Orthopedic Emergencies Expert Management for the

Emergency Physician 1st Edition

Visit the link below to download the full version of this book:

https://medidownload.com/product/orthopedic-emergencies-expert-management-for-th
e-emergency-physician-1st-edition/

Click Download Now

Orthopedic Emergencies: Expert Management
for the Emergency Physician

Michael C. Bond
Associate Professor and Residency Program Director, Department of Emergency
Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

Andrew D. Perron
Professor and Residency Program Director, Department of Emergency Medicine,
Maine Medical Center, Portland, ME, USA

Michael K. Abraham
Clinical Assistant Professor at the Department of Emergency Medicine, University of
Maryland School of Medicine, Baltimore, MD, USA
University Printing House, Cambridge CB2 8BS, United Kingdom
Published in the United States of America by Cambridge University Press, New York

Cambridge University Press is part of the University of Cambridge.

It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning,
and research at the highest international levels of excellence.

www.cambridge.org
Information on this title: www.cambridge.org/9781107696617
© Cambridge University Press 2013
This publication is in copyright. Subject to statutory exception and to the provisions of relevant
collective licensing agreements, no reproduction of any part may take place without the written
permission of Cambridge University Press.

First published 2013

Printed in the United Kingdom by CPI Group Ltd, Croydon CR0 4YY
A catalog record for this publication is available from the British Library
ISBN 978-1-107-69661-7 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy of URLs for
external or third-party internet websites referred to in this publication, and does not guarantee that any
content on such websites is, or will remain, accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and up-to-date information
which is in accord with accepted standards and practice at the time of publication. Although case
histories are drawn from actual cases, every effort has been made to disguise the identities of the
individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that
the information contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors and publishers therefore
disclaim all liability for direct or consequential damages resulting from the use of material contained
in this book. Readers are strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.
 Contents
List of contributors
Preface

1. Hand and wrist emergencies

Carl A. Germann
2. Shoulder and elbow emergencies
Sanjeev Malik, Molly Weiner, and George Chiampas
3. Pelvic emergencies
Michael C. Bond
4. Knee and leg emergencies
Arun Sayal
5. Foot and ankle emergencies
Brian Tscholl
6. Spine emergencies
Kelley Banagan
7. Pediatric orthopedic emergencies
Nathan W. Mick and Amy E. Valasek
8. Orthopedic infections and other complications
Stephen Y. Liang, Michael C. Bond, and Michael K. Abraham
9. Procedures for orthopedic emergencies
Moira Davenport, Dennis Hanlon, and Ryan Friedberg
10. Immobilization and splinting
Michael C. Bond and Michael K. Abraham

Index
 Contributors

Michael K. Abraham MD
Clinical Assistant Professor, Department of
Emergency Medicine, University of
Maryland School of Medicine, Baltimore,
MD, USA

Kelley Banagan MD
Department of Orthopedics,
University of Maryland School of Medicine,
Baltimore, MD, USA

Michael C. Bond MD, FACEP, FAAEM

Associate Professor and Residency Program
Director, Department of Emergency
Medicine, University of Maryland School of
Medicine, Baltimore, MD, USA

George Chiampas DO
Team Physician, Northwestern University
Athletics Team Physician, Chicago
Blackhawks Medical Director, Bank of
America Chicago Marathon Assistant
Professor, Department of Emergency
Medicine Northwestern University,
Feinberg School of Medicine,
Chicago, IL, USA

Moira Davenport MD
Associate Professor of Emergency
Medicine, Temple University School of
Medicine, Allegheny General Hospital,
Pittsburgh, PA, USA

Ryan Friedberg MD
Clinical Instructor, Sports
Medicine & Shoulder Surgery

Carl A. Germann MD, FACEP

Assistant Professor, Tufts University School
of Medicine, Department of Emergency
Medicine, Maine Medical Center, Portland,
ME, USA

Dennis Hanlon MD
Associate Professor of
Emergency Medicine, Temple
University School of Medicine,
Allegheny General Hospital, Pittsburgh,
PA, USA

Stephen Y. Liang MD
Infectious Disease Fellow,
Division of Infectious Diseases, Washington
University School of Medicine, Saint
Louis, MO, USA

Sanjeev Malik MD
Assistant Medical Director and
Assistant Professor Department of
Emergency Medicine, Northwestern University Feinberg School of Medicine,
Chicago, IL, USA

Nathan W. Mick MD, FACEP

Assistant Professor, Tufts
University School of Medicine,
and Director of Pediatric Emergency
Medicine, Maine Medical Center,
Portland, ME, USA

Arun Sayal MD, CCFP(EM)

Assistant Professor, Department of Family
and Community Medicine, University of
Toronto, and Staff Physician, Emergency
Department and Fracture Clinic,
North York General Hospital,
Toronto, ON, Canada

Brian Tscholl MD
Fellowship Trained Foot and
Ankle Surgeon, Orthopedic One,
Riverside Methodist Hospital and
Dublin Methodist Hospital Columbus,
OH, USA

Amy E. Valasek MD, MS

Johns Hopkins Department
of Orthopedics Pediatric Division,
White Marsh,
MD, USA

Molly Weiner MD
Resident Physician, Department of
Emergency Medicine Northwestern
University, Feinberg School of Medicine,
Chicago, IL, USA
 Preface

Providers working in Urgent Care centers, Emergency Departments, Casualty Rooms, and Accident
and Emergency (A&E) Departments are unlikely to work a single shift without seeing a patient with
an orthopedic injury. Providers in these settings evaluate more patients with acute injuries than our
sub-specialty colleagues, so it is imperative that we have a good understanding of how to diagnose
and treat these acute injuries. Many textbooks have been written on this subject. Most are large tomes
that are extremely indepth and designed for the orthopedic surgeon or a sports medicine physician,
while others are designed for the beginner. Neither, though, is designed to be a good bedside
reference to use as you care for the patient.

This orthopedic emergencies book has been designed to be a quick reference for the seasoned
provider who is looking to refresh their memory as well as the junior medical student who needs to
understand some of the key aspects of care. The authors have worked hard to provide Pearls and Key
facts that can be used for quick review, and specific and detailed recommendations on how to treat
the various conditions. Finally, we have worked with the publisher to make the book spiral bound so
that it can be opened and laid flat to be used as a bedside resource when doing procedures and
placing splints.

Each chapter is laid out with the description of the injury or fracture, a discussion on how to make
the diagnosis, treatment recommendations, and then common complications that the patients should be
informed of. Whenever possible we have recommended a definitive treatment plan. For conditions
where treatment is more controversial we have recommended that you discuss the case with your
local consultant.

This textbook is divided into sections based on the area of injury, but also includes a chapter on
orthopedic infections, pediatric injuries, common procedures, and finally a chapter on splints that
includes step-by-step instructions with photographs. The organization of the book is designed to make
it easy to just read up on orthopedic injuries and also to be able to find the necessary information
quickly during a busy shift.

The authors and editors hope that you find this textbook to be an invaluable resource that is
frequently left in the last room you saw a patient in. We welcome suggestions and recommendations
for future editions.

Best of luck caring for your injured patients.

 Chapter 1 Hand and wrist emergencies
Carl A. Germann

Orthopedic Emergencies, ed. Michael C. Bond, Andrew D. Perron, and Michael K. Abraham. Published by Cambridge University
Press. © Cambridge University Press 2013.

Distal radius and ulnar injuries

PEARL: Fractures of the distal radius and ulna are the most common type of fractures in patients
younger than 75 years.

PEARL: Distal radius and ulnar injuries are often associated with median and ulnar
neuropathies.

Distal radius fracture

Key facts
A Colles fracture (Figures 1.1 and 1.2): A transverse fracture of the distal radial metaphysis
with dorsal displacement and angulation, often caused by a fall on an outstretched hand
A reverse Colles or Smith fracture (Figure 1.3): A transverse fracture of the metaphysis of the
distal radius, with associated volar displacement and volar angulation. The mechanism of injury
is often a fall on to the dorsum of the hand with the wrist in flexion
Barton fracture (Figure 1.4): A distal radius fracture with dislocation of the radiocarpal joint
A volar Barton fracture occurs when the wrist is volarly flexed, and affects the volar rim of
the radius.
A dorsal Barton fracture occurs with dorsal flexion and affects the dorsal rim of the radius
Hutchinson fracture (Figure 1.5): An intra-articular transverse fracture of the radial
metaphysis with extension through the radial styloid, often caused by a direct blow or a fall on
the radial side of the wrist
Also termed a Chauffer’s fracture
Clinical presentation: distal radius fracture patterns usually present with pain, swelling, and
deformity of the wrist
On physical examination, Colles fractures have a dinner-fork deformity caused by the dorsal
displacement and angulation of the radius
Smith fractures often have fullness on the volar aspect of the wrist
Median nerve injury can occur with Colles and Smith fractures and a careful neurovascular
examination both on initial presentation and following treatment is required
Figure 1.1 Colles fracture. Note the dorsal angulation of the distal radius as shown in Figure 1.2.
(Image courtesy of Carl Germann, MD.)
Figure 1.2
Figure 1.3 Smith fracture. The hand and wrist is volarly displaced with respect to the forearm.
(Image courtesy of Carl Germann, MD.)
Figure 1.4 Volar Barton fracture. A fracture of the volar margin of the carpal surface of the radius.
(Image courtesy of Carl Germann, MD.)
Figure 1.5 Hutchinson fracture: An intra-articular fracture through the radial styloid process.
(Image courtesy of Carl Germann, MD.)

Diagnostic testing
For Colles and Smith fracture patterns, radiographs of the wrist will demonstrate the fracture
through the radial metaphysis. The lateral radiograph is the best view to determine the degree of
dorsal or volar displacement and angulation
The lateral radiograph is the best view for revealing an intra-articular fracture of the radius and
any associated carpal displacement in Barton fractures. A posteroanterior (PA) radiograph often
shows a comminuted fracture of the distal radius
PA radiographs of the wrist are best to see a Hutchinson fracture

Treatment
Colles fractures should undergo closed reduction. This can be facilitated by the use of a
hematoma block and finger traps. After successful reduction, patients should be immobilized in a
long-arm splint in neutral position or pronation with orthopedic follow-up in 7 to 10 days.
Emergent orthopedic consultation is necessary if initial attempts at closed reduction are
unsuccessful, if there is neurovascular compromise, or if there is an open fracture
Smith fracture should undergo closed reduction. Following reduction, patients should be placed
in a long-arm splint in supination. Emergent orthopedic/hand-specialist consultation is