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Emergency Medical Minute


Aug 19, 2019

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