Orthopedic Archives - The Emergency Medical Minute

Orthopedic

If the Patient Gets Stuck, Know Where to Turn

If the patient gets stuck, know where to turn Chief Complaint: Left hand pain and swelling HPI: 73 year-old right hand dominant female presents about 6 hours after accidentally self-injecting her left hand with about 2 mL of bovine viral vaccine (most of the vaccine got into the cow but when it moved she slipped)….

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Podcast 603: Don’t Sedate. Block.

Contributor: Don Stader, MD Educational Pearls: Fractures and dislocations that require reduction do not necessarily require sedation  Nerve blocks are an effective alternative that can provide analgesia to reduce fractures and dislocations and provide sustained pain relief after the reduction is completed Hematoma blocks are effective for distal radius and various ankle fractures Shoulder dislocations…

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Podcast 563:  DC ACs

Contributor: Nick Hatch, MD Educational Pearls: An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury XRs can help rule out other injuries as well as help with grading the injury There are six different grades for AC separations: Grade I: is stretching of the AC ligament without disruption or displacement of…

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Podcast 538:  Low Maintenance Boxer’s Fracture

Contributor: Jared Scott, MD Educational Pearls: A distal 5th metacarpal neck fracture is often referred to as a “boxer’s fracture” and a common fracture encountered in the emergency department Splinting with an ulnar gutter splint is the typical management of uncomplicated boxer’s fractures A recent study randomized patients to buddy taping or ulnar gutter splint…

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Podcast 527: Knee Dislocations

Contributor:  Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial inspection since dislocations can spontaneously reduce – Look for such findings as hemarthrosis, instability, or ecchymosis, as clues to an occult dislocation.  Knee dislocations are often…

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Podcast 506: Seymour Fracture

Contributor:  Don Stader, MD Educational Pearls: Seymour fracture is an eponym for a Salter-Harris I/II fracture of the distal phalanx of the finger or toe in children, associated with a nailbed injury These may present and subtle as a subungal hematoma with a fracture on x-ray but carry a significant risk of complications While in…

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Podcast # 498: Ortho Tips

Author: Susan Ryan, DO Educational Pearls: General orthopedic principles: Examine above and below the injury Document neurovascular status X-ray imaging typically requires three different views Fracture description should include name the bone, location of fracture, degree of displacement, and if it is closed or open Osgood-Schlatter (tibia) and Sever’s (calcaneus) disease are apophyseal injuries caused…

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Podcast # 495: Trauma in the Elderly 

Author: Rachel Brady, MD Educational Pearls: Elderly patients (>65 years old) have a higher trauma mortality compared to younger patients, even though they have lower mechanisms of injury Elder trauma is often under-triaged due to low-energy mechanisms and lack of physiologic response due to age and medications such as beta-blockers. Do not be reassured by…

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Podcast # 435 : UCL Injury

Author: Ryan Circh, MD Educational Pearls: Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb Can results from traumatic deviating the thumb radially (abduction) Poor rabbits Have a low threshold for referral to hand surgery for follow up – treatment for minor injuries can be conservative but more severe require surgery to…

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Podcast #403: Meniscus Lock

Author: Mark Hinton, MD Educational Pearls:   Meniscus lock can occur with a tear leading to inability to extend the knee Treatment can include an intra-articular joint block followed by straightening Medial meniscus injuries are more common   References: Allum RL, Jones JR. The locked knee. Injury. 1986 Jul;17(4):256-8. PubMed PMID: 3770920. Critchley IJ, Bracey…

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