Welcome to the Orthopedics Lower Extremity Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality orthopedic lower extremity content. Below we have listed our selection of the 3 highest quality blog posts within the past 12 months (as of March 2016) related to orthopedic lower extremity emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 1 AIRs and 2 Honorable Mentions. We recommend programs give 1 hour (20 minutes per article) of III credit for this module.
Orthopedic fractures and injuries are commonly managed in the emergency department. Often a quick bedside reference card is needed to remind the clinician about the acute management and follow-up instructions. Thanks to the efforts of a 2015-16 ALiEM Chief Resident Incubator team, we are pleased to announce the first of these reference cards. Ankle and hindfoot fractures covered include ankle malleolar fractures, talus, and calcaneus fractures. These cards were expert reviewed by Dr. Scott Sherman, co-editor of the Emergency Orthopedics textbook and illustrations were created by Dr. Mary Haas.
What is the most commonly fractured carpal bone in adults? It’s the scaphoid bone. As a bonus it has the dreaded complication of avascular necrosis. So how good are the physical exam and imaging modalities in diagnosing a fracture? What is the likelihood ratio (LR) that snuffbox tenderness predicts a fracture? Bottom lines: The exam is highly sensitive but poorly specific, such that one can only confidently state that a NON-tender snuffbox and scaphoid tubercle essentially rule out an acute scaphoid fracture. Also negative x-rays for patients with scaphoid tenderness still yield a fracture post-test probability of 25%. This PV card breaks down all the LRs.1
Hip fractures are an important cause of morbidity and mortality in older adults. The average age for hip fractures in the U.S. is 80 years, and a staggering 20% of women and 10% of men 1 will experience a hip fracture in their lifetime if they live to older age. This makes it a costly injury, racking up close to $15 billion per year in the U.S. alone. 2 Some hip fractures are obvious as soon as the patient rolls through the ambulance bay. Others can be subtle and require more than just a plain X-ray. This post will discuss risk factors for hip fractures, and how to diagnose and manage patients with hip fractures in the ED.
Distal radius fractures are among the most commonly encountered fractures in the emergency department (ED). They have been reported to account for around 25% of pediatric fractures and up to 18% of fractures in the elderly.1 Reducing minimally displaced distal radius fractures is a procedure that can be greatly facilitated by the presence of finger traps, which help hold traction while you reduce the fracture.2 Often While working in small 5-bed, free-standing emergency department (ED), I found myself needing to perform this vital procedure and finger traps were unavailable.
Case: An 18 year old male presents after a single gunshot wound to his left calf. He complains of pressure-like pain near the wound and sensory numbness below his left knee. On examination, the left leg is tense. He has no dorsalis pedis pulse. Based on the history, exam, and findings in the image, which of the following is true regarding this diagnosis?