JOCD Cases

Open Distal Both-Bone Forearm Fracture-dislocation with Wrist-Spanning External Fixation Following Hoverboard Fall

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This case illustrates several important orthopedic principles:

  1. Early Surgical Debridement

Prompt irrigation and debridement remain foundational in open fracture management and significantly reduce infection risk.

  1. Damage Control Stabilization

External fixation provided rapid stabilization while preserving access to soft tissues and minimizing further operative trauma during the acute inflammatory phase.

  1. Importance of Neurovascular Monitoring

Despite severe skeletal injury and exposed bone, the patient maintained intact neurovascular status throughout treatment, contributing significantly to his favorable outcome.

  1. Rehabilitation and Functional Recovery

Prolonged immobilization across the wrist often results in postoperative stiffness. Early physiotherapy and patient compliance were central to recovery.

  1. Post-Traumatic Neuropathy Consideration

Transient paresthesia and concern for carpal tunnel syndrome are recognized sequelae following distal forearm trauma and external fixation. Conservative management was appropriate in this patient due to limited symptoms and preserved function.

 

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A Challenging Lower Limb Pain Presentation – When Symptoms Don’t Match the X-ray

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  • There should be a high index of suspicion
  • It is important to consider other causes of symptoms
  • Think outside the box if the picture doesn’t add up (severity of pain versus x-ray findings in the knee)
  • Common things occur commonly (Hip Osteoarthritis)!
  • Always do a pelvic x-ray in patients with Knee pain
  • Avoid assumptions and pre-conceptions about diagnosis
  • Always listen to the patient and consider what they know or have been told before (GP informed the patient that she needs a TKR)
  • If in doubt, consider second opinion from a colleague or MDT.

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Unusual Case of Persistent Hip and Leg Pain

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  • Maintain vigilance when hip pain presents with a normal X-ray — the pathology may be extra-articular or systemic in origin.

  • Keep a broad differential diagnosis and a low threshold for investigating atypical causes of hip and leg pain.

  • Listen carefully to the patient’s history — subtle details often provide diagnostic clues.

  • Do not underestimate disproportionate or persistent pain, as it may signal serious underlying pathology.

  • Perform a comprehensive clinical examination, including assessment of the spine and adjacent joints.

  • Always examine the joint above and below the site of reported pain to avoid diagnostic oversight.

  • Consider advanced imaging (e.g. MRI of the pelvis and lumbar spine) when initial investigations are inconclusive.

  • Adopt a multidisciplinary approach — refer appropriately (e.g. to gynaecology or other specialties) when non-orthopaedic causes are suspected.

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