Pelvic Fractures
- Types of pelvic fractures
- Clinical exam findings: Unstable vital signs, visual and/or palpable deformity
- Diagnostic orders: CT scan
- Triage plan of care: Stabilize and transfer
Large Joint Dislocation of the Knee and Hip
- Knee: Traumatic high force injury. This is NOT a patella dislocation
- Limb threatening because of possible artery dissection
- Clinical exam finding-obvious deformity
- Diagnostic tests: Immediate x rays and MR arteriogram
- Triage: Immediate ortho consult and probable vascular consult
- Hip: Traumatic high force injury, typically from a MVA or motorcycle injury
- Hip dislocation alone can cause trauma to the head of the femur leading to AVN
- More importantly- associated acetabular fracture and /or pelvic ring inury
- Clinical exam leg length discrepancy
- CT scan
- Triage ortho consult hip reduction
Cauda Equina: Acute Dysfunction of the Lumbar and Sacral Nerves
- Etiology: herniated disc, gun shot wound, trauma
- Clinical exam: Peri anal numbness, bowel or bladder incontinence, decreased or absent rectal tone
- Diagnostic tests: Stat MRI
- Differential dx herniated disc
- Treatment: Emergent surgical decompression
Compartment Syndrome
- Etiology: crush injury, over anti-coagulated causing excessive pressure in isolated compartments
- Clinical exam: Pain, palor, paresthesia, pulselessness
- Diagnostic tests: Compartment pressure testing, x ray
- Differential dx Rhabdomyolisis
- Treatment: Ice elevation surgical fasciotomy
Rhabdomyolysis
- Etiology: Excessive breakdown of muscle tissue from excessive exercise (ie. crossfit)
- Proteins released damage kidney
- Clinical exam: Pain, extremely tight compartments, dark reddish urine
- Diagnostic tests: UA
- Treatment: Fluids, observation
Joint infection
- Etiology: Bacterial, viral or aseptic inflammation of a joint
- Clinical exam: Pain, febrile, joint swelling decreased range of motion
- Diagnostic tests: Labs, joint aspiration
- Treatment: Antibiotics, surgical joint lavage
Tenosynovitis- inflammation of a tendon sheath
- Etiology: Penetration of a tendon sheath (infectious), repetitive,
- Clinical exam: Pain, crepitus, fever, redness swelling of the tendon
- Diagnostic tests: X ray rule out foreign body, labs, MRI
- Treatment: Rest, NSAIDS, antibiotics, immobilization, surgical irrigation and debridement
Slipped Capital Femoral Epiphysis: Disruption of the Proximal Femoral Growth Plate in Adolescents
- Etiology: Boys more than girls, obese, left hip >right hip
- Clinical exam: Groin or knee pain reproducible with passive hip ROM
- Diff dx: Aseptic synovitis appendicitis, hernia, ovarian cyst
- Diagnostic tests: X Ray, Labs (if suspicious of infection)
- TIME SENSITIVE! Blood supply to the femoral head is compromised
