Daniel Purcell · Sneha A. Chinai Brandon R. Allen · Moira Davenport Editors Emergency Orthopedics Handbook 123 Emergency Orthopedics Handbook Daniel Purcell Sneha A. Chinai Brandon R. Allen Moira Davenport Editors Emergency Orthopedics Handbook Editors Daniel Purcell Sneha A. Chinai Emergency Department Department of Emergency New York University Langone Medicine Medical Center University of Massachusetts Brooklyn, NY Medical School USA Worchester, MA USA Brandon R. Allen Department of Emergency Moira Davenport Medicine Allegheny General Hospital University of Florida Temple University Newberry, FL Pittsburgh, PA USA USA ISBN 978-3-030-00706-5 ISBN 978-3-030-00707-2 (eBook) https://doi.org/10.1007/978-3-030-00707-2 Library of Congress Control Number: 2018964429 © Springer Nature Switzerland AG 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of transla- tion, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimi- lar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of pub- lication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Dedication Daniel Purcell Success is not the key to happiness. Happiness is the key to success. If you love what you are doing, you will be successful. –Albert Schweitzer This book is dedicated to all those involved in creating the ultimate reference manual depicting management of select musculoskeletal/orthopedic conditions in the emergency department. Without the sacrifice and tireless efforts of so many, this would not have been possible. Rejoice and celebrate, as we have created a masterpiece to be implemented by so many, fostering education and enhancing patient care for years to come. Special thanks to my wife Carmen, and my four children Cory, Miley, Aubrey, and Haley, who allowed me to follow my dreams and make this project a reality – I love you guys! Sneha A. Chinai This book is dedicated to all the providers who will use this guide to take better care of their patients with orthopedic complaints. vi Dedication Brandon R. Allen For my children, Nila and Owen, who continue to remind me what is important in life Moira Davenport Nobody said it’s going to be easy. You have to dig into yourself. Think about your family. Think about the journey itself. THINK IN THE MOMENT. –Meb Keflezighi 4× USA Olympic team member 2004 Olympic marathon silver medalist 2009 NYC Marathon Champion 2014 Boston Marathon Champion This book is dedicated to those who care for musculoskeletal conditions in the emergency department and on the sidelines. It goes without saying that this work is also dedicated to those who sustain orthopedic injuries in the pursuit of better health and competitive aspirations. Lastly, huge thanks to my family for putting up with me on this crazy journey and for supporting me every step of the way! I would not be where I am today without JD, PD, MG, JJG, CPG, MAG, SMG, RE, and EDE. I think you have all earned honorary medical degrees by this point. Foreword It might be cliché, but it is true that Emergency Medicine providers are a “Jack of All Trades” and are required to know how to diagnose life- and limb-threatening diseases that cross all specialties. With the wide breadth of knowledge that Emergency Medicine providers must know, there is an increased need for textbooks that specifically address the needs of Emergency Medicine providers. Reading other spe- cialty textbooks can lead to frustration as one tries to find the few nuggets of information that are pertinent to the emer- gency department. Ideally, Emergency Medicine textbooks are designed for quick reference, have great illustrations to be able to walk a provider through a rarely done procedure, and are focused on the life and limb threats. Orthopedics is one area that many Emergency Medicine providers do not have a specialist readily available to take over the case, and there can be considerable sequalae if frac- tures, dislocations, and infections are not diagnosed and treated quickly. In fact, though missing an acute myocardial infarction is associated with large malpractice payouts, ortho- pedic injuries account for more medicolegal cases overall. It is imperative that Emergency Medicine providers have a good systematic approach to orthopedic cases to ensure good outcomes, and they must be familiar with multiple different reduction techniques in order to ensure a successful reduction. This book, Emergency Orthopedics Handbook, ideally fits the needs of the busy Emergency Medicine provider. The text quickly gets to the pertinent information that is needed on a busy shift, while having great illustrations that can help viii Foreword ensure a successful joint reduction, arthrocentesis, or applica- tion of a splint. Unsure how to measure compartment pres- sures, or what pressure is consistent with acute compartment pressure see Chap. 3, need help reducing a nursemaid’s elbow see Chap. 5, and if you are worried about a septic ankle see Chap. 4 for detailed illustrations on how to approach the joint. This textbook will quickly become your handy resource for orthopedic emergencies and to confirm your treatment of the more common cases. Wishing you all the best in your care of patients with orthopedic emergencies. Michael C. Bond, MD, FACEP, FAAEM Department of Emergency Medicine University of Maryland School of Medicine, Baltimore, MD, USA Preface Musculoskeletal disorders are among the most common pre- senting complaints to the emergency department. Pathology may encompass acute traumatic injury, exacerbation of a chronic condition, and in extreme instances, limb and/or life threatening events. Knowledge of their management not only directly impacts results of immediate care, but also long-term patient outcomes. Preparation for success involves a favor- able combination of advanced education, skillful experience, and associated technical expertise. Creation of a reference source that combines scholarly activity and innovative visual demonstration would thus be an invaluable tool to facilitate this effect. The purpose of this publication was to formulate a com- prehensive, yet pertinent compilation of various musculoskel- etal conditions evaluated and remedied by assorted “emergency care” providers. It is intended to educate the novice practitioner in an expedient and adept manner, while also communicating advanced instruction to the isolated community provider. Our goal is to support enhanced recog- nition, as well as implementation of expert care for a multi- tude of receiving musculoskeletal conditions. This anthology resulted from collaboration among multi- ple contributors and is directly reflected within its organiza- tion and content. We suspect Emergency Medicine Orthopedics will have an immediate and extensive impact upon the care of countless patient circumstances, immeasur- ably heightening the functional quality of their lives. The authors would like to extend a sincere appreciation regarding consideration of this resource within your r espective x Preface treatment domains and are confident its delineated content will categorically optimize future musculoskeletal patient encounters. Thank you for your support and please contact us with any questions and/or feedback. Good luck! New York, NY, USA Daniel Purcell, MD Worcester, MA, USA Sneha A. Chinai, MD Gainesville, FL, USA Brandon R. Allen, MD Pittsburgh, PA, USA Moira Davenport, MD