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Orthopedic Emergencies
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    Au, John Palmer, Edward Johnson, Ian and Chehade, Mellick 2018. Evaluation of the utility of teaching joint relocations using cadaveric specimens. BMC Medical Education, Vol. 18, Issue. 1,

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  • Edited by Michael C. Bond, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
  • Edited in association with Andrew D. Perron, Department of Emergency Medicine, Maine Medical Center, Portland , Michael K. Abraham, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore
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    Orthopedic Emergencies
    • Online ISBN: 9781139199001
    • Book DOI: https://doi.org/10.1017/CBO9781139199001
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Book description

Acute care physicians are frequently faced with diagnosing and treating orthopedic emergencies with limited resources and without immediate specialist availability. Orthopedic Emergencies focuses on the acute management and stabilization of orthopedic injuries with specific recommendations on procedures and the stabilization of fractures and dislocation. The topics are organized anatomically with additional chapters on Procedures, Reduction Techniques, and Immobilization and Splinting. The information needed for a rapid diagnosis is available instantly through the bullet-point-style text, diagrams, images, pearls and pitfalls. There are specific recommendations on which splint to apply and how to position the affected limb, as well as advice on when to arrange follow up with an orthopedist or sports medicine physician. The spiral binding allows the book to lay flat for easy use at the bedside, making Orthopedic Emergencies the ideal companion for all emergency medicine providers including emergency department physicians, sports clinics, family medicine practitioners and mid-level providers.

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Contents

  • Chapter 8 - Orthopedic infections and other complications
    pp 178-190
  • View abstract

    Summary

    This chapter presents the key facts, diagnostic testing, treatments, and prognosis of various types of hand and wrist fractures such as distal radius fracture, distal radioulnar joint disruption (DRUJ), carpal bone fractures, metacarpal bone fractures, phalangeal bone fractures, and distal phalanx fracture. Distal radius and ulnar injuries are often associated with median and ulnar neuropathies. A transverse fracture of the distal radial metaphysis with dorsal displacement and angulation, often caused by a fall on an outstretched hand. The lateral radiograph is the best view for revealing an intra-articular fracture of the radius and any associated carpal displacement in Barton fractures. A posteroanterior (PA) radiograph often shows a comminuted fracture of the distal radius. Barton fractures require emergency orthopedic/hand-specialist consultation for early operative management. Non-displaced Hutchinson fractures can be managed with a short-arm splint and routine orthopedic/hand-specialist follow-up.
  • Chapter 9 - Procedures for orthopedic emergencies
    pp 191-247
  • View abstract

    Summary

    This chapter presents the key facts, clinical presentation, diagnostic testing, treatment of procedures, and prognosis of shoulder and elbow emergencies such as glenohumeral dislocations, scapular fractures, clavicle fractures, sternoclavicular (SC) injuries, acromioclavicular injuries, and proximal humerus fractures. Failure to obtain a lateral projection can result in missing a posterior dislocation in up to 50% of cases. Reductions performed with intra-articular anesthetic injections have been safely performed with equivalent success rates, similar patient comfort, shorter ED length of stays, and lower complication rates. Electromyogram (EMG) testing can be performed at a later date to evaluate suspected nerve injuries. Presence of a posterior SC dislocation should prompt evaluation for associated injuries to the trachea, esophagus, and great vessels, which are in close proximity to the SC joint. Plain radiographs are the preferred test for evaluation of suspected humeral shaft fractures.
  • Chapter 10 - Immobilization and splinting
    pp 248-269
  • View abstract

    Summary

    This chapter presents the key facts, mechanism, anatomy, symptoms, diagnosis, and treatment of pelvic fractures e.g. avulsion fractures, and non-displaced pelvic fractures such as pubic ramis fractures, ischial body fractures, ilium fractures, sacral fractures, coccyx fractures, displaced pelvic fractures, acetabular fractures and hip fractures. Pelvic fractures represent 3% of all fractures, and are associated with significant morbidity and mortality. The mortality rate for high-energy pelvic fractures is between 10% and 20%. The pelvis consists of the ilium and pubis, and the ilium on each side forming the innominate bones that are then joined at the pubis symphysis anteriorly and the sacrum posteriorly. Fractures involving a single pubic ramis are usually caused by a fall in the elderly, though in the young it is often the result of persistent tension/stress on the adductors or hamstrings resulting in a fracture at their site of origination.

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