Your patient in the Emergency Department has a Zone II or Zone III finger amputation which requires primary closure of the wound prior to discharge with appropriate outpatient follow up. However, a protruding piece of bone often prevents closure of the skin flap and requires trimming by using a rongeur. While this process is typically carried out by an orthopedic or hand surgical consultant, this post aims to introduce the use of a ronguer during management of finger amputation in the Emergency Department.
You have made the diagnosis of disseminated gonococcal infection in your patient presenting with history and physical exam findings suggestive of purulent arthritis, now what? Treatment for gonococcal arthritis goes beyond the one-time "shot and a pill" given for uncomplicataed gonococcal infections. A quick review of disseminated gonococcal infection:
Patella fractures represent 1% of all fractures and are commonly seen after direct trauma to the bone (fall onto flexed knee, "dashboard" injury"). When to involve your consulting orthopedic surgeon is a key branch point in the management and care of these patients.
Case: 43 year old woman presents to Emergency Department after falling from height of second-story window after locking herself out of the house. Patient reports falling onto her left hip. On physical exam, no leg length discrepancy and no bony tenderness to palpation of left hip. The patient cannot move her left lower extremity at the hip and has significant pain with minimal passive range of motion.
During Week 12 of this NFL season, Washington Redskins tight end Jordan Reed injured his shoulder while attempting to catch a pass in the endzone against the Dallas Cowboys. While Reed continued to finish the first half, he was diagnosed with an AC joint separation at halftime. This posts will give an review of the evaluation and management of AC joint separations in the ED.
Do you feel like you pour your heart, soul, blood, sweat, and tears into your fracture/reductions and still come up short? Does the orthopedics consultant always want to "re-do" your attempt? Here is a podcast interview between Patrick Sheehan, MD of the Department of Emergency Medicine and Joseph Legato, MD of the Department of Orthopedic Surgery at Cooper University Hospital on how to get a perfect reduction. Inside the interview are 5 tips on positioning yourself for success. Also included is a video of Dr.
During a preseason exhibition game of this NFL season, Dallas Cowboys quarterback Tony Romo suffered a compression fracture of his lumbar spine against the Seattle Seahawks. While this was not a season-ending injury for Romo, the veteran quarterback lost his starting position to the exceptional play of rookie quarterback Dak Prescott during his absence. Also included in this post is key pearls about a Chance fracture, another important fracture of the thoracic/lumbar spine!
There are an estimated 25 million golfers in the United States. Every time they step onto the course they spend hours walking in the sun and placing stress on their backs and nearly every joint in their bodies. It should be no surprise if one of these patients make their way into one of your Emergency Departments or Urgent Cares. Below are two of the most common golf injuries as well as pearls on how to prevent/treat them:
Low Back Pain/Strain:
In Week 8 of this NFL season, Houston Texans offensive tackle Derek Newton suffered bilateral patella tendons rupture against the Denver Broncos. Newton's injury was particularly rare not only because of it's bilateral nature but also because it occured without direct trauma. This is a season-ending injury for Newton. On the field, Newton received immediate immobilization and eventually underwent surgery to repair the tendons.