Emergency Medical Minute19 Aug 2019

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 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

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