The home for surgical residency

A 28-year-old man has a Gustilo IIIB open tibial fracture of the right leg after a motorcycle accident, with an 8 x 12 cm soft tissue defect exposing bone and hardware. You are consulted for soft tissue coverage at 48 hours post-injury.

A 13-year-old girl is referred by her pediatrician for evaluation of scoliosis detected on a school screening exam. She is pre-menarchal and has noticed that her clothes fit unevenly. She denies back pain, neurological symptoms, or bowel/bladder changes. Her mother had scoliosis treated with bracing as a teenager. On examination, she has a prominent right thoracic rib hump on forward bend testing (Adams test), shoulder asymmetry with the right shoulder higher, and a level pelvis. There are no skin stigmata (café-au-lait spots, hairy patches). Neurological examination is normal. Standing posteroanterior scoliosis radiographs show a right thoracic curve measuring 42 degrees (Cobb angle) with apex at T8. Risser sign is grade 1. How would you counsel this family and what is your treatment plan?

An 82-year-old woman presents to the emergency department after a ground-level fall at home. She is unable to bear weight on her right leg. Her right lower extremity is shortened and externally rotated. Radiographs show a displaced subcapital femoral neck fracture (Garden type IV). She lives independently, walks without an assistive device, and has no cognitive impairment. Her medical history includes hypertension, hyperlipidemia, and well-controlled type 2 diabetes. She takes aspirin, lisinopril, and metformin. Labs show a hemoglobin of 11.2 and creatinine of 0.9. How would you manage this patient?