Contributor: Nick Hatch, MD Educational Pearls: An AC (acromioclavicular joint) separation in the shoulder is a common traumatic injury XRs can help rule out other injuries as well as help with grading the injury There are six different grades for AC separations: Grade I: is stretching of the AC ligament without disruption or displacement of…
Read MoreContributor: Jared Scott, MD Educational Pearls: A distal 5th metacarpal neck fracture is often referred to as a “boxer’s fracture” and a common fracture encountered in the emergency department Splinting with an ulnar gutter splint is the typical management of uncomplicated boxer’s fractures A recent study randomized patients to buddy taping or ulnar gutter splint…
Read MoreContributor: Erik Verzemnieks, MD Educational Pearls: Knee dislocations are most common in high energy trauma, such as a motor vehicle accident The knee may appear grossly normal on initial inspection since dislocations can spontaneously reduce – Look for such findings as hemarthrosis, instability, or ecchymosis, as clues to an occult dislocation. Knee dislocations are often…
Read MoreContributor: Don Stader, MD Educational Pearls: Seymour fracture is an eponym for a Salter-Harris I/II fracture of the distal phalanx of the finger or toe in children, associated with a nailbed injury These may present and subtle as a subungal hematoma with a fracture on x-ray but carry a significant risk of complications While in…
Read MoreAuthor: 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…
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Author: Rachel Brady, MD Educational Pearls: Elderly patients (>65 years old) have a higher trauma mortality compared to younger patients, even though they have lower mechanisms of injury Elder trauma is often under-triaged due to low-energy mechanisms and lack of physiologic response due to age and medications such as beta-blockers. Do not be reassured by…
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Author: Ryan Circh, MD Educational Pearls: Ulnar collateral ligament injury is often called gamekeeper’s thumb or skier’s thumb Can results from traumatic deviating the thumb radially (abduction) Poor rabbits Have a low threshold for referral to hand surgery for follow up – treatment for minor injuries can be conservative but more severe require surgery to…
Read MoreAuthor: Mark Hinton, MD Educational Pearls: Meniscus lock can occur with a tear leading to inability to extend the knee Treatment can include an intra-articular joint block followed by straightening Medial meniscus injuries are more common References: Allum RL, Jones JR. The locked knee. Injury. 1986 Jul;17(4):256-8. PubMed PMID: 3770920. Critchley IJ, Bracey…
Read MoreAuthor: Ryan Circh, MD Educational Pearls: A “shoulder separation” is when the clavicle separates from the scapula – also referred to as an acromio-clavicular (AC) separation Diagnosis is clinical: pain over AC joint, pain with adduction, and difficulty raising harm past horizontal Early range of motion can be critical for recovery References: Lemos MJ. The…
Read MoreAuthor: Sue Chilton, MD Educational Pearls: An unusual cause of leg pain that can mimic sciatica/claudication Predominantly occurring in high endurance athletes, particularly cyclists and runners More common in men Check supine ABIs 1 minute after activity in the ED: a value < 0.5 is 80% sensitive References: Mansour A, Murney S, Jordan K,…
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