FRCS Experience Chesterfield Feb 2015 – HC
12 yr old girl with mother. GP letter just says b/l hip pain.
Difficult history, congenital hip deformity, multiple surgeries. Pt states “chromosomal bone disease?!”
Has problems with feet, knees, forearms.
Mum reports the legs were bent and the hip not in joint when born, she then had surgery.
Examination showed pes planus, hallux valgus, no knee creases with flexed left knee. Trendenburg –ve, Walking with a waddling gait.
Lying down I fumbled around with galeazzi and offered a tap measure but they moved me on. Hip movements were stiff and I didn’t even get to thomas’ test. Knee flexion was intact.
I said it sounded like pffd. The lack of creases on the knees looked like arthrogyposis but not with the range of movement.
Xrays showed dysplastic acetabulum and absent femoral heads
Asked about classification pffd – I said Aitken etc femoral head vs no head with or without socket. They asked about associations, talked about absent acl, hypoplastic lat condyle, fibula hemimelia
Asked about upper limb, I said lack of pronation/supination sounds like radioulnar synostosis. They asked what else –the bell rang.
1st CMCJ OA (B/L) and recent right wrist replacement.
Nice case, history of OA etc. Examination all the usual movements etc. some altered sensation over middle finger ?cause. APB intact and medial ok. Altered sensation over superficial radial nerve.
Discussion about xrays, treatment options, asked to describe sling and tendon interposition.
Hallux valgus, other side has had corrective osteotomy. Nothing complicated. Discussion on treatment options
Young girl with multiple scars over both legs. Fell on glass when 8 years old. Subsequent surgeries to treat the injury. I went for deep peroneal nerve, explained Tib ant loss. Then led to back of legs – sural nerve grafts – asked to quote a success rate (I guessed at 50% – examiner didn’t look impressed). Asked about tendon transfers in the foot. Failed miserably. Asked about principles of tendon transfer – managed to scrap a little back with that.
Walked with high stepping gait. Asked about management, I started talking about orthosis, bell rang. Not a great case
Man with “old knee injury” discuss. Weird gait, failing to extend knee – I said it looked like quads weakness, they asked about compensatory mechanisms. I muttered about bring centre of gravity over knee to compensate, they wanted something else.
They asked my differential I said old quads rupture. So they said fine examine the quads.
Sitting down I couldn’t palpate a patella. And the patient couldn’t straighten leg from bent position. I said the tendon was subluxed “how common is that”, not common. The examiner demonstrated the leg extends passively and then could be held by patient. I finally cottoned onto the laterally dislocated patella. Discussed treatment options then bell rang.
Cubital valgus in a young child following previous elbow injury
Brachial plexus injury – C5 spared
Functional assessment in the hand of an elderly lady with multiple scars
40 year old i/c hip fracture, management options, timing etc
Supracondylar fracture in a child – pink pulseless, how to manage, when to operate. 8pm, child ate 1 hour ago. Evidence behind
Pipkin head fracture in 55 yr old with ipsilateral tibial fracture
Dislocated knee, external fixator application on a prone pt etc
Segmental ulnar fracture with radial shaft fracture and head dislocation, how to fix and order to fix
Distal humeral fracture – low comminuted, management plan
Club foot in newborn management and then late presentation, medial release
Child with scoliosis secondary to leg length discrepancy, discussion on LLD, Anterolateral tibial bowing, neurofibromatosis diagnostic criteria etc
SUFE usual questions, severe slip a few days old – discussed uglow and clark paper. Gift of a question!
Dissection of APB, discussion about recurrent motor branch, tendon transfers,
Flexor sheath infection, management
Radial nerve palsy, tendon transfers, how nerve conduction studies work, seddon and sunderland etc
Lag screw, diagram of a screw, discussion on cannulated screws, second moment area
Polyethylene acetabular component, wear, fatigue failure,
Foot prosection discussion on anatomy, tendon transfer, approaches
Tibia, medioanterior wear ?why – ACL intact, discussion on mechanical axis
Cross section tibia – anatomy, compartment release, pressure monitoring
Biomaterials, titanium vs stainless steel
Humeral lesion, enchondroma, management, olliers/mafuccis, Ca risk etc.
AVN bilateral hips, ficat, management options, how to do a core decompression, type of hip replacement and why
Clinical picture of a erythematous ankle in a kid, short history etc. differientals, got to MRI which was a terrible picture showing osteomyelitis with subperiosteal abscess. Management options discussed. Common organisms in different age groups and appropriate antibiotics.
Told history of patient with back pain, asked a few questions, young man with stiffness, sounded like Ankylosing sponditlitis, HLA B27 xray showing spine with syndesmophytes. Absent SI joints, discussed new york classification. Treatment options, referral to rheum etc. Orthopaedic complications, problems with surgery anaesthetics etc. Draw an osteophyte vs a syndesmophyte! (my picture was embarrassingly poor)
Patient with sciatica, MRI, draw spine, where do roots go, which bits are compressed depending on disc types, MRI Sequestered disc L3/4. Treatment options conservative vs injections vs surgery
Prosection of a brain!!! Lots of little red dots, finally got to fat embolism in brain. Causes, symptoms, ways of reducing risk, pressurising cement. Risks of surgery. Management of post op surgical patient.