Contributor: Nick Tsipis MD Educational Pearls: The scaphoid bone is the most proximal carpal bone just distal to the radius Fractures of the scaphoid bone are sometimes missed by plain X-rays A 2020 review found a 21.8% incidence of missed scaphoid fractures later diagnosed by advanced imaging modalities Only MRI has a sensitivity above 90%…
Read MoreContributor: Jared Scott, MD Educational Pearls: If a patient is in significant pain, a digital block can be helpful. Pain management alone may allow for manual ring removal. Ring cutters and trauma shears with specialized ring cutters can be attempted but will destroy the ring and some materials may be resistant to cutting. 2 alternative…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Olecranon bursitis refers to inflammation in the bursa of the elbow and can be due to infection or trauma Recent study examined treating suspected septic olecranon bursitis with antibiotics versus drainage About 90% of the patients treated with antibiotic therapy for this issue did not require subsequent drainage or…
Read MoreContributor: Donald Stader, MD Educational Pearls: Hip Dislocation Prolonged dislocations can impair blood supply to femoral head Hip dislocation for >6 hours puts patient at high risk for needing a hip replacement in the next two year Knee Dislocation High mechanism Often looks anatomically normal on knee x-ray Vascular injuries of the popliteal artery can…
Read MoreContributor: Nick Tsipis, MD Educational Pearls: Humerus fractures can be characterized as proximal, midshaft, and distal fractures Proximal humerus fracture is the second-most common fracture in elderly patients Primary complication is with the axillary nerve and axillary artery Vast majority are managed nonoperatively with a sling, reduction usually not indicated Women comprise 70% of proximal…
Read MoreContributor: Jared Scott, MD Educational Pearls: While it is rare to have a native hip dislocation, it is relatively common to dislocate a prosthetic hip The mechanism for dislocation is usually adduction, flexion, and internal rotation the hip which can occur when walking Arthroplasty in the setting of trauma or fracture, posterior approach during surgery,…
Read MoreContributor: Jared Scott, MD Educational Pearls: Pathologic bone fractures occur due to weakened bones from chronic disease and with less force when compared to non-pathologic fractures Can be due to bone tumors, bone cysts, infections (osteomyelitis), osteogenesis imperfecta, Paget’s disease of bone, and multiple myeloma Have moth bitten or lytic appearance and you can sometimes…
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Erect sHoulder Chief Complaint: Shoulder Pain HPI: 63 year old female presents after falling while walking down the stairs outside. She notes it was icy on the steps and was using the railing for support with her left hand. She states when she slipped that she tried to catch herself and all of her weight…
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If the patient gets stuck, know where to turn Chief Complaint: Left hand pain and swelling HPI: 73 year-old right hand dominant female presents about 6 hours after accidentally self-injecting her left hand with about 2 mL of bovine viral vaccine (most of the vaccine got into the cow but when it moved she slipped)….
Read MoreContributor: Don Stader, MD Educational Pearls: Fractures and dislocations that require reduction do not necessarily require sedation Nerve blocks are an effective alternative that can provide analgesia to reduce fractures and dislocations and provide sustained pain relief after the reduction is completed Hematoma blocks are effective for distal radius and various ankle fractures Shoulder dislocations…
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