foot pain and developed calluses on the lateral side of his foot that have become painful. orthosis or foot wear changes to address alignment of hindfoot. Osteochondral Lesions of the Talus are focal injuries to the talar dome with variable involvement of the subchondral bone and cartilage which may be caused by a traumatic event or repetitive microtrauma. 3% (132/4454) 5. The patient has palpable pulses, active drainage at the ulcer, and does not have protective sensation with a 5.07 Semmes-Weinstein filament. Femoroacetabular impingement. posteromedial impingement lesion of ankle. forward shift of more than 8 mm on a lateral radiograph is considered diagnostic for an ATFL tear. Midfoot prominences associated with Charcot arthropathy, End-stage tibiotalar arthritis with limited motion. (OBQ12.166) Which of the following is a contraindication for a total ankle arthroplasty? When compared to medial talar OCDs, which of the following statements is true regarding lateral talar OCDs? 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