1 We’ve Got a Bone to Pick…. Pearls, Pitfalls & High-Yield Orthopedics David J. Heath, DO, MS, ATC, FAAEM Facility Medical Director, Emergency Medicine Saint Joseph-London Hospital Adjunct Clinical Professor, LMU-DCOM [email protected]Educational Objectives Upon hearing & assimilating this program, clinician will be better able to: 1. Identify each section of long-bone anatomy; 2. Identify & describe various types of fractures, including transverse, oblique, spiral, comminuted & segmental; 3. Correctly diagnose & describe pediatric fractures, including greenstick, buckle, & growth plate fractures using Salter-Harris classification; 4. Identify & describe from radiographs common hand/wrist fractures, ankle/foot fractures, different types of hip fractures, common spine fractures & common shoulder fractures; 5. Institute appropriate treatments for each of demonstrated fractures. Systematic Approach to PE • H istory – It’s ALL about that history! • O bservation – Abnormalities & symmetry • P alpation – Temperature, tenderness • R ange of Motion – PROM & AROM • S trength – Full & equal • S pecial Tests – “Provocative” tests HOPRSS Long Bone Anatomy 4 5 6
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We’ve Got a Bone to Pick….�Pearls, Pitfalls & High-Yield Orthopedics
David J. Heath, DO, MS, ATC, FAAEMFacility Medical Director, Emergency Medicine
Saint Joseph-London HospitalAdjunct Clinical Professor, LMU-DCOM
• Incomplete angulated w/ cortical breech to one side of bone
• Usually mid-diaphyseal• Treatment
– Splint w/ F/U to ortho
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Buckle (Torus) Fractures
• Compression-type force applied to relatively soft, immature bone
• Incomplete fracture– Bulging of cortex– Trabecular compression 2* axial loading to long axis– Commonly involve distal radial metaphysis
• Treatment– Volar fx = Splint molded in EXTENSION– Dorsal fx = Removable Velcro splint
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Solely relying on radiology report
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Dorsal Torus
Fracture
Salter-Harris Fxs
Separated Above Lower Through Rammed
SALTR
6% 75% 10% 10% 1%MOST
COMMONInfants & toddlers
Growth complications
ñ I to V
Salter-Harris Fractures
• Demographics– Most common age = 10 to 16 (80%) – Mostly males (2* delayed skeletal maturity)
• Physis (growth plate)– Composed of cartilage cells (not seen on XR)– Weaker than supporting ligaments
• Blood supply to GP from epiphysis– ñ epiphyseal injury = ñ growth disturbances – Type I = least growth disturbance– Type V = most growth disturbance 17
Hand & Wrist
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4
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DORSALVOLAR
Scaphoid Fracture
• Rare in kiddos• Pain in snuffbox & ulnar deviation• Imaging
– 1st XR = 14% missed– 2nd XR in 7 days– Bone scan to confirm dx
• Complication– High risk of AVN
• Treatment– Nondisplaced = thumb spica splint
Most common carpal fx (62-87% of all wrist fxs)
Scaphoid Blood Supply`
Scaphos = peanut
DORSAL VOLAR
Lunate & Perilunate Dislocations
• Lunate– MC carpal bone to dislocate– Volar swelling w/ palpable mass– Treatment
Abbreviated References1. Babcock O’Connell C. A Comprehensive Review for the Certification and
Recertification Examinations for PAs. 5th Ed. 20142. Diamond MA. Davis’s PA Exam Review: Focused Review for the PANCE &
PANRE. 1st Ed. 2008.3. Dietrich A et al. Carol Rivers’ Preparing for the Written Board Exam in EM.
6th Ed. Ohio ACEP. 2014.4. Herbert M. Hippo PANCE/PANRE Board Review for the PA.5. Rhee JV. PA Board Review: Certification and Recertification. 2nd Ed.6. Paulk DP & Agnew D. JB Review: PA Review Guide. 2010.