1/12. Low-energy scapular body fracture: a case report.scapula fractures are relatively rare and most often the result of high-energy trauma. However, they should always be included in a physician's differential diagnosis when a patient has a complaint of shoulder pain after trauma or violent muscular contraction about the shoulder. Because the vast majority are the result of a high-energy mechanism of injury, the physician should, as always, completely evaluate the patient for associated injuries. Most scapula fractures can be diagnosed on physical examination with localized tenderness, swelling, and hematoma formation over the fracture site. Radiographic confirmation and evaluation is routinely made using the three-view trauma series of the shoulder; additional views are rarely indicated. Treatment, consisting of a sling or sling and swath for comfort, mild narcotic medication, and early range-of-motion exercises virtually always leads to union and good glenohumeral function. Operative treatment is rarely indicated. A case of an low-energy isolated scapular body fracture sustained by a 41-year-old man is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Orthopedic pitfalls in the ED: scaphoid fracture.wrist injuries are frequently encountered in the emergency department. When a patient presents with such an injury, the possibility of scaphoid fracture must be at the top of the differential for the emergency practitioner. Unfortunately, these injuries can be missed on first presentation, as they are frequently radiographically occult. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. The emergency physician needs to be vigilant for scaphoid fracture and be aggressive in both its diagnosis and treatment to avoid this practice pitfall. This review examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/12. The posteromedial process fracture of the talus: a case report.Injuries to the ankle tend to be some of the most common injuries seen in practice. Of these ankle injuries, fractures of the posteromedial process of the talus are often misdiagnosed as ankle sprains because of poor visualization on routine ankle radiographs. The examining physician must have a heightened awareness of this injury to accurately diagnose and treat this fracture. Proper treatment could help to lessen the possibility of post-traumatic arthritis to the ankle and subtalar joints. The authors present a case of a fracture of the posteromedial process of the talus, after a medial subtalar dislocation, treated with open reduction and internal fixation with bioabsorbable pins.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/12. Orthopedic pitfalls in the ED: radiographically occult hip fracture.Acute hip fracture is among the most commonly encountered orthopedic injuries seen by the emergency physician. The majority of these fractures can be readily diagnosed on the basis of clinical findings and plain radiographs. When initial films are negative or equivocal, but a high clinical suspicion exists for a hip fracture, additional diagnostic studies need to be performed because significant morbidity can result from ambulation on an unrecognized fracture. The emergency physician needs to remain vigilant for this potential orthopedic pitfall. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/12. Bilateral bipartite medial cuneiform. A case report.A fracture to the intermediate cuneiform that was not definitively detected on routine radiographs because of the overlap of the cuneiform was presented. Weightbearing x-rays did not provide additional information. The anatomical location of the fracture was identified only after a computed tomography scan was performed. An incidental finding, bilateral bipartite medial cuneiforms, was also observed on the computed tomography scan, which contributed to the overlap on routine radiographs. The anatomy of the bipartite medial cuneiforms seen on computed tomography was similar to that described by Barlow in 1942. Retrospective comparison to the initial radiographs with the computed tomography scan sections did reveal bipartite medial cuneiforms on these films as well. The podiatric physician should keep bipartition in mind when evaluating x-rays for any osseous pathology, especially fractures.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/12. Minimalistic approach to treating wrist torus fractures.Thirty-three patients with unilateral wrist torus fractures were reviewed retrospectively. patients were all treated with a removable plaster-of-paris volar forearm splint and a symptom-based splinting protocol. This protocol emphasized the parents and patients deciding when to wean from the splint as their symptoms improved. patients were followed about 4 weeks after fracture, and initial and follow-up radiographs were compared for any changes in fracture angulation. All of the fractures healed without significant clinical change in angulation or complications. The authors propose the following treatment protocol: radiographic diagnosis and application of the removable splint in the emergency department, and one orthopaedic office/clinic visit to confirm the diagnosis and provide splinting instructions. The elimination of the additional orthopaedic visit for repeat radiographs and cast removal reduces the family's time lost from school and work and the physician's time and costs.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/12. Cervical spine fracture following a motor vehicle accident.We present the case of a 50-year-old man who visited our emergency department 12 h after an alcohol-related motor vehicle accident complaining of shoulder pain and neck stiffness. Cervical spine radiographs were obtained and interpreted as normal, and the patient was discharged. Subsequent review by a radiologist raised the question of a second cervical vertebra (C-2) abnormality, and the patient was recalled. Cervical computed tomography (CT) scan revealed an unstable oblique fracture of C-2 and a congenital nonfusion of the arch of C-1. The patient was placed in halo traction, and subsequent radiographs revealed a fracture of the transverse process of C-7. The patient made an uneventful recovery. The limitations of routine cervical radiographs are well-documented, but no feasible alternative exists as a screening procedure. Thus, a certain level of uncertainty must be accepted. Both physician and patient must recognize the limitations inherent in all medical practice and that follow-up examination and treatment are essential.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/12. Displaced intra-articular osteochondral fracture--cause for irreducible dislocation of the distal interphalangeal joint.One cause of irreducible dislocation of the distal interphalangeal joint is the interposition of the palmar plate or the flexor tendon between the joint surfaces. This case report describes another cause for an irreducible dislocation. Radiographic findings on the initial films are discussed to alert the attending physician to the possibility of an osteochondral fracture. Open reduction resulted in an essentially normal joint 17 months later.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/12. False aneurysm of the posterior tibial artery complicating fracture of the tibia and fibula.A false aneurysm of the posterior tibial artery associated with a fracture of the tibia and fibula is described. A review of the English language literature of the last 15 years revealed only six other similar cases. The physician should bear in mind that a persisting painful swelling at the fracture site of the leg might be the only clinical sign of a false aneurysm developing in one of the tibial vessels.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/12. Management of a multiply injured Jehovah's Witness with severe acute anemia.The refusal of blood products by jehovah's witnesses creates ethical and medicolegal dilemmas for the treating physician. Appropriate management involves some understanding of the beliefs of the jehovah's witnesses and knowledge of a variety of techniques to minimize blood loss. This case report describes the treatment of a Jehovah's Witness with severe anemia and multiple skeletal injuries. The need to keep blood loss to a minimum influenced the management of this patient.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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