SplintER Series: I Declare a Thumb War

Gamekeeper's Thumb

 

A 39-year-old female presents to the emergency department with right thumb pain after falling in a skiing accident. On exam, there is mild swelling and tenderness on the ulnar aspect of the 1st MCP joint. Additionally, there is laxity with valgus stressing of the 1st MCP joint. An x-ray is obtained and shown above (Image 1. Provided by Alex Tomesch, MD).

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SplintER Series: Don’t Go Breaking My Heart

A 45-year-old man presents to the emergency department with chest pain after a high-speed motor vehicle accident where his sternum hit the steering wheel. You notice an area of ecchymosis noted over his sternum, so you decide to get a CT scan (Figure 1).

Figure 1. Case courtesy of Dr Henry Knipe, Radiopaedia.org, rID: 26332

 

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SplintER Series: Pedal to the Metal

Talar Neck Fracture

A 32-year-old female presents to the emergency department with right ankle pain after a high-speed motor vehicle accident. On exam, she is noted to have ecchymosis and swelling over the distal foot, and pain with ankle dorsiflexion and plantarflexion. An x-ray is obtained as shown above (Image 1. Case courtesy of Dr. Charlie Chia-Tsong Hsu, Radiopaedia.org, rID: 18235).

 

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SplintER Series: My Foot Doesn’t Work Right

Achilles tendon rupture

A 35-year-old male felt a painful “pop” in his posterior left lower leg while playing football. Afterward, his “foot didn’t work right anymore.” X-ray of the left ankle and tib/fib was normal but he was unable to ambulate. You plan an ultrasound over the area of maximal tenderness and discover the above image (Image 1.Ultrasound of the left posterior ankle 11cm proximal to the calcaneal insertion of the Achilles tendon.  Case courtesy of Robert Lystrup.)

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SplintER Series: Fracture After a Fall From a Bunk Bed

 

A 6-year-old male presents to the ED after a fall from his 5 foot high bunk bed causing elbow trauma. On exam, there is significant focal swelling, ecchymosis, and tenderness at the lateral left elbow. The forearm, wrist, hand and shoulder are nontender. He is neurovascularly intact. You  suspect a fracture and obtain x-rays (Figures 1 and 2).
 
Elbow x-ray

Figure 1: Initial radiographs in the ED with the elbow slightly flexed.

Elbow x-ray

Figure 2: AP and lateral radiographs of the elbow.

 

 

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