1. Clinicopathological seminar

2. 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

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

4. 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

5. 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

6. 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

7. 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?

8. 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?

9. 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?

10. 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?

11. 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

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

13. 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

14. 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

15. 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

16. 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

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

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

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

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

21. 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?

22. 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

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

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

25. 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

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

27. 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

28. 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?

29. 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?

30. 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?

31. 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

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

33. 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

34. 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

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

36. 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?

37. 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?

38. 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?

39. 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?

40. 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

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