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Bones 101: Introduction to

Emergency Orthopedics

Amita Sudhir , MD and Claire Plautz, MD
(with special thanks to) Andrew D. Perron, MD
University of Virginia Health System

Intro to ortho: Overview
 General Terms & Principles
 Radiology
 Salter-Harris Classification
 Splinting
 Complications
 Pain Control
 Follow-up

How to describe an orthopedic injury
 Orthopedic History
 Ortho Physical

 Inspection, ROM, Palpation

-Neuro exam: motor and sensory
-Vascular exam
 Xray appearance of fracture

Ortho History  Mechanism of injury  Other injuries  Tetanus status (if skin break)  Handedness (for hand injuries) .

Inspection SWELLING COLOR DEFORMITY SKIN TENTING OPEN VS CLOSED .

Range of Motion Active Passive Palpation Point of maximal tenderness Crepitus Hematoma .

Limb Deformity  Valgus = away from midline  Varus = towards the midline .

Ortho Physical Motor  0 = Nothing  1 = Muscle fires (fasciculation). no movement  2 = Moves with gravity eliminated  3 = Moves against gravity  4 = Not full strength  5 = Full strength .

palpable or dopplerable . Ortho Physical  Sensation  2-point  Light touch  Neuropraxia vs true defecit  Vascular  Cap refill/skin temp  Pulses.

EMERGENCY!  Fracture or dislocation with loss of pulses  Skin tenting (fracture fragment can cause skin necrosis and require extensive grafting later)  May require instant reduction before xrays can be obtained .

Xray appearance  Which bone  Which side  Type of fracture  Location in bone  Subluxation or dislocation  Angulation  Displacement  Impaction  Shortening .

Nomenclature Epiphysis Metaphysis Diaphysis .

Nomenclature .

Nomenclature  Transverse/spiral/comminuted .

Nomenclature  Complete/incomplete .

Nomenclature  Buckle (Torus)/bowing fracture .

Nomenclature  Impacted/avulsed .

Nomenclature  Subluxation: partial loss of the nl anatomic relationship between joint surfaces  Dislocation: complete loss of the normal anatomic relationship between joint surfaces (Note: Fractures don’t dislocate. they displace) .

Fracture description Angulation Shortening Displacement/ apposition .

Joint involvement Does fracture line extend into a joint or involve the articular surface? .

. .  Tendons are stronger than bones.  Missed fractures in kids cost a lot.. A word on kids.  They can’t always tell you exactly where it hurts.

Salter-Harris classification .

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Fracture complications  Open fracture  Compartment syndrome  Neurovascular injury  Tendon injuries  Splinting errors  Fat emboli  Failure to look for other injuries  Retained foreign body .

Compartment syndrome Increased pressure in myofascial compartment leads to compromise of blood supply. nerve damage Pain Pallor Paresthesias Paralysis Pulselessness .

Open joint? Skin wounds can extend into the joint space Identify with methylene blue injection .

Describe some fractures… .

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QUESTIONS? .