Carpometacarpal Dislocation with Third Metacarpal Fracture.

CASE PRESENTATION: A 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. The dislocation was reduced bedside in the ED and ultimately underwent closed reduction surgical management with orthopedic surgery. DISCUSSION: Metacarpal fractures result from high-force impact injuries and account for 30-40% of all hand injuries. The most common sites of second through fifth metacarpal fractures are at the neck and the shaft, with the majority involving the fifth metacarpal neck (commonly coined "boxer's fractures"). Carpometacarpal (CMC) dislocations are a rare injury associated with high-force impact trauma to the wrist. These injuries account for as little as 1% of all acute hand and wrist injuries.1,2 Carpometacarpal dislocations are often difficult to diagnose on physical examination due to significant soft tissue swelling, and they can easily be missed on anterior-posterior views of the hand. Lateral and oblique plain radiograph views are essential in the diagnosis as they are more likely to show dislocations. Despite appropriate plain radiographic views, subtle CMC dislocations may be difficult to discern dependent on the level of dislocation or subluxation and overlapping of joints. These injuries are rare due to otherwise highly stable ligamentous and muscular attachments within the wrist. Because of these attachments, dislocations are often associated with concomitant metacarpal fractures.3.

Erratum: This Article Corrects: "Anticoagulation Reversal and Treatment Strategies in Major Bleeding: Update 2016".

[This corrects the article on p. 264 in vol. 17, PMID: 27330657.].

Ultrasound-guided three-in-one nerve block for femur fractures.

Femur fractures typically affect elderly patients with multiple co-morbidities. Pain control can be difficult, requiring intensive nursing and physician care as elderly patients may manifest cardiovascular and respiratory complications from opiate administration. Ultrasound (US)-guided three-in-one (3-in-1) femoral nerve block (FNB) is an option for pain management in patients with femur fractures, as it provides regional anesthesia to the femoral, obturator and lateral cutaneous nerves. Our goal is to provide medical education regarding the use of US-guided 3-in-1FNB as a rapid and easy procedure that may provide optimal patient care in patients with femur fractures.

Willingness to respond: of emergency department personnel and their predicted participation in mass casualty terrorist events.

In May 2003, the TOPOFF 2 national disaster drill demonstrated inadequate preparedness for mass casualty terrorist events and failed to address the willingness of Emergency Department (ED) personnel to assist with these events. The objective of this study was to examine ED personnel willingness to respond to various multiple casualty events. A prospective voluntary survey of ED personnel from multiple hospitals was randomly administered in the form of vignette-based questionnaires. The survey of 204 participants at eight hospitals in the Chicago area revealed that staff members were more willing to work additional hours for victims of an airplane crash (98.0%), than for a radioactive bomb (85.3%), or a biologic agent (54.0%). For the biologic agent only, men were significantly more likely to respond than women. Hospital management should anticipate significant reductions in workforce during biologic and radioactive disaster events. Employees' willingness to respond was not augmented by any incentives offered by hospitals, although enhanced financial remuneration and disability coverage showed the most potential to increase response.