ORTHOPEDICS

SCFE is a pediatric condition in which the femoral epiphysis (what will later become the femoral head) “slips” from its location on the growth plate. The direction of slipping is most often posteriorly and inferiorly in relation to the growth plate, also called the femoral physis, and the metaphysis. The slipped appearance on x-ray is often compared to a scoop of ice cream sliding off a cone. 

A 40-year-old male with a past medical history of ulcerative colitis, anxiety, and depression presented to the emergency room with pain and swelling to the right pectoralis area for two days…

A 33-year-old previously healthy male presented to the ED with right hip pain after an MVC in which he was the unrestrained passenger in a car going 30-40 MPH. Vitals were notable for HR of 105, and were otherwise within normal limits. On physical exam, his right lower extremity was without obvious deformity or overlying skin changes, but was noted to be shortened with tenderness to palpation and pain with range of motion about the hip…

Triplane fractures of the distal tibia are multi-planar fractures that violate the tibia and joint space in three configurations – the axial, sagittal and frontal planes.

63 y.o. male arrived to the ED following a motorcycle crash (MCC) in which he was riding at an unknown speed when he suddenly lost control and was launched off of his motorcycle...

A 24-year-old healthy male presented to the emergency department (ED) with right ankle pain…

A 3-year-old female is brought into the Emergency Department for left arm pain. She was at the park earlier today when she suddenly ran towards the street - her father pulled her back by the arm and felt a slight “click”…

Watch this video for a detailed description of the recognition and emergency management of a distal radius fracture.

A TAE occurs when a lesion extends into the joint capsule of the elbow, contaminating the articular space of a joint and increasing risk of infection. Patients typically present to the ED as a trauma (such as an motor vehicle collision or gunshot wound). Early identification of TAEs allows for timely washout and debridement. Inadequately identified and managed TAEs increase patients’ risks of septic arthritis, decreased mobility, chronic pain, and mortality [1]…

A 21-year-old male presents with pain, swelling, and obvious deformity to his right elbow after falling on his outstretched right hand while taking a turn too sharply on his motorcycle…

On one of the last nights of my orthopedic rotation of intern year, I saw a 92-year-old lady who had fallen down two stairs at home…

Knee arthrocentesis is a crucial procedure that all emergency medicine physicians should be comfortable performing. This video from Brown Emergency Medicine covers the ins and outs of knee arthrocentesis, including indications, contraindications, and step by step instructions.

A 20-year-old otherwise healthy male presents to the emergency department for right lower extremity pain after being tackled during a football scrimmage 2 days ago. He thought it would get better over time by taking ibuprofen, but still cannot walk on it…

A 37-year-old bodybuilder presents to the ED endorsing right upper arm pain. He is visiting from Virginia, and earlier in the day, he was lifting a suitcase from the baggage claim belt at the local international airport. He heard a “snap” accompanied with sudden sharp pain in his right upper arm. He also notes significant swelling along the middle of his arm compared to the contralateral side…

A 13-year-old otherwise healthy female presents to the emergency department for right knee pain after an injury while playing basketball. She states that she was dribbling the ball and attempted to pivot, when she felt a “pop” in her right knee. She fell to the ground with immediate right knee pain and denies any other injuries…

A 36-year-old female with no significant past medical history presents with pain and swelling to her right middle finger that has worsened over the last 3 days…

A guide to evaluation, management, and disposition for patients presenting to the ED with radial head fractures..

A 65-year-old right hand-dominant female was brought in by ambulance after a motor vehicle collision with left wrist pain and deformity. She states she was driving when another car turned and drove into the front of her car. She was wearing a seatbelt, the road speed limit was 35 MPH, and the front airbags deployed. There was moderate damage to the vehicle. However, the patient was able to self-extricate and was ambulatory on scene. She denied head strike, loss of consciousness, or taking blood thinners. She states she was in her usual state of health prior to this event…

A 68-year-old male with a past medical history of HTN, HLD presents reporting severe bilateral upper extremity pain…

A 46-year-old male with no past medical history presents to the ED via ambulance after crashing his bicycle. He was traveling at 25 mph when a dog ran out in front of him, causing him to swerve and fall onto his left side. He was helmeted and did not lose consciousness…

A 53-year-old male with hypertension presents to the emergency room with painful swelling of the right first toe at the MTP joint. The patient was in good health until a few days ago, where he was attending a college reunion. The swelling and pain increased overnight. The patient is having difficulty walking this morning due to the pain. He tried taking two Advil for the pain, which helped bring the pain from an 8/10 to a 6/10…

A 35-year-old-patient presents following motor vehicle collision as a restrained passenger. The vehicle's dashboard was displaced into the cabin, causing prolonged entrapment of the patient’s lower extremities. The patient’s left thigh was noted by EMS to have an obvious deformity with bleeding from an anterior wound. A tourniquet was placed to the proximal left thigh. A deformity was also noted to the right thigh without obvious external hemorrhage…

“In one overnight shift on the orthopedics service, our team evaluated three different pediatric patients with the same underlying injury: a femoral fracture. But, the management of all three children was different and the underlying reason for the different management: age….”

…complained of significant superior lateral knee pain and swelling, as well as difficulty moving his leg due to pain. On exam, he had notable swelling and tenderness of the left knee, particularly along the superior aspect of the patella. After controlling his pain with intravenous medications, he was able to flex at the hip but was unable to extend his lower leg at the knee or to perform a straight leg raise….

…complained of sudden-onset right knee pain with inability to bear weight during a hospital admission for syncope. Her knee joint had never before been affected by gout. Plain films and Commuted Tomography of her knee did not show any fracture or dislocation but revealed a moderate joint effusion…

A four-year-old female with no medical history presented to the emergency department with right leg pain and refusal to walk after falling while in her father’s arms. She was being carried by her father down a flight of outdoor concrete stairs when he slipped on black ice and her leg struck the ground. The patient refused to walk after the fall and her mother noted that her leg had been “cracking” since the accident…

Your patient is a 25-year-old male with a right hand laceration presenting the day after a “fight.” The patient says that he doesn’t remember what happened because he and his friends were drinking but thinks that he might have gotten into a fight the preceding night…