Presidential Address: Where Do We Go From Here?ĮMF/SAEMF Medical Student Research Training Grant Virtual Rotation and Educational ResourcesĬommittee Update: NBME EM Advanced Clinical Examination Task Force The athlete gradually proceeded to muscle-strengthening exercises and reached full active ROM.Visit us on Twitter LinkedIn Facebook YouTubeĮffective Consultation in Emergency Medicine Video A month later and after additional X-Rays, the circular cast and the k-wire were removed. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Post operation X-Rays showed success. The final treatment decision included closed reduction with one k-wire and circular cast. Ankle joint arthroscopy in case of non-satisfactory alignment of the fracture. Open reduction and internal fixation with cannulated screws and 3. Close reduction and osteosynthesis with k-wires 2. OUTCOME OF THE CASE: Due to delayed treatment, doctors had the following surgical options: 1. Urgent orthopedic evaluation and surgical restoration are crucial, especially in children and adolescents. Therefore, these injuries can result in growth retardation, altered joint mechanics, and functional impairment. Chronic disability is a potential outcome as these fractures can cause premature focal fusion. DISCUSSION: Type IV Salter Harris fracture involves all three elements of the bone and is an intra-articular fracture. FINAL DIAGNOSIS: Fracture across the metaphysis, physis and epiphysis: Salter Harris Type IV. Orthopedic Classification: Salter Harris Type IV. B) CT SCAN: The fracture line goes through the metaphysis, growth plate and down through the epiphysis. Orthopedic Classification: Salter Harris Type III. Orthopedic Classification: Salter Harris Type II and b) Lateral view: Fracture passes along the growth plate and down through the epiphysis. TESTS & RESULTS: A) Radiological evaluation: a) Posterior and anterior view: Fracture passes through most of the growth plate and up through the metaphysis. DIFFERENTIAL DIAGNOSES: Salter Harris II, Salter Harris III, Salter Harris IV, Salter Harris V, or additional fractures. Therefore, he ordered a MRI and spiral CT for the left ankle. That doctor suspected that the fracture may continue into the posterior malleolus with the fracture line going through the growth plate inside the joint of the ankle. Two days after that, the athlete decided to visit a different private doctor since the pain was not subsiding. He decided to visit a private orthopedic doctor who made the plaster rounded and placed the foot in tip-toe gait. Two days later, the patient was still in pain. Before getting discharged, a second X-Ray showed a well-aligned fracture. A short, leg cast was placed and per os analgesics were given. The diagnosis based on the first X-Ray was Type II, Salter Harris fracture. PHYSICAL EXAM: The athlete was admitted to Children’s Hospital. He complained about pain and swelling in the lateral aspect of the left ankle. He ended up landing abnormally on his left foot. CASE HISTORY: An amateur, 14-year-old soccer player celebrated his goal by attempting a backflip.
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