Patient 1: Restrained passenger of a head on MVC.
Patient 2: Elderly patient with fall from standing.
Patient 1: Hip flexed and internally rotated. Unable to straighten the leg. Unable to walk.
Patient 2: Hip flexed and externally rotated. Unable to straighten the leg. Unable to walk.
Patient 1: Posterior hip dislocation of native hip.
Patient 2: Superolateral hip dislocation of prosthetic hip.
Posterior Hip Dislocation
Prosthetic Hip Dislocation
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Tibial Plateau Fractures
Patient 1: Restrained MVC. Presented with knee pain and swelling.
Patient 2: Fall from height and chief complaint of shoulder and knee pain.
Patient 1: Swollen left knee with tenderness to palpation.
Patient 2: Knee visibly deformed, swollen, and bruised. Small open deformity w/ active bleeding. High risk for compartment syndrome.
Patient 1: Schatzker type 2 fracture (see table below for classifications of Schatzker fracture)
Patient 2: Schatzker type 6 fracture
Patient 1: Admitted. Splinted w/ ORIF as inpatient.
Patient 2: Admitted. Splinted w/ closed reduction and external fixation. Plan for definitive repair in ~2 weeks after soft tissue swelling has subsided.
1) Hinged knee brace w/ passive ROM - for patients w/ minimally displaced or split depressed fractures or minimal baseline mobility.
2) External fixation - for patient w/ open or comminuted fractures or significant soft tissue swelling.
3) ORIF - for >3mm articular step off or varus/valgus instability.
Types of Schatzker Fractures:
radial nerve palsy
HPI: Patient presents with a grossly deformed right upper extremity.
PE: Gross deformity of humerus, no open fracture. Unable to extend wrist. Unable to hyper-extend MP joints of fingers and unable to flex IP joint of thumb. Radial and ulnar pulses intact.
IMAGING: Multi-factorial fracture along the mid third of humerus along the expected course of the radial nerve.
DISPO (if at free standing ED): Transfer patient to ED with on-call orthopedics for definitive fixation. Reduce and splint prior to transfer.
TREATMENT: Nonoperative managment. Splinted and cast at bedside. Follow radial nerve palsy clinically for improvement.
CMC ER Residents
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