0071643192.pdf

ORTHOPEDICS

TREATMENT

■ First-degree dislocation:Arm sling

■ Second-degree dislocation:Figure-of-eight clavicular strap or sling

■ Third-degree dislocation:

■ Anterior: Reduction attempt and sling

■ Posterior: Neurovascular assessment, with possible need for emergent

orthopedic and thoracic surgery consults and rapid reduction

COMPLICATIONS

With third-degree posterior dislocations, there is a 25% chance of life-

threatening injuries to esophagus, trachea, or great vessels.

SCAPULARFRACTURES

Require a significant amount of blunt force and are frequently associated

with intrathoracic injuries

DIAGNOSIS

Shoulderand CXRs

TREATMENT

■ Most are treated with sling and immobilization.

■ ORIF is required for severely displaced or angulated fractures.

COMPLICATIONS

Rib fractures, pneumothorax, hemothorax, pulmonary contusion, clavicular

fractures, shoulder dislocation with associated rotator cuff tears, neurovascular

injuries, vertebral compression fractures

INJURIES TO THE LOWER EXTREMITIES

Knee and Lower Leg Injuries

PATELLAFRACTURE

Transverse fractures are most common and may result from blunt trauma or

from the pull of the quadriceps muscle (quadriceps avulsion fracture).

DIFFERENTIAL

Bipartite patellais a normal variant and can be differentiated from a true

fracture by its smooth cortical margins. If in doubt, x-ray the other knee as this

condition is usually bilateral.

DIAGNOSIS

■ Patellar tenderness and swelling: With a transverse fracture, the patient

may be unable to extend the knee.

■ X-rays of the knee: AP, lateral and sunrise views should be obtained.

Scapula fractures are often

associated with very serious

intrathoracic injuries.

Always check for an intact

extensor mechanism if a

patient has a patella fracture.