SplintER Series: Pediatric Elbow Pain

pediatric elbow

A 9-year-old male presents with right elbow pain after a fall onto the elbow. What is your diagnosis? What common pediatric elbow findings are you looking for? What is your management and disposition in the ED? (Image 1: Case courtesy of Dr Ian Bickle, Radiopaedia.org, rID: 47354)

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SplintER: Persistent Left Groin Pain

Femoral Neck Stress Fracture xray

A 24-year-old male presents with progressively worsening left groin pain for six weeks after he began training for a marathon. He states he had x-rays done by his PCP that were negative four weeks ago and was diagnosed with a groin strain. X-rays were obtained and featured to the right.

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SplintER Series: Finger pain

proximal phalanx fracture

A 45-year-old male presents to the emergency department (ED) with right hand pain after an e-bike accident. Physical exam shows deformity and tenderness at the 5th proximal phalanx. Radiographs are shown above (Image 1: Plain radiography of right hand with AP and oblique views. Author’s own images). What is the most likely diagnosis? What are the important aspects of the associated physical examination? What is the management in ED, including pain management? When do you consult orthopedics?

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EMRad: Radiologic Approach to the Traumatic Knee

Radiology teaching during medical school is variable, ranging from informal teaching to required clerkships [1].​​ Many of us likely received an approach to a chest x-ray, but approaches to other studies may or may not have not been taught. We can do better! Enter EM:Rad, a series aimed at providing “just in time” approaches to commonly ordered radiology studies in the emergency department. When applicable, it will provide pertinent measurements specific to management, and offer a framework for when to get an additional view, if appropriate. We recently covered the elbow, wrist, shoulder, ankle, and foot. Next up: the knee.

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By |2020-06-24T07:34:48-07:00Jun 29, 2020|EMRad, Orthopedic, Radiology, Trauma|

EMRad: Can’t Miss Adult Knee Injuries

knee radiology

Figure 1: Normal AP knee x-ray. Case courtesy of Dr Andrew Dixon, Radiopaedia.org, annotations by Stephen Villa MD.

Have you ever been working a shift at 3am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their PCP in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather to highlight and improve your sensitivity for these potentially catastrophic injuries. Now: the knee.

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By |2020-06-24T07:43:05-07:00Jun 29, 2020|EMRad, Orthopedic, Radiology, Trauma|

Trick of the Trade: Windex for Ring Removal

A 41-year-old male presents with left-hand pain after an altercation. The patient’s hand is noted to be swollen and tender, particularly over the 4th-5th metacarpals, with mild swelling extending to the 4th-5th digits. The patient also notes that he slightly deformed his wedding ring during the fight and he has since been unable to remove it. It’s a busy overnight and the patient has been in the waiting room for an hour. While waiting nursing staff had the patient ice his hand while elevated and attempted to remove the ring with a water-based lubricant. All attempts to remove the ring thus far have been unsuccessful.

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By |2020-06-16T09:21:38-07:00Jun 16, 2020|Orthopedic, Tricks of the Trade|

EMRad: Can’t Miss Adult Shoulder Injuries

AP view shoulder

Have you ever been working a shift at 3 am and wondered, “Am I missing something? I’ll just splint and instruct the patient to follow up with their primary doctor in 1 week.” This is a reasonable approach, especially if you’re concerned there could be a fracture. But we can do better. Enter the “Can’t Miss” series: a series organized by body part that will help identify injuries that ideally should not be missed. This list is not meant to be a comprehensive review of each body part, but rather aims to highlight and improve your sensitivity for these potentially catastrophic injuries. Now: the shoulder

(more…)

By |2020-05-14T22:35:01-07:00May 6, 2020|EMRad, Orthopedic, Radiology, Trauma|