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AP radiograph of the shoulder. ᭤ ᭤ ᭤ ᭤ What is the most likely diagnosis? What abnormalities are seen in the radiograph? What other abnormal findings are likely to be noted in this patient? What is the best treatment for this patient? 24 CASE FILES: ORTHOPAEDIC SURGERY ANSWERS TO CASE 1: Anterior Shoulder Dislocation Summary: A 20-year-old athlete sustained trauma to the right shoulder resulting in obvious deformity and pain, with an AP radiograph of the right shoulder demonstrating a dislocation and osseous defect of the posterolateral aspect of the humeral head.

This question is difficult because the next step has many possibilities; the answer may be to obtain more diagnostic information, to stage the illness, or to introduce therapy. ” because there may be insufficient information to make a diagnosis, and thus the next step may be to pursue additional diagnostic testing. Another possibility is that there is enough information for a probable diagnosis, and thus the next step is to stage the disease or to administer treatment. Hence from clinical data, a judgment must be rendered regarding where one falls on the “make a diagnosis → stage the disease → treat based on stage → follow the response” continuum.

In younger individuals with the same injury, open reduction and internal fixation may be attempted, as younger patients will typically have better bone stock and blood supply than their older counterparts. Additionally, younger individuals have higher physical demands than are typically tolerated by current shoulder prostheses. HOW IS THE DIAGNOSIS CONFIRMED? Although confirming the diagnosis of a traumatic fracture may be as simple as acquiring an x-ray of the affected bone, many injuries and diseases relevant to orthopaedics SECTION I: HOW TO APPROACH CLINICAL PROBLEMS 17 have complicated workups and diagnoses that physicians-in-training must be familiar with.