The EM Educator Series: Adult Orthopedic Misses

Authors: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome to this week’s EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. We are working on retroactively doing this for the past posts as well. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Mini-Cases:

#1: A 26-year-old female was running in a field and stepped into a hole. Since then, she has experienced severe midfoot pain, and you see bruising across the sole of her foot.

#2: A 62-year-old male presents after MVC with significant knee pain. His knee displays significant laxity in the ACL, PCL, and MCL. He has poor pulses distally in the affected leg compared with the other.

Considerations:

What should you consider with the following? What is the typical presentation? What is the evaluation and management?

1. Foot – Lisfranc / calcaneus / Jones
2. Ankle – syndesmosis / Tillaux / Maisonneuve / talus / Achilles
3. Knee – dislocation / quadriceps tendon / patella tendon / tibial plateau / septic arthritis / open joint
4. Hip / pelvis – occult hip fx / pelvic apophyseal / occult pelvic fx(s)
5. Shoulder/clavicle – posterior shoulder dislocation / sternoclavicular dislocation / SC joint septic arthritis
6. Biceps tendon rupture
7. Elbow – radial head
8. Wrist/Hand – scapholunate / DRUJ / scaphoid / triquetrum / hamate / fight bite / tendon lacerations
9. Compartment syndrome

Suggested Resources:

• Articles:
  • emDOCs – Foot Injuries in the ED
  • emDOCs – Knee Dislocation: Pearls and Pitfalls
  • emDOCs – Septic joint: Reminders, Updates, and Pitfalls
  • emDOCs – Snap, Crackle, POP! Open joint: ED evaluation and management
  • emDOCs – Wrist and Distal Forearm Injuries: Pearls & Pitfalls
  • LITFL – Posterior Shoulder Dislocation
  • LITFL – Sternoclavicular Joint Dislocation
  • LITFL – Compartment Syndrome
• Podcasts:
  • EM Cases – Commonly Missed Ankle Injuries
  • EM Cases – Occult Knee Injuries Pearls and Pitfalls
  • EM Cases – Hand Emergencies
  • EM Cases – Commonly Missed Uncommon Orthopedic Injuries
  • EM Cases – Commonly Missed Uncommon Orthopedic Injuries Part 2
  • EM Cases – Occult Fractures and Dislocations
  • Core EM – The Lisfranc Injury
  • Core EM – Radial Head Fracture