Challenge of the Week

Challenge of the Week / Foot & Ankle / 08.21.20

You have been following a 35-year-old female patient who is a recreational runner for peroneal tendinopathy in the setting of an overt cavovarus foot. She has undergone extensive nonoperative management including immobilization, physical therapy, and custom orthotics. Her pain and limitations persist, and she is ready to proceed with surgery. Your operative plan should address which of the following?

Challenge of the Week / Basic Science / 08.14.20

A 12-year-old male patient with a poorly controlled seizure disorder has been on high-dose anticonvulsants for 7 years. The patient sustains a low-energy fracture, and his primary care provider orders a dual x-ray absorptiometry (DXA) scan, which indicates a bone mineral density (BMD) measurement of 1.4 standard deviations below normal. Which of the following makes the interpretation of these results challenging?

Challenge of the Week / Sports / 05.22.20

An 18-year-old female patient who is a cross-country runner presents with hip pain. She reports that she occasionally misses menstrual cycles. She denies any disordered eating habits and states that she does not worry about her weight. She has a body mass index of 18 kg/m. She is currently in the middle of her cross-country season but has had increasing groin pain that is present even when walking. Which of the following is the most likely diagnosis?A 54-year-old male patient presents to the emergency department with non-radiating thoracic back pain. He has an intact motor, sensory, and reflex examination of the bilateral upper and lower extremities. The patient has a history of hepatitis C, a 30-pack per year history of smoking cigarettes, and chronic cough for the last 3 months. His white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein level are slightly elevated. Which of the following best describes the appropriate imaging modality and findings to diagnose spinal discitis/osteomyelitis?

Challenge of the Week / Spine / 05.15.20

A 54-year-old male patient presents to the emergency department with non-radiating thoracic back pain. He has an intact motor, sensory, and reflex examination of the bilateral upper and lower extremities. The patient has a history of hepatitis C, a 30-pack per year history of smoking cigarettes, and chronic cough for the last 3 months. His white blood-cell count, erythrocyte sedimentation rate, and C-reactive protein level are slightly elevated. Which of the following best describes the appropriate imaging modality and findings to diagnose spinal discitis/osteomyelitis?

Challenge of the Week / Foot & Ankle / 04.010.20

A female patient who is a ballet dancer presents for evaluation of 3 weeks of worsening posterolateral ankle pain. On examination, forced passive inversion of the foot is more bothersome than forced passive plantar flexion of the foot. Pain is elicited with resisted eversion of the foot. Which of the following anatomic structures is the most likely source of her pain?

Challenge of the Week / Trauma / 01.03.20

A 65-year-old female patient presents with persistent right groin pain 6 months after open reduction and internal fixation of a right pertrochanteric femur fracture. Imaging shows a cephalomedullary nail fixation with instability. She has no history of delayed wound healing. Evaluation for an infection is negative. Which of the following is the best option for revision for this patient?

Challenge of the Week / Spine / 12.13.19

A 5-year-old male presents for walking abnormalities. His parents observe that he is walking on his toes and his calves have become larger over the past 6 months. His serum creatine phosphokinase (CPK) level is 100 times the normal value. DNA testing confirms Duchenne muscular dystrophy (DMD). Further workup reveals hyperlordosis and scoliosis with a curve measuring 20°. Which of the following categories of medications is effective for preventing scoliosis curve progression?

Challenge of the Week / Foot & Ankle / 11.01.19

A 61-year-old female with type-2 diabetes presents with midfoot arthritis and an advanced plantar rocker bottom deformity. She has a history of recurrent plantar midfoot ulcers that are currently closed. She has no signs of infection and her HbA1c is 5.5%. Her ulcers have persisted despite orthotics and shoewear modification. Which of the following is the most appropriate treatment at this time?

Challenge of the Week / Basic Science / 10.25.19

A 12-month-old child is referred for short stature. The child has a history of frequent respiratory tract infections. Examination reveals a short neck, coarse facies, and claw hands. Radiographs indicate flaring of the ribs and medial clavicle, anterior vertebral wedging, and odontoid hypoplasia. Which of the following is most likely to limit this child’s mobility?

Challenge of the Week / Trauma / 10.18.19

A 35-year-old male patient who is right-hand dominant and works as an accountant is seen in the emergency department with closed radial and ulnar shaft fractures. He has insulin-dependent diabetes-mellitus and his current HbA1c is 5.8%. The radial fracture is comminuted and has 5 mm of displacement, but is not shortened. The ulnar shaft fracture has no comminution. The elbow and wrist joints are reduced and well-aligned. Which of the following would be the appropriate definitive management for this patient's fractures?

Challenge of the Week / Pediatrics / 07.19.19

A 3-year-old female patient presents with knee pain after falling from a swing set. The emergency department radiologist diagnosed the patient with a "toddler's fracture" and radiographs reveal a nondisplaced fracture of the proximal tibial metaphysis. The patient is treated with a long-leg cast. Which of the following clinical deformities is possible after this injury? … Continue reading Challenge of the Week / Pediatrics / 07.19.19

Challenge of the Week / Knee / 07.12.19

A 63-year-old female patient undergoes uncomplicated total knee arthroplasty (TKA). Postoperatively, she clears all physical therapy parameters for discharge but is concerned about being discharged to home because she lives alone. Which of the following will this patient have if she is discharged to a skilled nursing facility?

Challenge of the Week / Hand & Wrist / 06.28.19

A 37-year-old male patient who is a construction worker presents after suffering a thumb injury during a fall 1 week ago. He has pain and bruising on the ulnar side of the thumb metacarpophalangeal (MCP) joint. There is greater than 40° of valgus laxity, both in extension and 30° of MCP joint flexion. There is no appreciable endpoint during stress testing. Plain radiographs show no fracture. Which of the following is the most appropriate next step in management?

Challenge of the Week / Sports / 05.24.19

A 17-year-old male patient presents with leg pain that occurs whenever he attempts physical activity. The pain increases during the activity, and subsides once he stops. He reports that when running he has pain and numbness that radiates into his foot. On examination, he has no pain on palpation. Radiographs are within normal limits. Which … Continue reading Challenge of the Week / Sports / 05.24.19

Challenge of the Week / Spine / 05.17.19

A 48-year-old male patient who is a cigarette smoker undergoes a C2-C4 fusion with C3 corpectomy for treatment of metastatic lung cancer. The approach to the cervical spine is difficult with the tissue planes being more adherent than in non-smoking patients. Throughout the case, the anesthesia team has maintained a low endotracheal tube cuff pressure … Continue reading Challenge of the Week / Spine / 05.17.19