orthopaedics for the emergency department

ORTHOPAEDICS FOR THE EMERGENCY DEPARTMENT

Mr Anjan K Banerjee

A Cook’s Tour

Fractures

Infection

Back Pain & Sciatica

Complications

FracturesHand/WristForearmElbowHumerusShoulderFootAnkle/TibiaKneeFemurHipSpine

Wrist & Hand

CollesSmith’sBarton’sPerilunate dislocationMetacarpalsFingers

Fingers

Metacarpal

Metacarpal

Scaphoid

Scaphoid

Perilunate

lunateCapitate

Colles

Barton’s

Styloid

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)

Galeazzi #

Needs ORIF

Monteggia #

Capitellum

Radius should line up with the capitellum.

“Monteggia More Medial” (than Galezzi) (if patient’s arms where sticking out)

Gartland I & II

Supracondylar fractures

Gartland II & III

Ankle – Images I should not see

Ankle – Images I should not see

Cervical Spine

Canadian Rules.

Always Consider the mechanism.

Cervical Spine

Remember Collar & Blocks

Lumbar SpineDirect Axial Compression

Thoracic Spine

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. 

Extracapsular Hip Fracturesaka Proximal Femoral Fractures

Intracapsular Hip Fractures

Management

Assessment.

Analgesia.

Immobilize Limb (Where Possible).

Be Aware of the Risk of Compartment Syndrome.

Open Fractures

Tetanus.

IV Augmentin/ Cefuroxime.

Blood Loss?

Infection – Septic Arthritis

Fever including Rigors/ Swinging Fever.

Pseudoparalysis / unable to move joint due to pain.

Hot swollen tender joint.

Can affect any joint.

Infection - Ix

FBC, CRP, Blood Cultures & Aspirate.

X-rays.

ESR/ Plasma viscosity.

Urate

Infection - Pitfalls

Psuedo/ GOUT.

Transient Synovitis.

Implants.

Cellulitis

Upper limb & Hand.

Lower Limb & Foot.

Peripheral arterial foot problems – Gen Surg.

Diabetic Foot with microvascular disease – Gen Surg then Ortho.

Tendons

Tendo-Achilles/ Calf Tear.TA may require surgery (or cast in dorsal slab

or full equinus cast)

EPL/FPL.

Quadriceps.

Hamstrings.

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.

Not All Back pain is Like This!

Avoid Oxycodone

Complications

DO NOT TREAT PERIPROSTHETIC INFECTION

IN THE COMMUNITY!

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.

Remember

Not All Ortho Registrars are like this!

Some of us are Like this

So If In Doubt,Call us and ask

Questions?

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.