Orthopaedics for the emergency department

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Orthopaedics for the emergency department

  1. 1. MrAnjan K Banerjee
  2. 2. A Cook’s Tour Fractures Infection Back Pain & Sciatica Complications
  3. 3. Fractures Hand/Wrist Forearm Elbow Humerus Shoulder Foot Ankle/Tibia Knee Femur Hip Spine
  4. 4. Wrist & Hand Colles Smith’s Barton’s Perilunate dislocation Metacarpals Fingers
  5. 5. Fingers
  6. 6. Metacarpal
  7. 7. Metacarpal
  8. 8. Scaphoid
  9. 9. Scaphoid
  10. 10. Perilunate Capitate lunate
  11. 11. Colles
  12. 12. Barton’s
  13. 13. Styloid
  14. 14. Forearm Radial styloidIsolated ulna # Radial head“Nightstick #”From a direct blow tothe mid forearm.(Night stick is an oldname for a policetruncheon)
  15. 15. Galeazzi # Needs ORIF
  16. 16. Monteggia #Radius should lineup with thecapitellum.“MonteggiaMoreMedial” (thanGalezzi) (if patient’sarms where stickingout) Capitellum
  17. 17. Supracondylar fracturesGartland I & II
  18. 18. Gartland II & III
  19. 19. Ankle – Images I should not see
  20. 20. Ankle – Images I should not see
  21. 21. Cervical Spine Canadian Rules. Always Consider the mechanism.
  22. 22. Cervical Spine
  23. 23. Remember Collar & Blocks
  24. 24. Lumbar SpineDirect Axial Compression
  25. 25. Thoracic Spine
  26. 26. Salter-Harris S Slipped SH1 A Above SH2 L beLow SH3 T Through SH4 ER er, the mnemonic falls apart. Squashed SH5 Usually worse as you go down the list.
  27. 27. Extracapsular Hip Fracturesaka Proximal Femoral Fractures
  28. 28. Intracapsular Hip Fractures
  29. 29. Management Assessment. Analgesia. Immobilize Limb (Where Possible). Be Aware of the Risk of Compartment Syndrome.
  30. 30. Open Fractures Tetanus. IV Augmentin/ Cefuroxime. Blood Loss?
  31. 31. Infection – Septic Arthritis Fever including Rigors/ Swinging Fever. Pseudoparalysis / unable to move joint due to pain. Hot swollen tender joint. Can affect any joint.
  32. 32. Infection - Ix FBC, CRP, Blood Cultures & Aspirate. X-rays. ESR/ Plasma viscosity. Urate
  33. 33. Infection - Pitfalls Psuedo/ GOUT. Transient Synovitis. Implants.
  34. 34. Cellulitis Upper limb & Hand. Lower Limb & Foot. Peripheral arterial foot problems – Gen Surg. Diabetic Foot with microvascular disease – Gen Surg then Ortho.
  35. 35. Tendons Tendo-Achilles/ Calf Tear.  TA may require surgery (or cast in dorsal slab or full equinus cast) EPL/FPL. Quadriceps. Hamstrings.
  36. 36. Back Pain & Sciatica Red Flags  Cancer, steroids, IVDU, weight loss, fever, night pain, age > 50, significant trauma, pain worse on lying down. MRI/ X-ray? Treatment.
  37. 37. Not All Back pain is Like This!
  38. 38. Complications DO NOT TREAT PERIPROSTHETIC INFECTION IN THE COMMUNITY!
  39. 39. 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.
  40. 40. Not All Ortho Registrars are like this!
  41. 41. Questions?
  42. 42. Tibial plateau Sometimes difficult to see fracture line  May just have one plateau lower than the other or  One plateau wider than the femur  Typically from a blow to the lateral knee eg from a car bumper  Tender over proximal tibia.

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