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ORTHOPAEDICS FOR THE EMERGENCY DEPARTMENT
Mr Anjan K Banerjee
A Cook’s Tour
Fractures
Infection
Back Pain & Sciatica
Complications
FracturesHand/WristForearmElbowHumerusShoulderFootAnkle/TibiaKneeFemurHipSpine
Wrist & Hand
CollesSmith’sBarton’sPerilunate dislocationMetacarpalsFingers
Fingers
Metacarpal
Metacarpal
Scaphoid
Scaphoid
Perilunate
lunateCapitate
Colles
Barton’s
Styloid
Forearm
Radial head
Radial styloid
Isolated ulna #“Nightstick #”From a direct blow to the mid forearm.(Night stick is an old name for a police truncheon)
Galeazzi #
Needs ORIF
Monteggia #
Capitellum
Radius should line up with the capitellum.
“Monteggia More Medial” (than Galezzi) (if patient’s arms where sticking out)
Gartland I & II
Supracondylar fractures
Gartland II & III
Ankle – Images I should not see
Ankle – Images I should not see
Cervical Spine
Canadian Rules.
Always Consider the mechanism.
Cervical Spine
Remember Collar & Blocks
Lumbar SpineDirect Axial Compression
Thoracic Spine
Salter-Harris
S Slipped SH1
A Above SH2L beLow SH3T Through SH4ER er, the mnemonic falls apart. Squashed SH5
Usually worse as you go down the list.
Extracapsular Hip Fracturesaka Proximal Femoral Fractures
Intracapsular Hip Fractures
Management
Assessment.
Analgesia.
Immobilize Limb (Where Possible).
Be Aware of the Risk of Compartment Syndrome.
Open Fractures
Tetanus.
IV Augmentin/ Cefuroxime.
Blood Loss?
Infection – Septic Arthritis
Fever including Rigors/ Swinging Fever.
Pseudoparalysis / unable to move joint due to pain.
Hot swollen tender joint.
Can affect any joint.
Infection - Ix
FBC, CRP, Blood Cultures & Aspirate.
X-rays.
ESR/ Plasma viscosity.
Urate
Infection - Pitfalls
Psuedo/ GOUT.
Transient Synovitis.
Implants.
Cellulitis
Upper limb & Hand.
Lower Limb & Foot.
Peripheral arterial foot problems – Gen Surg.
Diabetic Foot with microvascular disease – Gen Surg then Ortho.
Tendons
Tendo-Achilles/ Calf Tear.TA may require surgery (or cast in dorsal slab
or full equinus cast)
EPL/FPL.
Quadriceps.
Hamstrings.
Back Pain & Sciatica
Red FlagsCancer, steroids, IVDU, weight loss, fever,
night pain, age > 50, significant trauma, pain worse on lying down.
MRI/ X-ray?
Treatment.
Not All Back pain is Like This!
Avoid Oxycodone
Complications
DO NOT TREAT PERIPROSTHETIC INFECTION
IN THE COMMUNITY!
Complications
Fractures in POP can still displace
Re-X-ray after applying a cast with Manipulation.
Re-Xray if represents with increasing pain.
If metal in-situ, Re-X-ray & Inflammatory markers.
Remember
Not All Ortho Registrars are like this!
Some of us are Like this
So If In Doubt,Call us and ask
Questions?
Tibial plateauSometimes difficult to see
fracture lineMay just have one plateau
lower than the other orOne plateau wider than the
femurTypically from a blow to
the lateral knee eg from a car bumper
Tender over proximal tibia.