Discuss the dilemmas associated with the various accepted classifications of Perthes disease with regard to treatment, prognosis and outcomes.

A 7 year old child with Perthes Disease affecting the right hip is sent to you for a second opinion by one of your colleagues. Current x-rays show changes consistent with Lateral Pillar A classification (Herring). You consider from serial x-rays that the disease is well into the consolidation stage of healing. The hip is asymptomatic and the femoral head is well contained. Your colleague has recommended a varus rotation osteotomy. You do not feel this is appropriate management.

  1. Discuss the dilemmas associated with the various accepted classifications of Perthes disease with regard to treatment, prognosis and outcomes. (20 marks)
  2. Write a letter back to your colleague explaining in detail your reasons for disagreeing with the proposed surgical management. (20 marks)
  3. List the complications of varus osteotomy of the femur in Perthes disease. (10 marks)

Question 2 (30 minutes) 50 marks
A 40 year old woman presents to you 6 months after a fracture of her radial head that was treated non¬operatively. She is unhappy with the restriction of movement and the pain associated with trying to straighten her elbow.

  1. Describe your assessment of this patient’s elbow. (20marks)
  2. Analyse the possible reasons for her elbow stiffness. (10marks)
  3. Discuss the place of surgery in her management if the X-Rays confirm a malunion of a Mason type 2 fracture of the head of the radius. (20marks)

Question 3 (30mins) –50 ‘marks
A 35 year old man is transferred to your care in his home city.
Three weeks earlier he suffered a cervical spine fracture dislocation, without neurological injury, whilst traveling elsewhere in the country. After two operations at that centre, his cervical spine was ‘eventually stabilized with both anterior and posterior instrumented fusions.
He expresses anger about the quality of his previous management and arrives without his imaging studies. Within days of arrival he develops a persistent fever and increasing neck pain.

  1. Describe your assessment of this patient? (20 marks)
  2. List your goals when taking over his management? (5 marks)
  3. What is your strategy in dealing with his anger? (5 marks)
  4. Propose a detailed plan of treatment. (20 marks)

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