Orthopedics

Diagnosis and Treatment of an Anterior Shoulder Dislocation with Bedside Ultrasound

Mary Rometti, MD*, Michael Rohinton Mirza, MD* and Christopher Bryczkowski, MD*

DOI: https://doi.org/10.21980/J8Z924Issue 4:3 No ratings yet.
Bedside ultrasound with the transducer placed on the posterior right shoulder revealed an anterior dislocation of the right humerus. This is evident by displacement of the humeral head further away from the posteriorly placed ultrasound transducer, and appears deep to the glenoid cavity.  In a posterior shoulder dislocation, the humeral head would appear closer to the transducer (and the near field of the ultrasound image) than the glenoid. Note that a hypoechoic, heterogeneous fluid collection is within the joint space, compatible with a hematoma. A right shoulder X-ray confirmed the anterior dislocation with no evidence of fracture.  Under direct ultrasound guidance the glenohumeral joint space was injected with 10 mL of 2% lidocaine as an intraarticular anesthetic block. The right shoulder was reduced using continual traction.  Post-reduction ultrasound demonstrated a successful shoulder reduction, depicted by the humeral head being relocated to its anatomical location, adjacent to the glenoid cavity, as noted on the ultrasound image.  A hematoma remains present within the joint space. Successful shoulder reduction was further confirmed by X-ray. The patient’s arm was placed in a sling and she was discharged home with orthopedics follow-up.
OrthopedicsVisual EM

Pectoralis Muscle Tendon Rupture

Wyatt Verplaetse, MD* and Gregory Podolej, MD*

DOI: https://doi.org/10.21980/J81D01Issue 4:2 No ratings yet.
There is a noticeable difference in appearance and location of maximal prominence of the right pectoral muscle with arms outstretched (image 1). This is accentuated by having the patient perform an isometric arm press. (image 2).There is absence of the anterior axillary fold with adduction against resistance. The stump of the pectoralis muscle was palpated along his armpit.  He otherwise has full range of motion in the shoulder with minimal pain.
OrthopedicsVisual EM

Pediatric Sedation for Forearm Fracture

Nichole Niknafs, DO* and Alisa Wray, MD, MAEd^

DOI: https://doi.org/10.21980/J8CS7K Issue 4:1 No ratings yet.
At the end of this simulation, participants will: 1) review options for pain control in pediatric patients, 2) perform a pre-sedation history and physical exam, 3) review the indications and contraindications for pediatric moderate sedation, 4) understand components of consent, and get consent from the patient’s parent, 5) list medication options for moderate sedation in a pediatric patient and review their appropriate doses, indications, contraindications, and side effects, 6) discuss management of moderate sedation complications, and 7) review criteria for discharging a patient after sedation. 
OrthopedicsPediatricsProcedures

Bilateral Shoulder Dislocation after Ski Injury

Alaina Rajagopal, PhD, MD*, Brian Knight, BS* and Lance Orr, MD^

DOI: https://doi.org/10.21980/J86929Issue 4:1 No ratings yet.
An anteroposterior chest X-ray demonstrates bilateral shoulder dislocations. Both the right and left humeral heads (blue lines) are displaced medially, anteriorly, and inferiorly from their normal positions in the glenoid fossae (red lines), thus signifying bilateral anterior dislocations. There is also a fracture of the left humeral head at the greater tubercle (green arrow).
OrthopedicsTraumaVisual EM

Talonavicular Dislocation

Joseph Zakaria, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8PG91Issue 3:4 No ratings yet.
The X-rays were significant for a subtalar dislocation. The calcaneus (red) is laterally displaced with respect to the talar head (orange), and the white lines indicate the normal articular surface. Additionally, there was a talonavicular dislocation, as seen in the fourth image: the talus (green) and navicular bone (purple) overlapping suggests a dislocation. In a normally aligned foot, the boundaries of the two bones create a point of articulation.
OrthopedicsVisual EM

Fight Bite with Tendon Laceration

Michelle Chang, MD*, Grant Wei, MD*, Christopher J Bryczkowski, MD*, Sha Yan, DO* and Chirag N Shah, MD*

DOI: https://doi.org/10.21980/J8MP7QIssue 3:3 No ratings yet.
The video shows a water bath ultrasound of the right 4th digit, demonstrating soft tissue swelling with a hypoechoic region along the tendon consistent with edema and tendon disruption (see video and annotated still image).
OrthopedicsTraumaVisual EM

Bilateral Tibia/Fibula Fractures in Automobile versus Pedestrian Accident

Kevin Roy, BS* and Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J8C636 Issue 3:3 No ratings yet.
Plain film shows severely comminuted and displaced mid tibia/fibula fractures of bilateral lower extremities (red arrows) and comminuted right fibular head (blue arrow) and proximal shaft fracture (yellow arrow).
OrthopedicsVisual EM

Dorsally-Displaced Metacarpal Dislocation-Fracture

Richard Barnett, DO* and Richard Brodsky, MD*

DOI: https://doi.org/10.21980/J8ZW54Issue 3:3 No ratings yet.
A two-view radiograph of the right hand was obtained which revealed a dorsal dislocation of the distal fourth and fifth metacarpals (see red and blue outline, respectively) with a concomitant fracture of the distal fifth metacarpal (see yellow line) and avulsion fracture of the lateral aspect of the hamate (see green line). After reduction the fourth and fifth metacarpal dislocations are resolved; however, the distal fifth metacarpal fracture (yellow line) and avulsion fracture of the lateral aspect of the hamate (green line) are still visible.
OrthopedicsVisual EM

Lisfranc Injury

Lisa Schwartz, BS*, Nelly Tan, MD^ and John Costumbrado, MD, MPH*

DOI: https://doi.org/10.21980/J8QD1MIssue 3:3 No ratings yet.
The frontal view of the right foot showed divergent dislocation of the second through fifth metatarsal bones (red outlines) consistent with Lisfranc injury. Though the Lisfranc ligament is not visualized by radiograph, the yellow markings represent the location of the Lisfranc ligament between the medial cuneiform (blue dot) and the base of the second metatarsal bone.  The first metatarsal and the medial cuneiform remain congruent. The lateral view shows dorsal dislocation of the midfoot (pink circle) consistent with instability. There is associated extensive midfoot soft tissue swelling.
OrthopedicsVisual EM

Lateral Epicondyle Fracture

Valerie Lew, BS*, John Costumbrado, MD, MPH* and Curtis Knight, MD*

DOI: https://doi.org/10.21980/J8J05F Issue 3:2 No ratings yet.
Radiographs of the right elbow revealed an acute fracture through the lateral epicondyle with dislocation of the radial head inferiorly. Radiographs of the left elbow revealed a slightly angulated fracture through the lateral epicondyle.
OrthopedicsVisual EM