orthopaedics for the emergency department
TRANSCRIPT
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ORTHOPAEDICS FOR THE EMERGENCY DEPARTMENT
Mr Anjan K Banerjee
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A Cook’s Tour
Fractures
Infection
Back Pain & Sciatica
Complications
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FracturesHand/WristForearmElbowHumerusShoulderFootAnkle/TibiaKneeFemurHipSpine
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Wrist & Hand
CollesSmith’sBarton’sPerilunate dislocationMetacarpalsFingers
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Fingers
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Metacarpal
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Metacarpal
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Scaphoid
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Scaphoid
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Perilunate
lunateCapitate
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Colles
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Barton’s
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Styloid
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Forearm
Radial head
Radial styloid
Isolated ulna #“Nightstick #”From a direct blow to the mid forearm.(Night stick is an old name for a police truncheon)
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Galeazzi #
Needs ORIF
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Monteggia #
Capitellum
Radius should line up with the capitellum.
“Monteggia More Medial” (than Galezzi) (if patient’s arms where sticking out)
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Gartland I & II
Supracondylar fractures
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Gartland II & III
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Ankle – Images I should not see
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Ankle – Images I should not see
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Cervical Spine
Canadian Rules.
Always Consider the mechanism.
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Cervical Spine
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Remember Collar & Blocks
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Lumbar SpineDirect Axial Compression
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Thoracic Spine
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Salter-Harris
S Slipped SH1
A Above SH2L beLow SH3T Through SH4ER er, the mnemonic falls apart. Squashed SH5
Usually worse as you go down the list.
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Extracapsular Hip Fracturesaka Proximal Femoral Fractures
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Intracapsular Hip Fractures
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Management
Assessment.
Analgesia.
Immobilize Limb (Where Possible).
Be Aware of the Risk of Compartment Syndrome.
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Open Fractures
Tetanus.
IV Augmentin/ Cefuroxime.
Blood Loss?
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Infection – Septic Arthritis
Fever including Rigors/ Swinging Fever.
Pseudoparalysis / unable to move joint due to pain.
Hot swollen tender joint.
Can affect any joint.
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Infection - Ix
FBC, CRP, Blood Cultures & Aspirate.
X-rays.
ESR/ Plasma viscosity.
Urate
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Infection - Pitfalls
Psuedo/ GOUT.
Transient Synovitis.
Implants.
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Cellulitis
Upper limb & Hand.
Lower Limb & Foot.
Peripheral arterial foot problems – Gen Surg.
Diabetic Foot with microvascular disease – Gen Surg then Ortho.
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Tendons
Tendo-Achilles/ Calf Tear.TA may require surgery (or cast in dorsal slab
or full equinus cast)
EPL/FPL.
Quadriceps.
Hamstrings.
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Back Pain & Sciatica
Red FlagsCancer, steroids, IVDU, weight loss, fever,
night pain, age > 50, significant trauma, pain worse on lying down.
MRI/ X-ray?
Treatment.
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Not All Back pain is Like This!
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Avoid Oxycodone
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Complications
DO NOT TREAT PERIPROSTHETIC INFECTION
IN THE COMMUNITY!
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Complications
Fractures in POP can still displace
Re-X-ray after applying a cast with Manipulation.
Re-Xray if represents with increasing pain.
If metal in-situ, Re-X-ray & Inflammatory markers.
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Remember
Not All Ortho Registrars are like this!
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Some of us are Like this
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So If In Doubt,Call us and ask
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Questions?
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Tibial plateauSometimes difficult to see
fracture lineMay just have one plateau
lower than the other orOne plateau wider than the
femurTypically from a blow to
the lateral knee eg from a car bumper
Tender over proximal tibia.