Orthopedic pitfalls in the ED: acute compartment syndrome.

Acute compartment syndrome is a rare but potentially disastrous complication of orthopedic injury to the extremities. Compartment syndrome occurs when the circulation and function of muscle within a closed fascial space are compromised by increased pressure within that space. Early diagnosis and treatment is crucial to prevent the devastating complications of this condition. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Principles of stress fracture management. The whys and hows of an increasingly common injury.

As the patient population becomes more involved with athletics, informally or in an organized fashion, risk of stress fracture increases. Rapid and safe recovery is best ensured with early diagnosis and expedient conservative therapy. A history of progressive pain, initially with exertion and ultimately at rest, suggests the diagnosis. Plain radiographs often do not reveal fractures, and specialized studies, such as bone scanning, SPECT, or MRI, may be necessary to confirm the diagnosis. Simple rest with progressive reintroduction of activity is the treatment of choice for most stress fractures.

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.

Orthopedic pitfalls in the ED: Galeazzi and Monteggia fracture-dislocation.

Occult dislocations at the wrist and elbow frequently accompany forearm fractures. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both Galeazzi (distal radius fracture with radioulnar joint disruption), and Monteggia (proximal ulna fracture with radial head dislocation) fracture-dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Orthopedic pitfalls in the ED: lunate and perilunate injuries.

Occult dislocations at and around the lunate can accompany wrist trauma. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. Emergency medicine practitioners need to be vigilant for both lunate and perilunate dislocations. This review article examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency practitioner.

Orthopedic pitfalls in the ED: Lisfranc fracture-dislocation.

Lisfranc fracture-dislocation of the foot is an injury that carries a high incidence of chronic pain and disability. Its emergency department presentation can be subtle, and more frequent than previously believed. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner.

Orthopedic pitfalls in the emergency department: closed tendon injuries of the hand.

Closed tendon injuries of the hand are frequently seen in the emergency department. Unlike open tendon injuries, however, these injuries are often missed on initial presentation. Early recognition and treatment can decrease the pain, dysfunction, and long-term sequelae associated with these injuries. This review article examines the clinical presentation, historical factors, diagnostic techniques, and management options applicable to the emergency practitioner. Injuries discussed include rupture of the flexor digitorum profundus, mallet finger, central slip rupture, extensor hood rupture, and ulnar collateral ligament injury.