Do you sound like a first year medical student when discussing hand injuries by phone with consultants? Forget all the tendon anatomy you crammed for in anatomy? FDP? FDS? FPL? Then check out this post for a "Back to Basics" online hand exam lecture by Dr. Fred Heckler from UPMC.
Independently interpreting plain film imaging is an essential skill for the Emergency Medicine provider. Among the most notorious of injuries likely to be missed is the Maisonneuve fracture. In this post we demonstrate the "can't miss" imaging findings to ensure that you don't make the mistake of thinking this is "just an ankle sprain!"
Case: 24 year old male with no significant past medical history presents to local urgent care with chief complaint of left knee pain. Patient reports playing basketball just prior to arrival and reports landing on left knee and "jamming it."
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.