Clinicopathological seminar

Clinical case 5/12 – female 54 y Pain in left groin duration 2 years activity related on initiation morning stiffness lately no rest or at night pain last 2 months get worse – analgesics No treatment in childhood

Clinical case 5/12 – female 54 y On examination palpation tenderness in groin area palpation tenderness over the greater trochanter restricted ROM flexion 0-100 ° internal rotation 0 external rotation 0-10 ° abduction 0-20 ° adduction 0-20 °

Clinical case 5/12 – female 54 y laboratory examination ESR 12/20, Hb 136 g/l, Ery 3 400 000/μl, Hct 0,38, Leu 8600/μl Na 141 mmol/l, K 4,4 mmol/l, Cl 120 mmol/l, bili 9,9 mmol/l, AST 0,20 μkat/l, ALT 0,22 μkat/l, urea 5,4 mmol/l, creatinin 85 μmol/l, CRP 7,4 mg/l urine analysis negative

Clinical case 5/12 – female 54 y laboratory examination ESR 12/20, Hb 136 g/l, Ery 3 400 000/μl, Hct 0,38, Leu 8600/μl Na 141 mmol/l, K 4,4 mmol/l, Cl 120 mmol/l, bili 9,9 mmol/l, AST 0,20 μkat/l, ALT 0,22 μkat/l, urea 5,4 mmol/l, creatinin 85 μmol/l, CRP 7,4 mg/l urine analysis negative

Clinical case 5/12 – female 54 y X-ray pelvis and hip joints flattening of the femoral head Rt acetabular subchondral sclerosis bilat. narrowing of joint space bilaterally marginal osteophytes acetabulum bilaterally cysts in head and acetabulum Rt findings worse in Rt

Clinical case 5/12 – female 54 y What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming?

Clinical case 5/12 – female 54 y What is this disease? coxarthrosis grade III. What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming?

Clinical case 5/12 – female 54 y What is this disease? What will be the conservative therapy? regime measures pharmacotherapy physiotherapy What pharmacotherapy is appropriate? What surgical treatment is possibly coming?

Clinical case 5/12 – female 54 y What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? anti-inflammatory drugs analgesics chondroprotectives What surgical treatment is possibly coming?

Clinical case 5/12 – female 54 y What is this disease? What will be the conservative therapy? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? osteotomies hip replacement

Clinical case 5/12 – female 54 y degenerative disorders of joints pathophysiology morphological changes

Clinical case 8/12 – male 45 y three days subfebrile swelling, redness and pain in the lower leg today can no longer stand on Rt leg 10 years ago treated for infected fracture of Rt leg

Clinical case 8/12 – male 45 y body temperature on lower extremity Rt 38,9 °C (102°F) on lower extremity Rt swelling and redness palpable tenderness no failure of blood supply and innervation of peripheral limb

Clinical case 8/12 – male 45 y laboratory examination ESR 68/90, Hb 146, Ery 3 600 000/μl, Hct 0,42, Leu 12600/μl Na 143 mmol/l, K 4,2 mmol/l, Cl 117 mmol/l, bilirubin 12,9 mmol/l, AST 0,30 μkat/l, ALT 0,42 μkat/l, urea 6,4 mmol/l, creatinin 75 μmol/l, CRP 268 mg/l urine analysis negative

Clinical case 8/12 – male 45 y laboratory examination ESR 68/90, Hb 146, Ery 3 600 000/μl, Hct 0,42, Leu 12600/μl Na 143 mmol/l, K 4,2 mmol/l, Cl 117 mmol/l, bilirubin 12,9 mmol/l, AST 0,30 μkat/l, ALT 0,42 μkat/l, urea 6,4 mmol/l, creatinin 75 μmol/l, CRP 268 mg/l urine analysis negative

Clinical case 8/12 – male 45 y X-ray of Rt leg deformed bone bony sequestra cannot be excluded appropriate use of CT

Clinical case 8/12 – male 45 y angiography aa. tibialis anterior et posterior visible to the periphery

Clinical case 5/12 – male 45 y What is this disease? What pharmacotherapy is appropriate? What surgical treatment is possibly coming?

Clinical case 5/12 – male 45 y What is this disease? osteomyelitis What pharmacotherapy is appropriate? What surgical treatment is possibly coming?

Clinical case 5/12 – male 45 y What is this disease? What pharmacotherapy is appropriate? analgesics, antipyretics antibiotics (what?) What surgical treatment is possibly coming?

Clinical case 5/12 – male 45 y What is this disease? What pharmacotherapy is appropriate? What surgical treatment is possibly coming? surgical revision of bone cavity removal of necrotic and infected tissue defect coverage with well-perfused tissues

Clinical case 8/12 – male 45 y osteomyelitis acute and chronic non specific and granulomatous infections

Clinical case (11/12) – female 46 y thigh pain duration 3 months get worse in morning on initiation, permanently now initially alleviated by aspirine

Clinical case (11/12) – female 46 y lower extremity Lt no palpation thigh pain no swelling and palpable mass ROM hip and knee without restriction during hip abduction feel tension in the abductors muscles no failure of blood supply and innervation of peripheral limb

Clinical case (11/12) – female 46 y X-ray of proximal femur thickening of medial cortex appropriate use of CT

Clinical case (11/12) – female 46 y CT of proximal femur well-formed bone tissue nidus not seen, but probably it is the osteoid osteoma

Clinical case (11/12) – female 46 y What is this disease? What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient?

Clinical case (11/12) – female 46 y What is this disease? osteoid osteoma benign tumour What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient?

Clinical case (11/12) – female 46 y What is this disease? What next treatment is possibly coming (conservative, surgical)? always surgical growing of tumour, progression of the symptoms What is the prognosis of patient?

Clinical case (11/12) – female 46 y What is this disease? What next treatment is possibly coming (conservative, surgical)? What is the prognosis of patient? prognosis is very good after surgical removal of the nidus

Clinical case (11/12) – female 46 y bone tumours primary metastases

Clinical case 6/12 – female 80 y fall she had a dizziness circumstances does´nt remember then can no longer stand on Rt leg pain in Rt groin area

Clinical case 6/12 – female 80 y head haematoma on her forehead lower extremity Rt shortening 2 cm pain in Rt groin area signif. painfull restriction of ROM no failure of blood supply and innervation of peripheral limb

Clinical case 6/12 – female 80 y X-ray pelvis and hip joints interruption of the femoral neck Rt distal fragment displaced proximally

Clinical case 6/12 – female 80 y What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what?

Clinical case 6/12 – female 80 y What is this disease? fracture of the femoral neck Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what?

Clinical case 6/12 – female 80 y What is this disease? Is necessary rule out coincidence disease or stroke? What? stroke subdural haematoma Next management (exam, Tx)? The patient is at risk for life? If so, what?

Clinical case 6/12 – female 80 y What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? standard preOP exam + neurological exam surgery (hemiarthroplasty) The patient is at risk for life? If so, what?

Clinical case 6/12 – female 80 y What is this disease? Is necessary rule out coincidence disease or stroke? What? Next management (exam, Tx)? The patient is at risk for life? If so, what? risk of bleeding complications (CNS) risk of immobilization

Clinical case 6/12 – female 80 y osteoporosis pathophysiology morphological changes