78 year old female seen in the ED s/p ground level fall in a | Figure 1

Candlemaker

Orthopedic Surgery


Case Report

78 year old female seen in the ED s/p ground level fall in a SNF. She has a history of falls. She has a h/o dementia, Parkinson’s, and today a positive test for COVID 19.

She is mildly cooperative with exam and confused.

Right lower extremity is shortened and externally rotated. She can flex and extend the ankle and wiggle toes. Palpable dorsal is pedis pulse.

Radiographs attached.

Questions:


Similar Cases

45 yo woman with this MRI after ankle sprain. How would you manage? She is able to walk but has some limping that's mild. Feels better with an ankle brace. Exam is otherwise benign.

You have a new patient referral to your clinic for an ankle sprain. She has not been seen by your group before. The injury occurred 5 days ago and she has an X-ray with her showing no fractures. After performing an appropriate exam and evaluation, you recommend over the counter anti-inflammatories and acetaminophen for pain control, and prescribe a physical therapy course for ankle rehab with as needed follow up if she does not achieve return to full activity in 3 months. How would you code this patient encounter?

~80 yo F had a ground level fall. She had some left hip pain off and on for the last ~6months prior to falling. What’s going on here? What would you ask, how would you treat?

46 year old female with a history of lupus and chronic steroid use sustains a fall injuring her left ankle. She was seen at an outside hospital where she stated her ankle was reduced. On exam she has robust diffuse swelling. Radiographs and CT images note the trimalleolar fracture with talar translation. She is splinted with strict elevation instructions pending surgery. How would you fix this injury? What approache(s) would you use? What would be your order of fixation?


Additional Cases

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis. He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?