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100 Cases in Orthopaedics and Rheumatology by Parminder J Singh, Catherine Swales

By Parminder J Singh, Catherine Swales

A 24-year-old lady 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 instances in Orthopaedics and Rheumatology provides a hundred situations mostly visible by way of scientific scholars and junior medical professionals in orthopaedic and rheumatology clinics, or within the emergency division. A succinct precis of the patient's historical past, exam and preliminary investigations, with medical and/or imaging photos, is through questions about the analysis and administration of every case. the reply incorporates a specified dialogue on every one subject, with extra representation the place applicable, delivering an important revision relief in addition to a pragmatic advisor for college kids and junior medical professionals.

Making scientific judgements and selecting the simplest plan of action is likely one of the so much not easy and tough components of teaching to develop into a physician. those situations will train scholars and junior medical professionals to acknowledge vital signs and symptoms and, the place applicable, their courting to different health conditions, and to strengthen their diagnostic and administration abilities.

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MRI is the investigation of choice where there is doubt about the diagnosis. If MRI is not available or not feasible, a radioisotope bone scan or repeat plain radiographs (after an interval of 24–48 hours) should be performed. Garden’s classification is the most widely accepted for grading a fractured neck of femur (see the box). The present case is stage IV. The blood supply to the proximal end of the femur is divided into three major groups. • The first is the extracapsular arterial ring located at the base of the femoral neck.

Type IIB fractures tend to be less stable and may require fixation with wires. Treatment of a type III injury is more complicated. The posterior cortex is disrupted with no cortical contact and the distal fragment is displaced posteriorly and proximally (by the pull of the triceps). If the fracture has medial displacement, the medial periosteal hinge is usually intact. If the fracture has lateral displacement, the lateral periosteal hinge is intact. Completely displaced fractures with no posterior intact hinge/cortex are unstable and require some form of wire fixation.

Non-surgical treatment can be considered for partial tears of the UCL; that is, grade I or grade II tears as in this case. The thumb is immobilized in a spica-type cast for 4 weeks. The cast should be well-moulded around the MCP joint, and the interphalangeal (IP) joint can be left free. If the fragment is displaced by less than 2 mm, non-surgical management is indicated. For greater displacement, the fracture should be opened and reduced. Complete ulnar collateral ligament tears require surgical repair.

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