SplintER Series: 2-Minute Knee Exam | Leg Day #3 | MSK Exam Series

Welcome to Leg Day #3 of the SplintER Series! Performing a fast and focused history and physical examination of a patient with an acute knee injury is an important skill that has the potential to be overlooked in our busy Emergency Departments. Our hope is that after reviewing this post and with enough practice you will be able to complete your exam within 2 minutes! These are can’t-miss points and expert tips on the knee exam for your next shift in the ED.

SplintER Series: Hip Dislocation | Leg Day #2

Welcome to Leg Day #2 of the SplintER Series. Following up with the Leg Day #1’s primer on tibial plateau fractures, another key orthopedic injury of the leg is hip dislocation. A hip dislocation occurs when there is separation of the head of the femur from the acetabulum of the pelvis in either an anterior or posterior direction.¹

(more…)

By William Denq, MD CAQ-SM|2019-03-28T21:40:37-07:00Jan 14, 2019|Expert Peer Reviewed (Clinical), Orthopedic, SplintER, Trauma|

Use of Point-of-care Ultrasound in Tibial Plateau Fractures | Case Presentation

A 70-year-old female with no past medical history was hit by a motor vehicle while crossing the street. She experienced no head strike or loss of consciousness, however she was unable to ambulate at the scene, and upon arrival to the ED, complained of left knee pain. The emergency physician noted moderate swelling on exam with intact skin and distal pulses. She was tender to palpation over the proximal tibia. Portable 2-view radiographs were obtained and interpreted as “no acute fracture.” On repeat examination, however, the patient continued to have pain and was now unable to bear weight on the affected extremity. Is there a role for point-of-care ultrasound (POCUS) in this situation?

(more…)

By Dawa Sherpa, MD|2018-10-28T22:17:27-07:00Oct 29, 2018|Orthopedic, Radiology, Ultrasound|

SplintER Series: Tibial Plateau Fractures | Leg Day #1

$lipohemoarthrosis tibial plateau fractures$ The SplintER series is back with a new sub-series – Leg Day! We will review lower extremity orthopedic injuries, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize the appropriate way to evaluate, diagnose, and manage tibial plateau fractures. This post is peer-reviewed by Dr. Kori Hudson, one of our expert sports medicine colleagues! Please read below for her commentary.

(more…)

By Max Hockstein, MD|2018-08-22T09:35:14-07:00Aug 23, 2018|Orthopedic, SplintER|

SplintER Series: Common ED Splint Techniques 104

The SplintER series is back with its fourth installment! In this series, we review splinting fundamentals, introduce advanced concepts, and highlight ways to implement these into your next shift. In this post, we summarize some of the most commonly deployed splints in the ED. Peer-reviewed by sports medicine experts (Dr. Kori Hudson and Dr. Anna Waterbrook), these injury-splint summary tables provide information on the origin, insertion, and positioning for each splint, along with the recommended number of layers of plaster.
(more…)

By William Denq, MD CAQ-SM|2020-08-08T15:17:38-07:00Jul 4, 2018|SplintER|

Trigger Point Injection for Musculoskeletal Pain in the ED

Musculoskeletal pain is a common ED presentation and emergency providers can often manage it with NSAIDs alone.¹ On the other hand, when patients present with small localized areas of intense muscle spasm called trigger points, NSAIDs won’t cut it. A trigger point injection (TPI), however, is a safe and easy way to treat the underlying cause of trigger point pain, and requires only basic equipment already available in most the EDs.

(more…)

By Alexis LaPietra, DO|2018-06-07T20:29:26-07:00Jun 8, 2018|Orthopedic, Tox & Medications|

Trick of the Trade: DIY Skyhook for Upper Extremity Swelling

A 25 year-old male presents to the ED complaining of left upper extremity pain, redness, and swelling. His cat bit him 2 days ago and his symptoms started today. On exam he has impressive induration, erythema, and warmth to the dorsum of the hand and forearm. He is neurovascularly intact and able to range his joints freely. In addition to IV antibiotics, you would like to keep his arm elevated while in the hospital. What is an easy and simple way help ensure that this patient keeps his arm elevated?
(more…)

By Luz Maria Silverio, MD|2018-05-29T10:36:07-07:00May 28, 2018|Orthopedic, Tricks of the Trade|