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Computed tomography (CT) revealed a burst fracture (Jefferson) of the anterior arch (white arrows) and of the posterior arch (yellow arrows) of the first cervical vertebrae (C1). There was also a fracture of the right lateral mass (blue arrow) of C1 with mild lateral subluxation of the lateral masses (curved arrows).
Chest X-ray revealed an inferiorly displaced right clavicle at the right sternoclavicular joint (blue arrow). A computed tomography angiogram (CTA) of the chest was therefore obtained and revealed a right posterior sternoclavicular dislocation with resultant compression of the left brachiocephalic vein (purple arrow). Even though the right clavicle is displaced, the anatomy of the brachiocephalic vein is such that it is positioned to the right of midline, placing the left brachiocephalic vein posterior to the right clavicle. The right brachiocephalic and common carotid artery were normal in appearance. The CTA also revealed a comminuted fracture of the left anterior second rib at the costochondral junction that had not been previously seen on the x-ray.
The patient's chest and clavicular radiographs showed a comminuted displaced acute fracture of the right mid-clavicle (green, blue, yellow). The clavicular fracture was also visible on the chest computed tomography (CT). The remainder of his trauma workup was negative for acute findings.
Radiographs of the left elbow and wrist were obtained. Left elbow radiographs showed simple posterolateral dislocation of the olecranon (red) without fracture of the olecranon (red) or trochlea (blue). Left wrist lateral radiographs demonstrated DRUJ dislocation with dorsal displacement of the distal ulna (green) without fracture or widening of the radioulnar joint (purple). Post-reduction radiographs demonstrated appropriate alignment of the elbow with the trochlea seated in the olecranon and improved alignment of the DRUJ.
ABSTRACT: This report demonstrates a case of a severe talar neck fracture. Although rare, talar neck fractures have a high potential for morbidity. Typically caused by a high energy injury, this patient’s mechanism of injury was relatively minor, and presentation was not immediately concerning for such a severe fracture. Initial x-rays provided a gross demonstration of the fracture, but a
On her right hip radiograph, the patient was found to have a right femoral neck fracture with superior displacement of the intertrochanteric portion of the right femur. Moreover, the radiograph demonstrated diffuse osteopenia of the right hip and femur from chronic disuse as characterized by the increased radiolucency of the cortical bones compared to the left side.
After this simulation case, learners will be able to diagnose and manage patients with spinal epidural abscesses. Specifically, learners will be able to: 1) Obtain a detailed history, including past infectious, surgical, procedural and social history to evaluate for epidural abscess risk factors; 2) describe clinical signs and symptoms of spinal epidural abscesses and understand that initial clinical presentations can be variable; 3) perform a focused neurological exam including evaluation of motor, sensory, reflexes, and rectal tone; 4) order appropriate laboratory testing and imaging modalities for spinal epidural abscess diagnosis, including a post-void bladder residual volume; 5) select appropriate antibiotics for empiric treatment of spinal epidural abscess depending on patient presentation; 6) disposition the patient to appropriate inpatient care.
By the end of this session, learners should be able to name and identify all bones of the hand; arrange and construct an anatomically correct bony model of the hand; build functional phalangeal flexor and extensor tendon complexes onto a bony hand model; describe the mechanism of injury, exam findings, and management of the tendon injuries Jersey finger, Mallet finger, and central slip rupture; draw/recreate injury patterns on a bony hand model; and describe the mechanism of injury, exam findings, imaging findings, and management of scapholunate dissociation, perilunate dislocation and lunate dislocation, Bennett’s fracture, Rolando fracture, Boxer’s fracture and scaphoid.
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At the end of this session, learners will be able to: recognize and identify various orthopedic injuries on plain film images, describe the mechanism of injury of the various orthopedic injuries, describe the physical examination findings seen in various orthopedic injuries, recall associated injuries and at-risk anatomic structures associated with various orthopedic injuries, and describe the emergency department management of various orthopedic injuries.