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Orthopaedics pitfalls 1

HKCEM College Tutorial. Orthopaedics pitfalls 1. Author DR. PC Yuen & dr. TW Wong Revised by Dr. Shek Kam Chuen Oct 2013. Case 1. What is this fracture?. Monteggia Fracture dislocation.

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Orthopaedics pitfalls 1

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  1. HKCEM College Tutorial Orthopaedics pitfalls 1 Author DR. PC Yuen & dr. TW Wong Revised by Dr. ShekKamChuen Oct 2013

  2. Case 1 What is this fracture?

  3. Monteggia Fracture dislocation Failed to XR the joints above and below the fracture of forearm or leg and missed concomitant joint dislocation.

  4. Case 2 Is this a fracture?

  5. Failed to XR both limbs for comparison in children with limb injury and mistaken epiphyses as # Is this NOT a fracture? This is the #

  6. Case 3 What is this injury? That’s it?

  7. Failed to XR 2 or more regions and missed injuries due to transmitted forces Where else should one look for concomitant injuries?

  8. Case 4 Lat view has bulging ant fat pad. Any #?

  9. Failed to XR in 2 or more views and missed # or dislocations AP view looks normal. What about the oblique view?

  10. Case 5 Fall on outstretched hand. Any #? Discharged by MO since no # noted

  11. Patient return 10 days later Failed to repeat XR later when initial XR normal and missed # e.g. scaphoid #

  12. Case 6 A child with wrist injury

  13. Fracture easily missed on AP view Missed # of epiphysis in childhood injury

  14. Case 7: Cervical Spine Injury Anything wrong?

  15. Missed C7 # because of inadequate film

  16. Case 8 Child with C2-C3 subluxation? Mistaken as cervical spine injury in children with pseudosubluxaton on XR

  17. Other pitfalls Missed cervical spine injury in unconscious patient with head injury. Ruling out # based on lateral film only. (may miss 15% of #)

  18. Case 9: Upper Limb Injury Left shoulder pain After a fall. Any pathology?

  19. Upper Limb Injury Subluxation more obvious with weight Missed AC joint subluxation/dislocation by not taking a standing weight-bearing film

  20. Case 10: Shoulder pain after a fall Anything wrong?

  21. Which one is abnormal? • Mistaken as normal XR film in patient with posterior dislocation of shoulder

  22. Failed abduction may be due to 2 causes... • Failed to document neurovascular integrity before and after closed reduction of dislocation e.g. shoulder

  23. Case 11: A Child with elbow injury Is there a fracture? Is X-ray normal?

  24. Ant and Post Fat Pads Visible. Where is the fracture? • Missed fat pad sign on XR elbow and missed occult #

  25. Case 12: Forearm # # Radius and...?

  26. Galeazzi # • In forearm bone #, missed dislocation of radioulnar joint

  27. Case 13:Fall on outstretched hand CR + Short arm slab is ordered.

  28. Mistaken Smith # as Colles # when viewing XR

  29. Case 14: Wrist pain after a fall Dx as normal Xray by your colleague

  30. A“normal X-ray”may harbour significant pathologies • scaphoid # • Scapho-lunate dissociation • #/dislocations of carpal bones

  31. Case 15: Hip pain after a fall This patient can walk without aid.

  32. Impacted # NOF In case of doubt frog-view may help. • Missed impacted # NOF in elderly lady walking in after a fall

  33. Case 16: Hip pain after running Adolescent after running in PE lesson.

  34. Missed slipped femoral epiphysis Caution: Missed hip pathology in a child with knee pain

  35. Case 17 Sprain ankle

  36. Missed # base of 5th MT with ankle film only for sprained ankle

  37. Case 18: A Paed Case What is the dx?

  38. CR done Discharge patient with POP?

  39. Thank You

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