By far the greatest contributor to patient’s ongoing morbidity are his multiple and seemingly ceaseless musculoskeletal injuries. The most significant of these was sustained several years ago, when he was rushed to GCGH with several fractures of his lumbar vertebrae, reportedly after falling while rappelling. Skeletal series obtained at that time revealed numerous (>20) areas of orthopedic injury in various states of healing, which could not be fully explained by recent fall, including areas of all extremities and many ribs; confirmatory bone scan similarly showed many areas of increased uptake. Patient’s robust stature is not consistent with osteogenesis imperfecta, and skin biopsy was negative for abnormal collagen and P3H1 or CRTAP genetic defects. Malignancy was suspected, but eventually ruled out following oncology consultation. Patient explained most of these (and most subsequent) injuries as being the result of membership in a private and apparently quite intense mixed martial arts club. Patient has denied being the victim of domestic abuse by Mr. Grayson following indirect and direct questioning on numerous occasions.
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