Keywords: winged scapula, trapezius, serratus anterior, long thoracic nerve (PubMed Search)
Winged scapula is caused by muscular injury or damage to corresponding muscular innervation. Mechanism can be due to blunt or penetating thoracic trauma.
Clinical findings include
Keywords: Scaphoid Fracture, CT (PubMed Search)
Snuff Box Tenderness:
It has become the standard of care that individuals with snuff box tenderness, or pain with axial loading of the thumb, be placed in a thumb spica splint for 1-2 weeks until follow up x-rays can be done. This is done to rule out an occult scaphoid fracture. However, this practice can be hugely inconvenient to the patient and result in some atrophy of their forearm.
An alternative approach is to obtain a CT scan through the wrist to look specifically at the scaphoid bone. If the CT scan is negative you can send them home with some pain control, RICE (Rest, Ice, Compression, Elevation) treatment and let them use thier thumb. No splint is needed. If it is positive then you can splint them and have them follow up with orthopedics or hand surgery.
Keywords: AC Joint, Separation, Dislocation (PubMed Search)
AC Joint Dislocations
The acromioclavicular (AC) Joint is commonly injured when a person falls onto their shoulder.
The AC Joint consists of three ligaments:
Injuries to this joint are classified as Type I – Type VI and involve sprain or tears of the AC or CC ligaments
Keywords: Monteggia's Fracture (PubMed Search)
Wheeless' Textbook of Orthopaedics http://www.wheelessonline.com/ortho/monteggias_fracture
Keywords: jones fracture,foot fracture,malunion (PubMed Search)
Presented with persistant foot pain from
Jones fracture malunion.
Keywords: Blast, hand, injuries (PubMed Search)
In honor of the 4th of July holiday, here is a quick pearl about blast injuries.
Philipson MR, Southern SJ. The blast component of firework injuries--not to be underestimated. Injury. 2004:35; 1042-1043.
Keywords: Metacarpal, Fracture, Growth, Plate (PubMed Search)
Metacarpal Fractures and Growth Plates:
The growth plates on metacarpals are on the distal end of the bone, except for the 1st metacarpal which is on the proximal end near the carpal bones.
Don't mistake this for a fracture line, however, make sure you get comparison views if they are tender over the area, as this can help you diagnosis a Salter Harris Type 1 fracture.
Keywords: High Pressure, Injection, Injury (PubMed Search)
High Pressure Injection Injuries:
Hogan CJ, Ruland RT: High-pressure injection injuries to the upper extremity: a review of the literature. J Orthop Trauma 20:503, 2006
Keywords: shoulder, dislocation, treatment (PubMed Search)
Shoulder Dislocations -- Treatment
McNeil NJ. Postreduction management of first-time traumatic anterior shoulder dislocations. Ann Emerg Med. Jun 2009;53(6):811-813.
Keywords: Nursemaid, Radial head, dislocation (PubMed Search)
It is typically taught that the way to reduce a nursemaid's elbow is to hold the elbow at 90 degrees, then firmly supinate and flex the elbow. Place your thumb over the radial head and apply pressure as you supinate.(Taken from Sean Fox's Pearl on 7/20/2007)
However, there is a growing body of evidence that is showing that hyperpronating the forearm actually has a higher success rate on first attempt, is easier to perform, and is associated with less pain then supinating the forearm. The overall reducation rates where similar for both methods.
The hyperpronation method consists of hyperpronating the forearm and then flexing the elbow. Since the child tends to already hold their arm in partial pronation, the hyperpronation technique tends to need less force and has been associated with less pain.
Bek D, Yildiz C, Kose O, Sehirlioglu A, Basbozkurt M. Pronation versus supination maneuvers for the reduction of 'pulled elbow': a randomized clinical trial. Eur J Emerg Med. Jun 2009;16(3):135-138.
Green DA, Linares MY, Garcia Pena BM, Greenberg B, Baker RL. Randomized comparison of pain perception during radial head subluxation reduction using supination-flexion or forced pronation. Pediatr Emerg Care 2006; 22:235–238.
Macias CG, Bothner J, Wiebe R. A comparison of supination/flexion to hyperpronation in the reduction of radial head subluxations. Pediatrics 1998; 102:e10.
Keywords: Elbow Dislocation (PubMed Search)
Quick clinical clues that the elbow is dislocated:
Keywords: Trimallelor Fracture (PubMed Search)
Bimallelor fracture involve both the medial mallelous of the tibia and the distal fibula. The third malleloi is the posterior tip of the articular surface of the tibia. Can result in instability in the posterior and lateral directions along with external rotation.
Some indications for Open Reduction Internal Fixation when the posterior mallelous is fractured are:
Are relatively rare injuries, but can result in loss of the limb if missed. Patients will sometimes say they dislocated their knee when they actually mean their patella, so a good history where they describe what their knee looked like, and what they were doing at the time will help differentiated the two.
Some signs that you are dealing with a spontanously reduced knee dislocation are:
The loss of limb is due to unrecognized injury to the popiteal artery which as be estimated to occur 7-45% of the time.
If you would like to see some videos of knee injuries in the making follow this link www.csmfoundation.org/Educational_Lower_Extremity.html
Keywords: radius, fracture, colles, smith, barton, chauffer (PubMed Search)
Distal Radius Fractures
Keywords: Phalanx, fracture, treatment (PubMed Search)
Keywords: Radial, Head, Fracture (PubMed Search)
Radial Head Fractures:
Radial head fractures are more common in adults, where radial neck fractures are more common in children. Remember to look for fat pads to help make the diagnosis if it is not obvious on plain films. On plain films, a line drawn down the middle of the radial head should always line up with the capitellum of the humerus. If this does not occur the radial head is dislocated and/or fracture.
Orthopaedics use the Mason classification to help guide treatment, and break down fractures into 3 different types.
Keywords: Hamate, Fracture, (PubMed Search)
Walsh JJ 4th. Bishop AT. Diagnosis and management of hamate hook fractures. Hand Clinics. 16(3):397-403, viii, 2000 Aug.
Keywords: Lunate, Dislocation, Perilunate (PubMed Search)
Lunate Dislocation and perilunate dislocation are broken down into 4 stages that relates to the progressive disruption of the carpal ligaments due to hyperextension and ulnar deviation of the wrist:
For a good indepth review of lunate and perilunate injuries please read the article by Andy Perron with this attached link.... doi:10.1053/ajem.2001.21306
If you are interested in seeing some xray examples please visit LearningRadiology.com
Perron AD, Brady WJ, Keats TE, Hersh RE. Orthopedic Pitfalls in the ED: Lunate and Perilunate Injuries Am J Emerg Med 2001;19:157-162
Keywords: Child Abuse, Fracture (PubMed Search)
A lot of what is taught about fracture patterns in abused children has been extrapolated from post-mortem studies which is a different population then what you will see in the Emergency Department. The study referenced did a metanalysis of all the literature in an attempt to determine what fractures suggest abuse and looked at all comers that had fractures. Some of the patterns they were able to extrapolate are:
Patterns of Skeletal Fractures in Child Abuse: Systemic Review. BMJ, Alison M Kemp et al. 2008;337:a1518
Keywords: Galeazzi, Fracture (PubMed Search)
The Galeazzi Fracture:
To see a photo of a Galeazzi fracture please visit the Learning Radiology Website by clicking on the following link: