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Fall From Trail Leaves Woman in Pain
ANSWER
The radiographs demonstrate a left inferior pubic ramus fracture. The patient was referred to orthopedics for follow-up. She was given a walker and a series of home exercises for hip stretching and strengthening, as well as anti-inflammatories as needed for discomfort. She was scheduled for a four-week follow-up visit and repeat radiographs of the pelvis.
ANSWER
The radiographs demonstrate a left inferior pubic ramus fracture. The patient was referred to orthopedics for follow-up. She was given a walker and a series of home exercises for hip stretching and strengthening, as well as anti-inflammatories as needed for discomfort. She was scheduled for a four-week follow-up visit and repeat radiographs of the pelvis.
ANSWER
The radiographs demonstrate a left inferior pubic ramus fracture. The patient was referred to orthopedics for follow-up. She was given a walker and a series of home exercises for hip stretching and strengthening, as well as anti-inflammatories as needed for discomfort. She was scheduled for a four-week follow-up visit and repeat radiographs of the pelvis.
A 56-year old woman presents for evaluation of left hip pain. Several hours ago, she says, she was walking on a trail when she fell from an embankment. The 4-ft fall ended with her landing primarily on her left hip and elbow. Afterward, she was able to ambulate with assistance but noticed increased pain in her left hip and groin with movement. The elbow discomfort resolved shortly after the incident. She denies numbness or tingling in her extremities and loss of bowel or bladder function. Physical exam reveals a well-developed, well-nourished female without any extremity deformity or leg shortening. Palpation elicits left-sided groin pain, as well as left posterior hip and sacroiliac joint pain. Both active and passive range-of-motion of the hip elicit pain, but straight-leg raise does not. The patient can bear weight on the left leg with the assistance of a walker. There is no laxity in the knee joint, and the ankle mortise is stable. There are no signs of swelling or bruising, and the skin is intact. Dorsalis pedis and posterior tibial pulses are 2+, and sensation in the left foot is intact. Radiographs of the left hip and pelvis are obtained. What is your impression?
A Not-So-Old Football Injury
ANSWER
Imaging shows a ventral dislocation of the lunate. There is also a tiny avulsion fracture on the ulnar aspect of the adjacent triquetrum.
The patient was referred to orthopedics for a perilunate dislocation of the left wrist. He underwent successful closed reduction and was placed in a short arm cast for four weeks.
ANSWER
Imaging shows a ventral dislocation of the lunate. There is also a tiny avulsion fracture on the ulnar aspect of the adjacent triquetrum.
The patient was referred to orthopedics for a perilunate dislocation of the left wrist. He underwent successful closed reduction and was placed in a short arm cast for four weeks.
ANSWER
Imaging shows a ventral dislocation of the lunate. There is also a tiny avulsion fracture on the ulnar aspect of the adjacent triquetrum.
The patient was referred to orthopedics for a perilunate dislocation of the left wrist. He underwent successful closed reduction and was placed in a short arm cast for four weeks.
A 15-year-old boy presents for evaluation of left wrist pain. He says that two days ago, while playing football, he fell onto his outstretched left hand, which twisted upon impact with the ground. Immediately after the fall, he experienced severe pain. Since then, the pain has been constant, although it lessens to a moderate dull ache at rest and sharpens with activity. He denies any numbness or tingling in the affected hand and wrist. There are no other areas of injury from the fall, nor is there significant medical history. Physical exam identifies moderate left wrist swelling with focal tenderness over the volar aspect of the distal radius, extending to the wrist. The patient has limited active and passive flexion and extension of the left hand and wrist, along with reduced grip strength due to pain. There is mild navicular tenderness. Radial pulse is 2+, the hand is warm to the touch, and the skin is intact. Sensation is intact in all of the digits, which also demonstrate brisk capillary refill. Radiographs of the left wrist are obtained. What is your impression?
