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 by ligaments that are “stronger” than the bones they attach to
• When looking for scaphoid injuries, get extra (turned) views of the wrist. Remember that the scaphoid has a reverse blood flow and is prone to avascular necrosis
• Acute carpal tunnel syndrome can occur in forearm fractures. Again, don’t forget your neuro exam.
• Distal radial-ulnar joint (DRUJ) injuries are caused by tears in the ligaments that stabilize the wrist. They cause chronic pain with pronation and supination.
• Posterior effusions in the elbow in the 90 degree view nearly always indicate a fracture
• Lisfranc injuries are commonly missed, especially if the mechanism is perceived as low energy. Look for the “fleck sign”, which is an avulsion fracture at the base of 2nd metatarsal
• Syndesmotic injuries of the ankle (a high ankle sprain) can be identified through the squeeze test
• Knee dislocations are neurovascular emergencies