case 07

Question 1

HPI

Answer 1

Patient is a 45 yo male with a significant pmh of obesity, psychiatric condition, remote IVDU, chronic pain, low back pain with a work related left hip injury. laborer; pallets fell on him.

Patient underwent greater than 12 month of conservative care to include activity modification, therapy, spine/pain management evaluation, and short but incomplete responses to intra­articular corticosteroid injections and trochanteric bursa.

Patient was unable to return to work at his previous level of function.

HTN prediabetes morbid obesity s/p gastric bypass in 2012 psychiatric hospitalizations schizoaffective disorder previous IVDU Gastric bleed

Question 2

Answer 2

1. BMI-42, antalgic gait.
2. Localized tenderness to anterior hip, lateral hip.
3. Reproduction of hip pain with flexion and internal rotation of left hip. negative log roll.
4. 5no significant weakness with hip abduction/no trendelenburg stance/gait
5. Distally NVI/ Normal Neuro exam

Question 3

Combined FAI

Answer 3

1. Greater than 2mm joint space
2. Tonnis grade 0-1
3. Cam greater than 45
4. LCEA greater than 40
5. Combined FAI

Question 4

Hip

Answer 4

My MRI interpretation

1. Labral Tear
2. GM tendinosis without tear
3. MRI–CAM-Radiologist
4. labral frayingoRadiologist
5. no mention of GM

Question 5

Answer 5

Spine second opinion

Non-operative care option

Increased risk with Obesity (BMI)

attorney opinion

Question 6

Surgical Decision making

Answer 6

1. 1 year failure of conservative measures
2. Radiographic signs of FAI
3. MMI without surgery not accetable to him
4. Additional ITB bursectomy–optimize outcome and minimize delay in return to work
5. elevated BMI-do in hospital

Question 7

Surgical Technique

Answer 7

1. labrum
2. Acetabulum
3. Cam
4. Bursa
5. ITB

Question 8

Answer 8

Answer 9

Question 10

Answer 10

Question 11

Medical Complications-

admission

PE

Lovenox 150mg bid

Answer 11

Admitted overnight for 02 monitoring secondary to OSA and obesity. HCT-25, tachycardic, unable to do PT. POD3-HCT-22, symptomatic, US negative,

Transfusion

LE ultrasound

Discharged to rehab pod 5

Admitted to Hospital for PE pod 9–SOB, bloody stools, negative rectal,

Question 12

Return to ED with LLE hematoma

return to OR for washout

IVC filter

Vascular arteriorole embolization

Answer 12

Returned to hospital after fall at rehab

symptomatic anemia

large hematoma leg

CT/Ultrasound/Vascular Consult

Transfusion/IVC filter/ Hematoma evacuation

Continued bleed

Vascular surgeon percutaneous embolization

Question 13

Answer 13

1. Physical therapy
2. Pain management
3. Hematology
4. vascular
5. Work conditioning