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PRESENTATION
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OUTCOMES
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VIDEOS
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EVIDENCE
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Comments
15
CASE DESCRIPTION
AGE 8 / Female
CC Left ankle pain
HPI An 8-year-old female presents with a 1-week history of inability to bear weight on the left side. Endorses tripping and falling 2 weeks prior to the onset of pain. Previously she had been diagnosed with osteomyelitis of her right ankle (culture negative), which presented very similarly to her current symptoms.
PMH Unremarkable medical history and she is up to date with immunizations.
PE Mild tenderness over the medial distal tibia with no overlying erythema. Full active range of motion of her ankle with minimal discomfort. Stable ligamentous examination. Labs: CRP is 8 μg/ml (normal < 3), and normal White Blood Cell count.
Pre-procedure IMAGES:
https://devupload.orthobullets.com/cases/101816/9dbf4a33-a9c0-463e-97ca-751f8acb7990_ap_ankle.jpg https://devupload.orthobullets.com/cases/101816/d6009d16-6e32-492d-805a-76618b032c72_lateral_ankle.jpg https://devupload.orthobullets.com/cases/101816/3be30c6c-bf62-447d-adde-ee52103763a8_xr_r_ankle_ap.jpg https://devupload.orthobullets.com/cases/101816/159d9478-5758-496c-afce-8769bcc501e7_xr_right_lateral.jpg https://devupload.orthobullets.com/cases/101816/a88591e2-22c6-435b-b7a8-982e1845f813_mri_coronal.jpg https://devupload.orthobullets.com/cases/101816/3324d962-f58c-46fa-9720-163be0e5fc76_bone_scan.jpg
POLLS
OB Community
1) In addition to the plain film radiographs, would you obtain any further imaging to guide your treatment?
Other
2) What is your leading diagnosis based on the clinical presentation and available imaging?
Other
3) Considering the patient had a similar presentation 1 year ago on the contralateral ankle, would you obtain a tissue biopsy as part of your diagnostic workup?
Other
4) If you performed an open biopsy, where would you send the sample for further evaluation?
Other
5) An open biopsy is performed and shows no clear evidence of malignancy or infection (see report below). Cultures come back negative several days later. What would be your next step in management?
Other
6) If you choose Operative management, what procedure(s) would you recommend?
Other
7) If you choose Nonoperative management, what medications, if any, would you prescribe?
Other
8) If you performed an open biopsy and choose Nonoperative management, how would you manage weight-bearing?
Other
CASE OUTCOMES
PROCEDURE 1: Open biopsy left distal tibia
DOP: 10/2/2021
Post-procedure P1
2 days Post-procedure P1
https://devupload.orthobullets.com/cases/101816/77c256fc-01a3-444b-b098-e12d65b83b3a_screen_shot_2021-10-18_at_10.35.29_pm.jpg https://devupload.orthobullets.com/cases/101816/7be1f5d9-8aa8-48bb-8bc2-597e3100b673_screen_shot_2021-10-18_at_10.35.01_pm.jpg
VIDEOS & PODCASTS (2)
EVIDENCE (7)
EXPERT COMMENTS