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Let's Review Upper extremity Splinting

2/28/2016

0 Comments

 
 Volar Splint

Indications:
-Hand and Wrist injures (NOT distal radius or ulna fractures, can still supinate and pronate)
-Carpal fractures
-Lunate dislocation
-2nd-5th metacarpal head fracture
​
Application:
-Extends along volar forearm from metacarpal heads to just proximal to radial head
-Allow flexion of elbow
-Wrist at 20 degrees of extension
​-Can add dorsal "sandwich" for stability
​Ulnar Gutter Splint

Indications:
-4th and 5th phalanges and metacarpals

Application:
-Extends from 5th DIP to proximal forearm
-Wrist at 20 degrees of extension
-Flex MCPs at 50-70 degrees, PIP and DIPs in slight flexion
​Thumb Spica Splint

Indications:
-Scaphoid and lunate fractures
-1st metacarpal fracture
-Thumb fractures
-De Quervain tenosynovitis

Application:
-Extends from tip of thumb to proximal forearm
-Wrist at 20 degrees of extension
-Thumb slightly flexed
​Long Arm Splint

Indications:
-Proximal forearm and elbow fractures
-Intraarticular fractures of distal humerus and olecranon

Application:
-Elbow at 90 degrees of flexion
-Neutral forearm and wrist
Picture
Sugar Tong Splint

Indications:
-Wrist and distal forearm fractures

Application:
-Extends from MCPs on dorsum, around elbow, to volar midpalmar crease
-Elbow at 90 degrees of flexion
-Neutral forearm and wrist
​-Double sugar tong for complex or unstable forearm and elbow fractures
Resources:
Michael T Fitch, MD. Basic Splinting Techniques. New England Journal of Medicine. 2008; 359:e32.
​Wikiem.com
Ortho-teaching.feinberg.northwestern.edu/docs/Splinting.pptx

0 Comments

Clavicle Fractures

2/21/2016

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HPI:  23 yo male s/p MCC. Patient reports that he swerved to avoid hitting a vehicle in front of him that stopped abruptly and layed down his bike, landing on his right shoulder. He was helmeted and did not lose consciousness. Ambulatory after the event, hemodynamically stable, and complaining of right shoulder pain.
​
Exam:
Picture
Radiology:
Picture
Management:  Middle Third (80-85%)
Picture
Lateral Third (10-15%)
Picture
Medial Third (5-8%)
Picture
Treatment:

Nonop
  • sling immobilization with gentle ROM exercises at 2-4 weeks and strengthening at 6-10 week
Operative
  • ​ORIF



Resources:
​Orthobullets.com
0 Comments

Posterior hip dislocation

2/12/2016

1 Comment

 
HPI: 22 yo otherwise healthy male presents s/p head on MVC vs tree. Patient is awake and alert, hemodynamically stable, complaining of right hip pain.
​
Physical Exam: No external signs of trauma. Right lower extremity is shortened compared to the left and internal rotated. No numbness, 2+ DP pulse.
Picture
Picture

​Classification:
​- Simple: pure dislocation
​- Complex: with associated fracture of acetabulum or proximal femur

​Mechanism:
​- Axial load on femur while hip flexed and adducted or through flexed knee (dashboard injury such as this patient)​

​Requires emergent reduction (within 6 hours!) due to risk of vascular compromise to hip and osteonecrosis

​However...

​Examine femoral neck closely on XR to rule out fracture prior to attempting closed reduction.
​
With ipsilateral femoral neck fracture, closed reduction is contraindicated!

Picture
 
​Patient must be adequately sedated for procedure.  Propofol helps with tissue relaxation!

​Post reduction CT must be performed to evaluate for:
​- femoral head fractures
​- loose bodies 
​- acetabular fractures 

​Commonly associated with ipsilateral knee injuries (up to 25%) 

​Dispo: For simple dislocation, protected weight bearing for 4-6 weeks
​

Resources:
1. Serna, Fernando MD, Corczyca, John MD. Hip Dislocations and Femoral Head Fractures. University of Rochester Medical Center. March 2004.
2. Orthobullets.com

1 Comment

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    CMC ER Residents 
    (for learning purposes, imagine all cases present to a free standing ED for dispo and treatment options)

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    Disclaimer: All images and x-rays included on this blog are the sole property of CMC EM Residency and cannot be used or reproduced without written permission.  Patient identifiers have been redacted/changed or patient consent has been obtained.  Information contained in this blog is the opinion of the author and application of material contained in this blog is at the discretion of the practitioner to verify for accuracy.
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction