Extremity Injuries

Cont’d
Treatment
Conservative

RICE
Tube cast or
Long leg cast with leg in full extension for
6-8 weeks
Weight bearing
Straight leg raises
Quadriceps exercises.
Follow up xray at 2 weeks and 6 wks
Jones fracture

• Conservative management.
• High incidence of non union due to low vascularity
• Consider surgery if malunion after 6 weeks
• Patients with high risk of malunion such as athletes should get
ORIF
• Require prolonged immobilization and non weight bearing
Compound fracture Treatment in ER

• Copious irrigation and removal of foreign matter

• Good pain control and/or procedural sedation
• Antibiotics and tetanus prophylaxis
• Cover with sterile saline dressing
• To OR for washout and ORIF
• R/O NV compromise
 TREATMENT IN ER
• ABCs
• Pain control
• R/O Neurovascular injury
• Immobilization
• Orthopaedic evaluation
THOMPSON’S TEST
Achilles rupture
Treatment

• Causes : Conservative treatment increasingly

utilized along with rehabilitation.
RICE
Surgical treatment is preferred for
• Traumatic
younger more active patients.
• Steroid therapy
• Quinolones
• Chronic tendinitis
• Diabetes Mellitus
Jacques Lisfranc

• Surgeon in Napoleonic army

• First to describe midfoot injuries in his
• Soldiers in 1800s
 Clinical Presentation
• Midfoot pain with difficulty in weight bearing
• Swelling across the dorsum of the foot
• Deformity variable due to possible spontaneous reduction
• Plantar ecchymosis is pathognomic for Lisfranc injury
 Treatment
• A mild Lisfranc fracture with <2mm displacement can often be treated the same
way as a simple sprain
• Ice, rest, and by elevating the injured foot.
• Non-weight bearing cast for 6 weeks then a weight bearing cast for additional 4
weeks.
• use crutches to help with the pain that can occur upon walking or standing.

• Fractures with displacement >2mm need ORIF

Scapular fracture

• Considerable trauma, consider intra-thoracic injury

• Usually with concomitant clavicle a d rib fractures.
• Remember to ask for Axillary view and lateral “Y” when suspecting
scapular fractures.

• Management
• most of these fractures are treated conservatively even if they are
moderately displaced.
Murphy’s Sign
 Treatment
• Adequate anesthesia is vital.
• Muscle tension from pain will make reduction more difficult.
• Consider intraarticular anesthetic, systemic analgesia, or both
• Procedural sedation is preferred
• Ortho consult for operative management if: 5
• Fracture causing glenohumeral instability
• Chronic dislocation, >3 weeks
• Irreducible dislocation

• Disposition:

• Discharge if reduced successfully and pain controlled.

• Place in shoulder immobilizer for 4-6 weeks.
• Referral to orthopedics and physical therapy for follow-up.
Take home-worst first
• Think like an Emergency Doctor-is there a life threat from
hemorrhage or non orthopedic injury?
• Is there a limb threat from ischemia or compartment
syndrome?
• Is there neurovascular compromise from fracture of
dislocation?
?