Orthopedics

A Formalized Three-Year Emergency Medicine Residency Musculoskeletal Emergencies Curriculum

Andrew King, MD, FACEP*, Jeffrey Yu^, Mark J Conroy, MD*, Robert Cooper, MD*, Jennifer Mitzman, MD*, Colin Kaide, MD, FACEP* Sarah Greenberger, MD*, Sorabh Khandelwal, MD* and Michael Barrie, MD*

DOI: https://doi.org/10.21980/J8RG6HIssue 2:1[mrp_rating_result]
Resident learners will master the diagnosis and management of emergent musculoskeletal conditions including fractures/dislocations, soft tissue injuries, compartment syndrome, joint complaints, infections, and complex injuries.
OrthopedicsCurricula
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Irreducible Traumatic Posterior Shoulder Dislocation

Blake Collier, DO* and Christopher Trigger, MD*

DOI: https://doi.org/10.21980/J8V884Issue 2:1[mrp_rating_result]
Radiographs demonstrated posterior displacement of the humeral head on the “Y” view (see white arrow) and widening of the glenohumeral joint space on anterior-posterior view (see red arrow). The findings were consistent with posterior dislocation and a Hill-Sachs type deformity. Sedation was performed and reduction was attempted using external rotation, traction counter-traction. An immediate “pop” was felt during the procedure. Post-procedure radiographs revealed a persistent posterior subluxation with interlocking at posterior glenoid. CT revealed posterior dislocation with acute depressed impaction deformity medial to the biceps groove with the humeral head perched on the posterior glenoid, interlocked at reverse Hill-Sachs deformity (see blue arrow).
OrthopedicsVisual EM
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Pseudogout and Calcium Pyrophosphate Disease

Andrew Williamson, MD*

DOI: https://doi.org/10.21980/J8QG66Issue 2:1[mrp_rating_result]
Radiographs of the knee showed multiple radio-dense lines paralleling the articular surface (see red arrows) consistent with calcium pyrophosphate crystal deposition within the joint often seen in calcium pyrophosphate disease (CPPD) also known as pseudogout.
OrthopedicsVisual EM
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Lunate Dislocation

Jonathan Peña, MD*

DOI: https://doi.org/10.21980/J86K56Issue 2:1[mrp_rating_result]
Plain film of the right wrist showed the classic “spilled teacup” consistent with a lunate dislocation. There is a loss of the normal articulation between the distal radius and lunate.
OrthopedicsTraumaVisual EM
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Pediatric Supracondylar Fracture

Jonathan Peña, MD* and John R. Marshall, MD*

DOI: https://doi.org/10.21980/J8T88TIssue 2:1[mrp_rating_result]
Plain film radiography showed a displaced supracondylar fracture with disrupted anterior and posterior periostea, consistent with a type 3 supracondylar fracture.
OrthopedicsVisual EM
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Calcaneal Fractures and Böhler’s Angle

Lindsey Spiegelman, MD* and Mohammed Helmy, MD^

Issue 2:1[mrp_rating_result]
The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle).
OrthopedicsVisual EM
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Monteggia Fracture in an Assault Patient

John Jiao, MHS* and Shannon Toohey, MD, MAEd*

DOI: https://doi.org/10.21980/J81S3ZIssue 2:1[mrp_rating_result]
On the axial elbow x-ray, the radial head (red arrow) is dislocated anteriorly from the humerus; the humeroulnar articulation is intact. On the AP forearm x-ray, there is a closed, displaced, comminuted fracture of the ulna (blue arrow).
OrthopedicsVisual EM
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Hill-Sachs Deformity

Jessa Baker* and Shannon Toohey, MD*

DOI: https://doi.org/10.21980/J8Z59DIssue 1:2[mrp_rating_result]
In the post-reduction film, there is a lateral depression in the humeral head (arrow, a Hill-Sachs deformity). A Hill-Sachs deformity is a cortical depression (fracture) in the humeral head that forms as the humeral head hits the glenoid rim during the dislocation.
OrthopedicsVisual EM